Health System Ethics Made Simple

Over the generations, hospitals and health systems across the nation have created and passed on homegrown cultures of conduct, trust, and accountability that rely on long-term personal relationships, an understanding of their vital healing mission, and a sense of commitment to the communities they serve.

Healthcare delivery is changing rapidly, of course, and the tradition of building a culture of ethics one relationship at a time could be overwhelmed. Healthcare consolidations are a weekly event. Hospitals merge, or they are swallowed by larger health systems that sometimes merge into super-systems serving several states. The sense of community that existed in a small hospital can experience growing pains and an identity crisis when the newly merged physicians, staff, and executives find themselves among thousands of employees in a larger health system.

"We are dealing with that right now," says Andrejs Avots-Avotins, MD, PhD, a gastroenterologist and chairman of the board of directors at Scott & White Healthcare in Temple, TX. "When I came here 21 years ago we had 350 physicians and it was pretty easy to get to know most of them. Today we have closer to 900 physicians, a total of about 1,200 healthcare providers, and12,000 employees at 60 different sites spread out over 25,000 square miles. It's not so easy to do."

Even though Scott & White has built a strong culture since its founding by two physicians in 1897, "how do you communicate that to all 12,000 employees---particularly when half of our employees, including half the docs, have been with us for less than five years? This is a challenge for us as well," Avots-Avotins says.

In the face of dynamic growth, Avots-Avotins says Scott & White leadership continues to focus on what it knows best: patient-centered, physician-led healthcare.