Effective leadership is an innate process which is evolving and paramount in determining the success of any institution. There is need for transformation in public health care via integration of public health dynamics and functions to ensure superb healthcare delivery. This calls for visionary and effective leadership through subtle management which will guarantee and sustain change. The objective of this paper is to describe a challenge I have faced as a leader and highlight as well as analyze its ethical implication. The case under study is a situation whereby a new immigrant population moves to the community through the help of a local church. There exists many health needs and no payment sources. The hospital leadership needs to consider its responsibility in serving the needs of this population that do not speak English. The situation is surrounded by many ethical challenges which we are going to dwell on as well as look at the implications for patient outcomes and safety.
Ethical Challenges Presented in the above Situation
Lack of health care/ medical insurance: International migration emanates from globalization affecting health in one way or another in immigrant source. Additionally, the number of immigrants in the nation is on an upward trend bringing in new cultures besides language barriers. One of the challenges faced by public health personnel is providence of medical care to immigrants who lack health care/ Medicare. In addition, such patients have no financial capability to cater for their medical expenses or seek treatment. This leaves one feeling ethically obligated to offer medical services to this immigrants. The situation becomes more difficult in a situation whereby the immigrants are illegal aliens which means that they have no legal documentation. The implication is that as a public health physician, I will have no access to resources to support such patients. Lack of health insurance means that immigrants cannot afford drug therapy and as a physician, the only alternative I have is to volunteer time and help them which is a costly ordeal and infeasible procedure. .Otherwise, informing a patient that he/ she cannot access treatment as a result of financial handicap is not an easy practice/ step to take. My hands are tied in such a situation but there is little I can do if immigrants lack insurance or legal immigration documentation.
Treating Immigrants: Immigrants are social members who in more than one way play a crucial role in the society. The society has a role to regulate immigration however, as a leader, it becomes an ethical issue on how the society should exercise the right of treating immigrant. Lack of state regulation on immigrants can be catastrophic but as a leader in public health domain, it is my responsibility and task to respect human rights of immigrants because all human beings deserve equal access to health care. Lack of policies and practices which structure health care industry also inhibit a platform upon which as a leader one can expand his/ her ability and capabilities. Furthermore, immigration laws and policies limit one’s access to health care as well as emergency care. Immigrants perceive policies as a threat to them meanwhile as a leader, this is an economic dilemma because either primary/ secondary health care is entitled to all without discrimination/ harassment by either government or non- governmental organization. Health care should be accessible to all without ethical biasness and this is only achievable through national and international health policies and regulations. Language and socio-economic factors shape individual values and beliefs. Lack of language barrier encourages cultural competence in health care resulting to good health care for all patients regardless of one’s race or gender.
Confidentiality: As a health care personnel, it is expected that an individual should report persons who are immigrants whether legal/ illegal and disclose personal information to authorities. This is an unethical act because a health worker is not a police agent something which is against professional ethics. It is unethical to disclose migrant’s status since it is not a medical/ public health obligation (Sheninger, 2014). There exists a thin line between social role and professional ethics while the core business of a health care public provider is to cater for all immigrants in dire need of medical attention. Political measures limit medical care for immigrants which in itself is a violation of professional ethics.
Implications for Patient Outcomes and Safety
According to a report by Department of Health and Human Services (HHS) 2012, majority of the illegal immigrants form approximately 80% who are Hispanic. They are uninsured and are not conversant to English which makes it difficult accessing medical care. Moreover, they are not actively involved in an endeavor to improve basic health care of Hispanic Immigrants leaving the patient outcome position dim in comparison to normal population. Immigrants also face the challenge of accessing low –income paying jobs and as such they cannot access credit neither can they cater for private health insurance (Wild, 2015). Immigrants have been left with no option but to fully depend on safety-net health care since they are not eligible for any federal benefits such as health insurance while the duration it takes for one to be a legal permanent residence is lengthy, five years in waiting after which a person now qualifies for Medicare. Furthermore, anti-immigrant regulations for instance Arizona SB (1070) (Duara, 2016), have repercussions on children whose parents are undocumented immigrants. The offspring of such parents take gross time before accessing health care and health care insurance enrollment. This lengthy procedures are not encouraging for such parents and as a consequence, show no interest in taking part in health care reforms. There is need for immigration reforms to widen access to health care provisions for immigrants. The response needs to be fast enough to lessen lack of access to medical aid in addition to decreasing health disparities affecting immigrants to a larger extent of increasing suffering of sick patients (Omar Martinez,…& Silvia Chavez Baraj, 2015). It is an uphill task to incorporate immigrants into the systematic health care system we do have in place. It is the duty of every health care personnel to be a Spokesperson for all patients regardless of whether they are immigrants or not. By excluding immigrants from health insurance and public programs, the implication is an economic turmoil for all related stakeholders in our society.
The stakeholders who have an interest in the immigration issue are several. The Policy makers playing a key role towards making immigration reforms need to urgently address the manner in which low income immigrants can access health care whenever they are making policy. For instance, it would suffice for policy makers to address the problem of waiting for five (5) years before enrolling for Medicare otherwise it derails the economic sense of having safety-net providers in place and having Immigrants access medical care. The frame of State Policy maker in collaboration with Health policy Analysts is major in terms of supporting safety net funding for institutions taking care of immigrants. Additionally, Health Analysts have a duty in improving the health and safety of immigrants until the time when they become incorporated in mainstream health care. The Health Secretary is in charge of distributing safety net funding in proportion to the size of states and mitigate upon health care issues (AHRQ, 2012). He / she analyzes and assesses immigrant communities and offers data necessary to make appropriate information vital for planning and evaluating health services overcoming cultural diversity besides financial management and planning skills necessary for controlling budgeting and use of public resources. In essence, efficiency is obtained and as a leader one is able to effectively offer health care within diverse immigrants. Health Secretary facilitates program planning and policy development to support health of immigrants and their families. Each stakeholder has a paramount role to play and the success is dependent on the level of communication within community stakeholders. Successful communication in a non – English speaking population will ensure access to health services rebuilding a healthy public workforce via international agencies. The social dynamics of diverse groups exhibiting their own sets of needs and agendas ensures an effective and stronger public health workforce which lead to a more improved health for all population. In conclusion, effective leadership ensures a successful journey towards a successful public health care professional exposure and a vibrant public health team.
AHRQ. (2012, Sep). Improving Patient Safety Systems. Retrieved from ahrq.gov: https://www.ahrq.gov
Duara, N. (2016, Sep 15). Arizonas once-feared Immigration law, SB 1070. Retrieved from latimes.com: http://www.latimes.com
Omar Martinez,…& Silvia Chavez Baraj. (2015). Evaluating the impact of Immigration Policies. Immigration Minor Health, 947-970.
Sheninger, E. (2014, Jan 23). Essential elements of effective leadership. Retrieved from huffingpost.com: http://www.hiffingtonpost.com
Wild, V. (2015, Jul 9). Health of Migrants. Retrieved from phe.oxfordjournals.org: http://www.phe.oxfordjournals.org