You as a non-physician can not change a physician's practice pattern. It is difficult to change practice patterns even among physicians emplyed by a hospital.

Please define the ethical problem(s) in this case. As a hospital or practice manager, what actions can you take? Consider the impact of your actions on your career, patients, your employees, physicians in the department and administration.

Practice Varies-a Lot Able Hospital is a large, general-acute care facility that serves a diverse commu- nity in the mid-Atlantic. It has a well-deserved reputation for high-quality obstet- rics services. Able has more births than any hospital in the region. Thus, when a large, well-respected group practice plan established a presence in Able's ser- vice area, it affiliated with Able for obstetrics services. Able's board was pleased with the affiliation. It meant a steady patient load of insured patients who were medically well managed. To meet the demand, Able expanded its obstetrics unit. Within 5 years, practice plan patients accounted for 40% of deliveries at Able. A new administrative resident was asked to compare obstetrics lengths- of-stay for plan and nonplan patients who were low risk. Nonplan patients are attended by obstetricians in about 20 two or three-physician partnerships. The data show statistically significant differences in lengths-of-stay between the two groups. Further analysis found the rate of caesareans (C-sections) for plan pa- tients was about half that of women attended by nonplan physicians. The demo- graphic characteristics of women attended by the two sets of physicians were the same. Looking at her analysis, the resident pondered how such a large differ- ence in C-section rates was possible, The resident sent her report to the chief operating officer (COO). She was confident the coo would praise her work and that her findings would stimu- late action by the administration, or even the board. The resident was very disap- pointed when neither happened. After hearing nothing for several months, it was apparent the report had been set aside or forgotten