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. Please make your own argument

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