The requirement to analyze the ‘Code of Ethics’ is derived from that professional work plays a vital role in social change. The code of ethics can best be described as a set of guidelines for daily professional life which should be utilized by every individual who has decided to be a professional worker. Additionally, society also has a right to know that the work of human service professionals has its specific protective measures, which guarantee that the work can be trusted and is reliable in every aspect (Cwikel, 1991).
The issue of ethical code at any organization has been discussed by a number of management experts, corporate executives, and business professionals. In recent years, human service professionals have started to adopt a realistic approach while considering the moral aspects of their businesses. (Reamer, 1997) As the awareness level among the general public is increasing and people are expecting the companies to be more socially and morally responsible, service professionals have started to seriously consider the ethical aspects of their business. The objective of this paper is to discuss the concerns which develop when working with a client of interest. Human service professionals are concerned about the following ethical issues, which may cause problems between the two parties.
- Human service professionals ethical responsibilities to clients,
- Human service professionals ethical responsibilities towards quality service,
- Human service professionals’ ethical responsibilities in practice settings.
Service quality is one of most major issues faced by human service professionals because, without it, professionals would find it difficult to build relationships with their clients. Trust in a client relationship is important, as a client would not want to make business relations with someone if they felt there were no criteria for quality management. This could be why new employees in the professional world find it difficult to relate to their clients until a relationship has been formed. Quality professional work, especially in the services providing profession, depends on professional reviewing and critiquing (Cwikel, 1991).
Providers across each of the states focused heavily on the challenge associated with hiring, training, supervising, and retaining a high-quality workforce and monitoring services in order to maintain quality control. Hiring the right worker was consistently identified as the key element in delivering quality care on a consistent basis. Agencies routinely conduct criminal background checks, require physical exams, tuberculosis screening, and references. Management staff in many of the agencies stressed the importance of supporting their workers and highlighting their value to the organization.
Informants in all three states identified complaints as an important but limited quality assurance tool. State administrators, case managers, supervisors, and service provider agencies indicated that most clients are reluctant to complain about their workers or case managers. Human service professional agencies in Washington are required to have a dispute resolution process and to inform clients that it is available. The state agency also operates a complaint hotline (Reamer, 1997).
A human service professional agency in Massachusetts reported that it reviews complaints to identify trends. (Reamer, 1997) Complaints are reviewed by supervisors who meet with the worker. An agency quality improvement committee also receives information on complaints. The agency also views the homecare corporation as a “client” and sends surveys to case managers to measure satisfaction with the agency from the case managers’ perspective. Some of the questions include the following: Are your calls returned promptly? Is the communication satisfactory? Are you notified of problems when they occur? (Reamer, 1997).
Almost all human service professionals reported completing some type of client satisfaction surveys–in most instances, by mail. Provider agencies report a high level of satisfaction and consistently raise concerns about the reliability and validity of the measures and data collection process. Certain providers have attempted to complete in-person interviews. Respondents highlighted the importance of collecting client satisfaction information but also discovered the measurement and data collection challenges in this area.
Many of these professionals described a strategy that included random phone calls to the client’s home. Such calls would occur during the beginning or end period of an aide visit to verify attendance or to ensure that major tasks were being performed. Respondents indicated that such approaches give providers more confidence that care is being provided in the appropriate manner. (Cwikel, 1991)
Numerous problems arise in adopting a service quality orientation, particularly in the public sector. Often human services workers have a social control role to play and multiple clients to serve. For example, a child abuse worker must consider the best interest of the child while relating to the abusing parents. Human service professionals are often placed in the difficult dual role of social control agent and treatment specialist (Polsky, 1991). These and other issues do the business of delivering human services complex and difficult. However, improving quality in human services does not require that every service delivery controversy be resolved. Rather, it simply requires a commitment to treating people with respect and dignity. (Heermance, 1999)
Mistakes in the delivery of services are inevitable. How an organization recovers from such situations will greatly affect the perception of the quality of services an organization provides. Recovery services and other similar efforts tend to be viewed as an expensive nuisance, and many organizations are ill-equipped to recover from service failures. Nevertheless, customers have higher expectations for recovery services. When a service organization delivers quality recovery services promptly, they often are repaid with a rebound in customer confidence and loyalty.
Recovery should be seen as an opportunity. Human service professionals should reward clients for complaining. (Hoffman, 1994) Direct complaints allow organizations to respond to the client, whereas indirect complaints damage an organization’s reputation and do not provide an opportunity for a recovery. (Kuczewski, 1999)
Services Quality and Clients
Service professionals often face instances in which workers became involved with clients at a level that was beyond the worker’s training or position. In some cases, for example, workers attempted to resolve family problems or had to assist with money management. It was reported that because of the complexity of the client’s condition, both physical and human service professionals often become involved in situations in which they felt action was needed, even though their training was limited. On the one hand, this observation highlights the worker’s commitment to quality. On the other hand, such a recognition of the complexity of cases underlines the importance of training for the tasks actually being performed and highlights training as a significant management issue facing service professionals (Hoffman, 1994).
Although policymakers and researchers have made contributions to the service professionals quality arena, a number of key research challenges remain. These challenges include defining and measuring quality, developing adequate information systems and quality benchmarks, and evaluating the effectiveness of quality initiatives.
Additionally, client choice plays a vital role in affecting the quality of care. Client choice is often described as an important component of comprehensive quality assurance. In theory, when clients or their representatives have a choice, they can leave agencies or workers providing poor services and seek better quality services from another agency. Informants in South Carolina and Washington indicated that Medicaid freedom-of-choice rules, which are designed to protect clients, actually create severe limitations for clients and add to the cost of administering programs. These limitations can occur for both case management itself and direct services. For example, case managers are unable to advise clients as to which provider agency has a poor or excellent experience serving other clients. Although clients have a choice of providers, they have no basis for knowing which agency offers quality care. Furthermore, the large number of providers leads to several agencies obtaining such a low volume of clients that it is difficult to deliver services efficiently. (Kuczewski, 1999)
Human service professionals that develop ongoing programs of quality improvement commonly begin by establishing a dedicated committee empowered to oversee efforts and recommend system-wide changes. This is required by NCQA (National Committee for Quality Assurance, 1996) and typically involves a multidisciplinary group of helping professionals and administrators. (Dolgoff, 1992)
Quality has also been defined through the use of the word “expectation” but not so widely as the word “need.” Quality has also been defined from the perspective of the organization. This is especially connected with the quality of working life and is based on the “organization assessment movement.” Quality assessment from this point of view means all those features which are important for employees as contributors to working conditions; that is, social, physical, and mental features. (Ingle & Ingle, 1985) Some researchers, such as Jones (1985), Kumpusalo, and Makela (1993), more than others, link the concept of quality to objectives. Quality is thus the continuous and measurable attainment of previously defined objectives. In their definition of quality, the improvement of quality is a circle, which starts with defining the problem and then setting the objectives. Activity is measured, and the measurements are assessed. The assessment will result in a change, and the objectives will be checked. The quality circle of Kumpusalo and Makela (1993) is close to the assessment of profitability: setting objectives-process-results-measurement of the results. (Ingle & Ingle, 1985)
Cheetman et al. (1992) and Donabedian (1982) stress the meaning of the process in addition to structure- and result in criteria. (Davis, 1998) Cheetman et al. say that, especially in human services, the process is often more important for clients than the results themselves. Samuelsson and Brink (Davis, 1998) have also stressed the process of in-home help activities, stressing that it is necessary for the older person to cooperate in certain aspects of the process in order for the work to be properly carried out. The user is already a participant in the service process from the beginning when wishes, needs, and resources are discussed (Davis, 1998).
Understanding the Customer’s Point of View
To understand quality, one must be able to view the service from the consumer’s point of view. Customers’ perceptions of service quality are complex, and enhancing their perception requires the management of”moments of truth.” A moment of truth is that precise instant when the customer comes into contact with any aspect of your business and, on the basis of that contact, forms an opinion about the quality of your product. (Hoffman, 1994)
Central to the notion of service reliability is doing it right the first time. Service unreliability is especially costly to a service organization and can result in lost customer confidence, lost customers, and the added expense of replacing lost customers with new customers. Negative word-of-mouth advertising, negative publicity, and even restrictive legislation are also costly to service organizations. The effect of such actions may indirectly cost organizations more than the direct cost of reperforming the service and placating customers. (Ingle & Ingle, 1985)
The implementation of quality-focused management entails a change in culture as much as it requires a change in technique. Such changes may be of either an incremental or a revolutionary nature. In some settings, the dramatic introduction to Total Quality Management (TQM) is appropriate. However, many human services organizations are not ready or able to completely embrace TQM. In such cases, the overselling of TQM may simply breed cynicism and a sense of alienation. Swiss (1992) argued that TQM offers a variety of useful tools that can be implemented either in a wholesale or in a piecemeal fashion (Davis, 1998).
In short, the perfect should not be the enemy of the good. Quality management entails continuously striving for improvement. Even modest movements toward quality can be difficult in overly rigid organizations. The bureaucratic stranglehold on a service organization can be mitigated by reducing excessive layers of management and turning the management pyramid (putting customers and frontline personnel first) upside down (Davis, 1998).
A commitment to quality involves embracing the continuous nature of the quality improvement process. With a mission to maintain the quality during the provision on services, the smallest changes become steps–along the high road to quality: Without such a mission, the most grandiose reforms are little more than interesting diversions. Perhaps human services, especially those in the public sector, are not ready for the total quality revolution. Regardless, every sector of the human services industry should be able to move toward providing higher quality service products to their customers now. (Fulford, 2001)
When service personnel has no control over service processes and outcomes, they may actually take sadistic pleasure in client’s frustrations. Human resources departments can assist supervisors in empowering their employees by giving them more opportunities to participate in decision-making and by allowing them more autonomy in their practice.
The employee selection process should be driven by the notion of recruiting people who can contribute to quality. For example, because quality management programs often emphasize the group process in developing TQM teams (suggestion systems, work teams, and so forth), selection tactics should identify candidates who can function well in group settings. This notion has led to the development of creative new selection activities, such as team interviews and the use of assessment centers (Fulford, 2001).
Client service issues and a democratic orientation to problem-solving should be integrated into training, career development, and other human resources-oriented functions. Naturally, the enhancement of technical skills is important, but in human services organizations, skills that relate to client interactions are equally important. Direct-service workers should understand the client’s experience during the service encounter and further understand the flow of activities across departments that make up the total service encounter. This approach requires the development of future managers through a series of lateral experiences so that they understand the cross-functional aspects of the organization. It is not practical to expect to be able to develop managers who can facilitate Intra organizational coordination when their entire experience has been tightly focused and specialized (Moore, 1999).
I believe that the main purpose of a human service professional is to provide essential human services, especially for those who are least able to help themselves. The ethical standards for a human service professional and his or her personal values are guides that aid each human service professional to provide adequate services to his or her clients. Identifying, assessing, and developing one’s personal values may give a person the opportunity to identify what they stand for in life.
Guidelines to help human service professionals when handling ethical conflicts
The following guidelines may help service professional to handle ethical conflicts which may be encountered:
Know federal and state laws about quality, as well as the most recent court decisions. Service professionals should have an understanding of important federal laws and recent Supreme Court decisions that affect quality. It is also important that service professionals be knowledgeable about their own state laws and recent state court decisions about quality issues. The local chapter, a law library, or the Internet may be helpful sources of information. (Heermance, 1999)
Know the Code of Ethics and how it applies to quality. The new Code stresses that the professional worker must share with clients the limits of quality posed by third-party payers. Service professionals also are advised to maintain client quality while using technological means.
Assess the level of quality that is needed. Service professionals should understand the level of quality required for the information to be provided. Service professionals should discuss with clients how sensitive the information is and incorporate their concerns about safety in a decision about the type of quality needed (Heermance, 1999).
Explore how quality is protected in one’s agency. Policies about the quality are usually included in agency policies and procedures manuals. Service professionals have a responsibility to know what these policies are and to work in their agencies to delineate the scope of these policies more clearly (Dolgoff, 1992).
Convey to clients both verbally and in written form limits quality. Discussing the limits of quality with clients is not new. For a number of years, service professionals have been advised that absolute quality cannot be guaranteed and that certain information to others should not remain secret. The burden of responsibility is on the professional worker to provide informed consent so that clients have an understanding of what is to remain confidential, what will be shared, and how the information will be shared.
Advocate for clients’ rights to quality. Service professionals must advocate for clients within their agencies, as well as with other companies, to maximize quality. Also, advocacy groups, including professional organizations, can maximize advocacy efforts on a macro level.
Educate professionals, providers, and students about quality service with advanced technology in a professional environment. Professional work educators have a responsibility to teach about the new quality services to current providers as well as those entering the field.
In conclusion, confidentiality is important, and to build on relationships with clients, then confidentiality must be in place. I have talked about the different types of consent that people give regarding confidentiality, also about when they are unable to give consent. I understand that confidentiality can be a difficult issue. The main point is how much information a professional worker can disclose about a client, and if they disclose too much, this could be breaching professional confidentiality. Ethics is something learned; to take the right path, the ethical path is sometimes a difficult decision, but rewarding in the long run (Davis, 1998). The behavior of organizations, therefore, stems from what ethical path is chosen, either be internal or external. The customers, shareholders, and employees hear about the decisions one way or another, therefore if your business relies on reputation, which most do, the ethical way is always going to be the more profitable and rewarding way. (Moore, 1999)
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