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You work in a hospital that serves mostly privately insured, well-to-do patients. The management has worked hard to make the hospital both a good place

You work in a hospital that serves mostly privately insured, well-to-do patients. The management has worked hard to make the hospital both a good place to work and an attractive place to be treated. Many of the region's best specialists work with or for the hospital. You serve as midlevel manager. In the three years you've held the management position, you've gained the trust and admiration of nurses, physicians, and administrators. Over the past year, nurses from both the neonatal department and the geriatric department have come to you privately to discuss what turns out to be a similar issue. Nurses in the NICU have become concerned because physicians are sending more babies to the NICU, even babies with fairly high birth weights. This is partially because parents are requesting "the best possible care" for infants with potential complications, but nurses also hear rumors that more babies in the NICU means higher profits for the hospital. However, babies who are in the NICU experience less mother-baby bonding and more frequent invasive procedures (IVs, etc.). Likewise, nurses in the geriatric department have shared that physicians order a fair number of tests and surgeries that recent research shows to be unhelpful. Again,the patients and their families appreciateand sometimes requestthe procedures, and the procedures are done routinely at facilities around the country. However, the plain fact is that the hospital profits from these procedures. On the other hand, every unnecessary procedures brings risks, and unnecessary surgeries even more so. You compile the data and find that the nurses' observations are backed up by the data. Thankfully, nothing in either department constitutes fraud. However, you do have concerns.

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