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Essay: Planned Parenthood NYC Ethics Audit

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December 5, 2017

Planned Parenthood NYC Ethics Audit

Administrative Ethics

Leading the way in advocating for women’s healthcare rights has been Planned Parenthood Federation of America, Inc. (PPFA), a nonprofit organization. Protection and governance of a woman’s body was surprisingly not always the responsibility of the woman and this is reflected in history books through cultural norms and acquisition of property. Often men controlled a woman’s body through birth and also marriage. Sadly, women were known as possessions of men and today women are still protesting this antiquated practice.

Managing a workforce specifically geared to protect an individual’s right to reproductive health and education including pre-cancer screenings, safe practices to stop and prevent the spread of disease, and distribution of contraceptive devices or procedures for men and women can be difficult. The organization offers hormone replacement therapy for transgender individuals and is widely opposed by some religious groups, conservatives, and politicians that have been entrusted to represent and preserve society’s changing values. Family planning plays an important part in a person’s overall well-being and providing services to all genders without exclusion is a huge responsibility chartered by those passionate enough to recognize healthcare as a human right. In an analysis reviewing ethical practices within Planned Parenthood Federation of America, this paper will give an in depth perspective of Planned Parenthood of New York City (PPNYC) established in 1916.

Although America’s culture and growth surrounding healthcare as a human right, women’s healthcare remains a tedious fight. Demonstrations and protests have been common at facilities throughout the United States that provide abortion services and family planning. The reasons for protest vary from condemning a woman’s right to choose what happens with her body to religious groups denying the advancement of contraception to taxpayers unhappy about the disbursement of federal and state funding. Protesters have been known to line the streets and crowd the parking lots, holding signs that say things like “baby killer”,  spit on employees and those seeking services, pray for them and block the entrance. There have been numerous reports of violence including shootings and physical altercations at various locations. Not everyone experiences the same thing and perhaps a person employed by PPNYC never gets spat on but will experience adversity at some point during their career while trying to contribute to the mission of Planned Parenthood.

Having access to adequate counseling and training is essential in moral crises such as the intense and highly risky situations that employees face with integrity. (Cooper, p.171)  In terms of relativism, “postmodernism furthers the erosion of foundational assumptions as the universal and ultimate status of the core beliefs of modernism, rooted in science, is also called into question. The relativity of values threatens to undermine any belief in obligation and duty. Thus the intentional social construction of public ethical norms becomes even more crucial” (Cooper, p. 49)  When tested, whether one passes or fails, they learn something new which could be a very valuable perspective. What is done inside PPNYC is the business of client and health care provider, however some protestors are compelled to express their first amendment right outside of the medical facility and are protected by the law.

PPFA has long stood the challenges of a government and society that was unsupportive of its mission. Founder Margaret Sanger was jailed for thirty days for handing out brochures about birth control due to the Comstock laws banning the making, mailing, distribution, and purchase of ‘obscene’ nature. The internal moral work people do looks inside at personal values but externally, society looks at the greatest good. “Our socialization, the constant organizational pressure to identify with collective goals and values, and the absence of ineffectiveness of legal and institutional supports for individual autonomy create a murky environment in which it is difficult to discern the boundaries of our obligation” (Cooper, p. 239). Working at a nonprofit that has had many victories in the past one hundred years of existence has had an equal share of hardship and reconciling that as an employee can be difficult.

PPFA’s website states there are “56 unique, locally governed affiliates nationwide operating more than 600 health centers, which reflect the diverse needs of their communities”. PPFA believes, “in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual’s income, marital status, race, ethnicity, sexual orientation, age, national origin, or residence”. Expanded values include diversity contributing to well-being, individual privacy, family, and quality of life which can be advocated through public policies, educational programs, and promotion of research. Similarly, PPNYC has dedicated their mission and core values to incorporate the national platform but has also narrowed in on their specific community’s needs including those listed below,

Our Mission

To empower individuals to make independent, informed decisions about their sexual and reproductive lives, we provide information and health care, and promote public policies that make those services available to all. Planning is power.

Our Core Values — We Believe:

that sexual and reproductive freedom is a foundation for equality for all people — regardless of gender, gender identity, and sexual orientation.

that every individual deserves equal access to quality sexual and reproductive health care services, including safe, legal abortion.

that all people deserve to be treated as morally capable decision makers entitled to make their own sexual and reproductive decisions, free from judgment, coercion, or violence.

in strong families and caring communities, where all children are loved, cared for, and warmly welcomed, with access to the care and support that will enable them to reach their full potential.

that adolescents and adults have the right to access the information they need to make well-informed sexual and reproductive health decisions in a safe, supportive, and confidential environment.

in providing the best sexual and reproductive health care and education possible, grounded in evidence-based practice, enhanced by innovation, and informed by respect for every person’s unique needs and circumstances.

that we have a responsibility to address the inequities — rooted in gender, race, class, sexual orientation, gender identity, and neighborhood — that drive health care disparities, and to support public policies that promote more equal access to resources and opportunities.

that we are a part — sometimes leaders, sometimes partners, sometimes allies — of a broad community that works together for reproductive freedom, justice, education, and health care.

While the above information is well formatted and clearly stating objectives for serving the public, it is opposed by many. Working or even volunteering for this organization can be dangerous due to public perspective and interpretation of federal, state, and local laws.

Organizational Chart of Planned Parenthood of New York City

Board of Directors (effective December 2016)

Officers

Katie Danziger*-Chair

Leah Johnson*-Vice Chair

Lana Lewin-Ross*-Treasurer

Courtney Smith*-Secretary

Committee Chairs

Jennifer Sturman-Audit and Compliance Chair

Lana Lewin-Ross*-Budget and Finance Chair

Susan Weil-Compensation Chair

Katie Danziger*-Executive Chair

David Sherman-Investment Chair

Leah Johnson*-Issues and Advocacy Chair

Stephen Chasen, M.D.*-Medical Advisory Chair

Melinda Wolfe*-Nominating and Board Development Chair

Lisa Beattie Frelinghuysen* and Courtney Smith*-Philanthropy Ad Hoc Co-Chairs

Directors-William J. Borner, Jenny Brorsen, Rita Carrillo, Ana Cepin, M.D., Chris Creatura, M.D., Caroline Curry, Beth Essig, Meryl D. Hartzband, Andrew L. Herz, Ann Hicks, Valerie L. Johnson, Tracey Kemble, Erika Munro Kennerly, Margot Levy, Silda Palerm, Diane Rosen, Lisa Rubin, Moitri Savard, M.D., Adjoa Tetteh, Nicole Wachter

Emeritus Members-Cathy A. Cramer, Peggy Danziger, Marion F. Levy, Wendy Mackenzie, Diane Max, Laura A. Philips, Elizabeth F. Rosenman, Roberta Schneiderman, Patricia J. Volland

Honorary Members-Marcia Allina, Clare Russell Gregorian, Betty Kowaloff, Mrs. George N. Lindsay, John N. Mayberry, Barbara S. Mosbacher, Hector P. Prud’homme

*Executive Committee Executive Staff

Joan Malin-President and Chief Executive Officer (until July 2017)

Laura McQuade-President and Chief Executive Officer (as of September 2017)

Meg Barnette-Chief of Staff and General Counsel

Michele Bayley-Interim Vice President, Education and Training (2017)

Alice Berger-Vice President, Health Care Planning

Christina Chang-Vice President, Public Affairs

Keith Corso-Vice President, Development

Ila Dayananda, M.D., M.P.H.-Chief Medical Officer

Jacqueline Johnson-Vice President, Clinical Services

Francisco Ramirez-Vice President, Education and Training (until August 2017)

Anne Robinson-Chief Program Officer

Jonathan Segal-Chief Financial and Administrative Officer

Lauren Stewart-Vice President, Human Resources

Marcella Tillett-Vice President, Project Street Beat

AUDIT – 2

AUDIT PART 3

The ethical infrastructure of PPNYC shown in part two is structurally sound and based in the code of conduct established by the organization. The Chief Compliance Officer leads the Corporate Compliance Program. The Chief Compliance Officer reports to the Chief Executive Officer and to the Audit and Compliance Committee of the Board of Directors. The Chief Compliance Officer works closely with PPNYC’s Compliance Committee, which is composed of key executive staff including representatives from finance, clinical operations, and human resources(p.4). Because stakeholders, such as the public and employees outside of the board are not included in the compliance committee, the transparency promoted by corporate can be subject to nepotism and corruption. “Finally, organizational context can influence behavior in many ways, including job pressures to behave unethically, unrealistic organizational goals, rewards or incentives to act improperly, and weak sanctions for questionable behavior and organizational cultures that normalize unethical conduct. The ethical infrastructure, designed to counteract these factors and encourage right behavior in the workplace, includes robust formal and informal systems” (Bowman and West, p.169, 2015). Compliance is not just an issue that affects authority. It’s impact is far reaching and can be felt in the public domain. Employees could suffer because their needs are not meant or recognized because they do not report to responsible administrators that personally and professionally take actions to stand againt unethical behaviors like corruption.

“Not-for-profit organizations are also adversely impacted by scandals. Stories of the misdeeds tarnish the reputation not only of those smeared with the taint of corruption, but also legitimate programs that might lose favor in the public’s perception. Damaged reputation can sour potential donors who may withhold cash because of real or actual misdoings” (Bowman and West, p.228, 2015). Nonprofits are encouraged to stand up for integrity and implement an ethical infrastructure that is well-known and provides everyone with an understanding of procedural and systematic happenings. “The inability or unwillingness to employ anti corruption approaches amounts to the institutionalization of corruption that not only degrades democracy and the rule of law, but also imperils the future of the nation” (Bowman and West, p.235, 2015). An organization can experience similar effects when an administrative team does not acknowledge stakeholders as valuable assets. The focus of the authority in place should be seeking reform, end any wrongdoings, then deter corruption from taking place in the future. Without proper attention to potential bias and corruption within an organization, the problem can easily become exacerbated. The sooner an organization can eliminate any form of coercion from taking place, it makes the transparency and trust of the organization to increase.

Administrators do not have an infinite amount of time to reflect on situations that require analysis and problem-solving such as unethical behavior. A skilled administrator will try to address issues as they arise if prevention was not possible. Time plays a huge role in administrative ethics (Cooper, p. 245).  One of the best ways to avoid unethical behavior and foster responsible administration is to be personally responsible for it and set an example whether at the top of the hierarchical structure or the bottom. It is said that you cannot change an organization by leaving it, but instead stay and affect change by being the example. A public administrator made aware of their responsibilities using an ethical approach doesn’t have to make ethical decisions later about bad consequences to unethical decisions.

The culture of medical offices and other facilities including PPNYC have to regard the Health Insurance Portability and Accountability Act of 1996 also known as HIPAA which provides data privacy and security provisions for safeguarding medical information. The United States Department of Health and Human Services online portal contains training modules and comprehensive information surrounding HIPAA including patient safety, education, compliance, and application of laws to different entities. This law was brought about by the advancing technologies and efficiencies of providing multi-disciplined health care. This improvement in delivering services to the public creates a culture of privacy similar to the code of silence taught about in the police force. Structure and rules surrounding the liability of care provided to patients encourage ethical decisions by engendering a safe space for the patient to ascertain proper information regarding their personal health. This cultural structure could also impede ethical decisions by withholding potentially damaging information from the public about the organization. Transparency as a measurement helps manage expectations of the organization and those that work there. If an organization is not transparent, it is viewed as unethical. Below is an excerpt found on page six from PPNYC’s Code of Conduct:

We Protect the Privacy of Our Patients’ Health Information

PPNYC’s commitment to confidentiality applies to all staff and volunteers. It applies to everyone who comes to any Planned Parenthood office or center and asks us for help related to his or her own sexual or reproductive life, or who might be presumed by an observer to be coming to us for that purpose. It applies regardless of the form of help requested and regardless of the person’s age. It applies to all written (or otherwise recorded) material about such people and to all personal knowledge staff have of them. It also applies to the physical privacy of the areas in which the agency serves such people.

PPNYC expects HIPAA compliance as well as compliance with New York State confidentiality laws governing HIV information throughout the agency and our operations.

Frederic G. Reamer, PhD says, “one way to assess the adequacy of one’s ethics-related practices, policies, and procedures is to con
duct an ethics audit”. His article goes on to state that employees should form an ethics audit committee that would elect a colleague with prior knowledge in ethics policies and procedures. This team can assess which ethical practice should be given attention in an audit. The employees could conduct an exhaustive audit reviewing things like the effectiveness of an organization’s code of conduct or thoroughly review what responsibility it is for the administrators to provide access to confidential mental health because of daily protests. Next, they would need to organize and analyze any data, including interviews with the staff that pertain to the audit topic. If a more comprehensive review is done like a full assessment of every policy in the code of conduct, than each policy, after reviewed should receive a risk value. According to Reamer, there are four levels of risk including: no risk, minimal risk, moderate risk and high risk. Each level increases the priority of modifications that need to be made. From this point, the organization can develop action plans. Timetables and accountability measures ensure implementation. Once all of this is finished, the complete process should be published in case questions are ever raised about ethics-related practices.

The National Council of Nonprofits provides a ‘roadmap’ for handling an ethics audit which should be conducted regularly, such as ‘every 3 – 5 years (depending on the needs of the organization) with periodic reviews more frequently (such as an annual review of any changes to external legal standards), to review written guidelines (such as a code of ethics), or the soundness of training or preventive assistance programs’. Training can help to prepare employees for when they are faced with ethical decisions and moral reckoning. Avoiding legal liability is a very important aspect to many organizations. Administrative evils to monitor while conducting an ethics audit include un-naming evil, technical rationality, moral inversion, and diffusion of responsibility. It is vital that protection is in place to allow the organization’s mission to be fulfilled that way it can continue serving the public. After gathering all necessary information, and conducting an analysis, it is crucial that ethics audit be published and action plans are created.

PPNYC’s 2016 Annual Report, 2016 Return of Organization Exempt From Income Tax Form 990, or Code of Conduct published in 2014 have indicated a very strong leadership team with particular styles used to match initiatives listed in the annual report and policies in the code of conduct. Though nonprofit employees have the right to unionize, it is rare to see a union outside of a healthcare (mostly hospital) or school settings. “Because employment laws are complicated and subject to change, it is helpful for every charitable nonprofit to have a resource on hand to consult when questions arise about employment issues. Access to expertise on employment laws and human resource management practices is much more prudent than trying to “go it alone” in this highly regulated area”(Managing Nonprofit Employees).

Another challenge employees have working at nonprofits is the likelihood of the organization restructuring job responsibilities and programming due to reduction or increases of funding whether private or governmental. This adaptability is not the only challenge groups like PPNYC face; an increase of females, minorities, disabled, older workers and veterans affect organizational culture and add diverse perspectives to the workplace. Overall, employees and volunteers benefit from having quality of life through appropriate balance in job duties and their personal lives. Though PPNYC has celebrated one-hundred years of public service providing stability and security to employees, their work-life balance could be impacted because of protests infringing on their well-being by claiming paid staffers are morally wrong as well as making violent threats to their individual lives.

Pynes (2013) suggests training for employees should include knowledge on the position as well as advanced skills that make them candidates for accepting more responsibilities. Every employee should feel that they are valued and appreciated. Afterall, an organization’s success is achieved through the dedication of a well-trained and knowledgeable workforce. Through a mission statement, every person working at the organization can contribute to the shared vision of Planned Parenthood. Employee retention in nonprofit organizations can grow stronger if adequate pay and advancement in career are available to nonprofit employees. Opportunities such as those listed, will increase overall satisfaction and ability to have a positive perception of the organization’s mission and culture.

Our Commitment to Ethics and Compliance

At Planned Parenthood of New York City (PPNYC), our work is rooted in a public trust that requires us to meet the highest standards of customer service, confidentiality, and honesty in all that we do. Whether we are serving clients, engaging with the public and our local communities, or managing our financial and other business activities, we are committed to acting with integrity at all times.

We expect our employees, volunteers, interns, and board members to act in a manner that promotes our reputation as an organization that exceeds the strict requirements of the law and operates in accordance with the highest ethical standards. For us, a code of conduct is more than a regulatory requirement; it is an essential part of who we are and what we do.

This Code of Conduct sets forth the basic principles that guide the decisions and actions of Planned Parenthood of New York City in support of our mission to empower individuals to make independent, informed decisions about their sexual and reproductive lives. All employees, volunteers, interns, and board members must read and understand the Code of Conduct and agree to follow the standards contained in the Code in carrying out their job duties.

Thank you for taking this important commitment seriously. Joan Malin, President and CEO

The Chief Compliance Officer leads the Corporate Compliance Program. The Chief Compliance Officer reports to the Chief Executive Officer and to the Audit and Compliance Committee of the Board of Directors. The Chief Compliance Officer works closely with PPNYC’s Compliance Committee, which is composed of key executive staff including representatives from finance, clinical operations, and human resources(p.4).

PPNYC’s Code of Conduct is in place to ensure ethical behavior from everyone at the organization which may contribute to lower turnover because structure and written guidelines are essential for performing at optimal productivity. Clearly, the responsible administrator assumes accountability and also holds others accountable which can make them an examplar. “The structural, affirmative, “high-road,” integrity commitment system is aimed at deterring—rather than merely detecting—problems by emphasizing right behavior. Rather than blame and punishment, it focuses on reform and improvement. It is easy to manipulate an organization’s policies and procedures relative to trying to change individual behavior” (Bowman and West, p.186, 2015). PPNYC promotes representative democracy where employees represent the population that they are serving and recognize the significance of strategy and approach helping to achieve the results needed.

AUDIT – 4

The ‘designed approach’ by Whitbeck is used to address administrative ethics through various and articulated steps. Defining the ethical problem clearly and systematically would be an organization’s first step in solving any dilemma. Once the ethical behavior or act is determined, intervention strategies that can be employed should be brought forth and analyzed. Part of that analysis should include any relevant organiza
tional factors that may be affected by the potential intervention and are crucial to which approach should be applied. Overall, the organization will need to agree on what the best course of action should be and follow through (Cooper, p.252-253).

PPNYC employees have decreased satisfaction at work due to hostile work environments. The kind of changes that would need to be made at PPNYC to begin a process of aligning conduct required and conduct acted out by employees regarding a culture of privacy would include in-depth training provided to employees and research done by the administration on best practices.

Internal Recommendations:

Create career advancement opportunities within the organization

Send HR or office managers to strategic training courses that include employee protections and rights

Implement daily check-ins with employees of approximately 5 minutes and if a concern arises, schedule an appointment in your (office manager/ HR) to follow up with the employee so they have the time and privacy to disclose or expand on their concern

Provide adequate pay and incentives where necessary (additional paid days off, office lunches, recognition programs like employee of the month)

External Recommendations:

Something for PPNYC to consider is an Employee Assistance Program (EAP). These third-party programs can aid employees that are dealing with trauma related to their job or in any other area of their lives. The United States Office of Personnel Management Employee Assistance Program (EAP) model:

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.  EAPs address a broad and complex body of issues affecting mental and emotional well-being, such as alcohol and other substance abuse, stress, grief, family problems, and psychological disorders.  EAP counselors also work in a consultative role with managers and supervisors to address employee and organizational challenges and needs.  Many EAPs are active in helping organizations prevent and cope with workplace violence, trauma, and other emergency response situations.

Third parties often offer a variety of services customized to the organization making an inquiry. EAPs can even aid in training and development of staff. Even if a third party is not foreseen in the future of PPNYC, initiatives or trainings should be held to educate staff about the dangers of working for their organization. Overall, Planned Parenthood may surprise everyone if this study is conducted.

Pynes (2013) writes, “Changes in the labor market, coupled with ineffective and sometimes arbitrary and unfair management often lead employees to unionize when they feel threatened”. Though PPNYC is a nonprofit, it has remained stable for employees. “For public and nonprofit organizations that are not yet unionized, it is important to have a progressive HRM system in place that respects employees. Examinations, performance appraisals, promotions, and merit pay systems must be administered in an equitable and consistent manner. Jobs must be matched to eliminate test data routine and boring, and career enrichment opportunities must be provided. Employees must feel that their jobs are important and that they are contributing to the mission of the agency” (Pynes p. 372). When an organization plans to make a difference in the lives of many, the many that will make a difference show up and commit to that mission. The expected outcomes from following these recommendations will decrease turnover, increase a healthy environment and provide an outlet for communication.

References

Anon, (2014). [pdf] New York City: Planned Parenthood of New York City. Available at:

https://www.plannedparenthood.org/uploads/filer_public/61/d8/61d89fed-967d-4c34-984e-38e06ed6d0bb/code_of_conduct_2014.pdf [Accessed 10 Dec. 2017].

Attridge et al. (2010). The Business Value of EAP: A Conceptual Model. EASNA RESEARCH

NOTES, Volume 1.

Bowman, James S. and Jonathon P. West (2015). Public Service Ethics; Individual and

Institutional Responsibilities, CQ Press, Thousand Oaks, CX, 368p.

Cooper, Terry L. (2012). The Responsible Administrator: An Approach to Ethics for the

Administrative Role, 6th edition, Jossey-Bass, San Francisco, CA, 320p.

Federal Employee Assistance Programs. (n.d.). Retrieved December 1, 2017, from

https://www.opm.gov/policy-data-oversight/worklife/employee-assistance-programs/

Internal Revenue Service. (2016). Form 990: Return of Organization Exempt from Income Tax:

Planned Parenthood of New York City. Retrieved from plannedparenthood.org.

Managing Nonprofit Employees. (2017, December 06). Retrieved December 10, 2017, from

https://www.councilofnonprofits.org/tools-resources/managing-nonprofit-employees

Parenthood, P. (n.d.). Mission & Values. Retrieved December 7, 2017, from

https://www.plannedparenthood.org/planned-parenthood-new-york-city/who-we-are/mission-values

Planned Parenthood of New York City. (2016). 2016 Annual Report of Planned Parenthood New

York City. Retrieved from https://www.plannedparenthood.org/uploads/filer_public/e6/30 /e 63029a1-695f-49a6-9a45-f6f20c8de18c/online_version_of_2016_annual_report.pdf

Pynes, Joan E. 2013. Human Resources Management for Public and Nonprofit Organizations ,

4th edition. San Francisco, CA: Jossey – Bass.

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