It is simple enough to say, “I am for justice”. I have yet to come across someone who says, “I am for injustice”. It is much more complicated to be just. One reason -- the sacrifices and the risks. Another reason – the damaging consequences when a single definition for determining what is ‘just’ is applied.
Prior to coming to Barnes-Jewish this past January, I worked for nine years as a member of the executive leadership team for a non-profit community health center in a rural East Tennessee Appalachia service area burdened by generations of poverty. We took seriously our mission statement’s resolve to deliver comprehensive primary medical care “in a fair and gentle manner”. During one of our strategic planning sessions, I called attention to the fact that we had employed several different ways to determine what is fair. Can you see them imbedded in these decisions?
Our seven family physicians all received the same compensation (other than small additional stipends for the three physicians who did surgical obstetrics). There were no productivity incentives.
Fairness is: _________________________________________________________________
Our clinical and administrative support staff members were compensated as near to ‘market’ as possible, with the distance from ‘market’ increasing across the compensation spectrum to the physicians (whose compensation was @80% of ‘market’ for community health center physicians).
Fairness is: _________________________________________________________________
Bonuses for non-physician employees were the same amount for all, whereas bonuses for physicians were calculated using an equation that took tenure into consideration.
Fairness is: _________________________________________________________________
We were committed to delivering the same quality of care to all patients.
Fairness is: _________________________________________________________________
We gave disproportionate attention to the health care needs of our most disadvantaged patients.
Fairness is: _________________________________________________________________
As a community health center, we made decisions about the utilization of human and capital resources based on ‘public health’ funding priorities.
Fairness is: _________________________________________________________________
We exempted physicians from covering Saturday AM clinics; mid-level providers, from call.
Fairness is: __________________________________________ _______________________
Is it legitimate to use different interpretations of fairness within the same community of individuals? If so, what integrates their experience together as ‘fair’? Should fairness be identified by such results as harmony, balance, reciprocity? Are ‘treating equals equally’ and ‘treating unequals with disproportionate regard for the less powerful’ the anchors for fairness? If so, can complacency (or resignation) about inequalities be overcome? What (in)equalities by/at birth matter re fairness? Should the interests, rights, and/or liberties of a few ever be sacrificed (as distinguished from being voluntarily surrendered) for the interests, rights, and/or liberties of the many? How far beyond the delineated community of individuals should consequences be tracked in assessing the fairness of decisions? How should deliberations about a fair distribution of benefits and advantages be affected by an organization’s being ‘not-for-profit’? What does having policies/procedures to handle grievances imply?
