[July 2003 journal entry]
It is simple enough to say – “I am for justice”. I have yet to come across a person who says – “I am for injustice”. It is much more complicated to live out a commitment to justice as fairness. One reason has to do with the risks associated with such resolution. Another reason has to do with the complexity re defining/envisioning fairness. For some time, I have given thought to the way the executive leadership team (of which I am a member) for the non-profit community health center where I work employs different definitions/concepts of fairness in our decision-making from situation to situation – e.g.,
- our seven physicians all receive the same compensation (other than a small additional stipend for the three physicians who also do surgical obstetrics),
- our physicians have no productivity incentives,
- our nursing and administrative support staff members are compensated as nearly as possible to their ‘market’ earning potential, with the distance from ‘market’ increasing across the compensation spectrum to the physicians (who are compensated at about 70% of their ‘market’ earning potential among community health center physicians),
- bonuses for nursing and administrative support staff members are the same amount for all, whereas bonuses for physicians are calculated using an equation that weights tenure,
- we are committed to delivering the same quality of care to all patients, though we intentionally give disproportionate attention to the health care needs of the most disadvantaged patients in our impoverished service area,
- as a community health center, we make decisions re the use of human and capital resources based on public health needs/priorities,
- we have exempted our physicians from the Saturday morning walk-in clinic schedule (covered instead by our three mid-level providers).
I suspect there are still other illustrations to be found in our decision-making. Is it legitimate to employ such varying and distinguishable interpretations of fairness within the same organization or ‘community’? If so, what holds these decisions together as ‘fair’? Is there an aesthetic quality to fairness (e.g., harmony, balance, health, beauty, reciprocity)? Are ‘treating equals equally’ and ‘treating unequals with disproportionate regard for the less powerful’ the anchors for fairness? If so, how is complacency (or resignation) re inequalities overcome? What (in)equalities by/at birth matter re fairness? Should the interests, rights, and/or liberties of some ever be sacrificed (as distinguished from being voluntarily surrendered) for the interests, rights, and/or liberties of others? How far beyond the defined/gathered ‘community’ should consequences be considered in assessing the fairness of decisions made within/for the ‘community’? How should being ‘non-profit’ affect deliberations about a fair distribution of benefits and advantages? Why do organizations intentional about fairness have/need personnel policies and procedures to address grievances?
