Code of Ethical Business and Professional Behavior

  1. Purpose

Cleveland Clinic Health System (CCHS), including all of its components strives to adhere to ethical principles in carrying out its primary mission:

Better care of the sick

Investigation of their problems

Further education of those who serve

Five fundamental values are central to the culture of CCHS. These include quality, integrity, compassion, collaboration and commitment. These core values are expressed both in clinical and business operations. This Code of Ethics and Professional Behavior is intended to provide guidance to all system members and employees regarding the standards of conduct, which are expected of every individual. All members of the Cleveland Clinic Health System are expected to aspire to the highest standards of ethical conduct in all aspects of professional, business, and organizational performance.

  1. Ethics Council

The CCHS Ethics Council is a sub-committee reporting to the CCHS Medical Operations Council composed of representatives of each component. The Ethics Council coordinates ethics-related activities with the Ethics Committees of each component in collaboration with all applicable CCHS Integration Councils.

The CCHS Ethics Council provides leadership to address the ethics of professional, business, and organizational behavior within the system, reviews system-related ethics issues, and coordinates the development of ethical standards for patient care and business operations for the system. Activities include, but are not limited to: development of standards for patient rights, advance directives, admission, discharge practices, management of conflict of interest, clinical decision making, fair marketing practices, fair and legally compliant billing practices, and bioethics education and services.

  1. Basic Standards of Ethical Conduct
  1. Admissions, Transfers and Discharges
  • Decisions regarding admissions, transfers and discharges are to be based on the best interests of the patient. Care is to be provided to only those patients for which the system possesses the necessary knowledge and skills.
  • Referrals outside the system will occur when appropriate services are not available within the system or when the patient desires to be transferred.
  • Patients shall be transferred and discharged in accordance with the physician’s transfer and discharge instructions in accordance with the patient’s best interests and with due respect for the patient’s privacy and dignity.
  1. Marketing
  2. Marketing practices are conducted with truth, fairness, and responsibility to patients, the community, and the public at large.
  3. Marketing materials accurately reflect services available, the level of licensure at time of publication and accreditation, and will comply with applicable laws and regulations of truth in advertising and non-discrimination.
  1. Respect for Patient Values & Benefits
  2. All patients are to be treated with dignity, respect, and courtesy.
  3. Patients and their surrogates (as appropriate) are to be involved in decisions regarding care.
  4. Patients are to be treated with consideration for their personal values and beliefs.
  1. Privacy and Confidentiality
  2. The system and its components maintain medical and patient financial information in ways that are designed to protect privacy and confidentiality.
  3. Business, personnel, and management information is utilized only by those individuals authorized to review and act upon such information.
  1. Informed Consent
  2. Physicians within the system will ensure that their patients provide informed consent to tests, treatments, procedures, as appropriate. Informed consent includes disclosure of risks, benefits and therapeutic alternatives.
  1. Research
  2. All research involving human subjects is reviewed by the appropriate Institutional Review Board (IRB).
  3. The IRB has the responsibility for assuring that the rights and welfare of human subjects of research are protected.
  4. Participating in research is voluntary.
  5. Scientific integrity and the responsible conduct of research are addressed in component-based policies that establish a mechanism to investigate charges of scientific misconduct.
  1. Clinical Decision Making
  2. The system respects the rights of its professional, medical, nursing, and allied health staffs to exercise professional judgment in the discharge of their duties.
  3. CCHS components implement policies and procedures to assure that the integrity of clinical decision-making is not compromised by financial incentives or risk sharing relationships with leaders, managers, clinical staff or licensed independent practitioners.
  1. Resolution of Conflict
  2. Each component of the system maintains mechanisms to address and resolve patient, personnel and management related conflicts.
  3. The system respects the rights of its professional, medical, nursing, and allied health staffs to exercise professional judgment including the right to question or appeal issues within defined unit and component structures.
  1. Conflicts of Interest
  2. Each component of the system maintains policies that require disclosure of potential conflicts of interest to ensure that such conflict does not inappropriately influence business or professional decision-making.
  3. No employee or member of administration or professional staff shall accept gifts, favors, entertainment, or other items of value that might compromise their independent decision making abilities.
  4. Gifts or donations made to the system or system component in furtherance of its defined mission are permissible.
  1. Fair Billing
  2. The system maintains mechanisms to ensure that accurate billing occurs.
  3. The system and its components provide assistance to patients and third-party payers seeking to understand the charges associated with patient care.
  4. The system and its components maintain mechanisms to resolve questions and objections.
  5. The system is committed to working with third-party payers to assure timely communication of patient and financial information.
  1. Continuity of Care
  2. Relationships or contracts developed by the system or its components with other health care providers shall not conflict with the mission of the system.
  3. The system is committed to timely and effective collaboration with other providers to ensure continuity of care for patients being served by the system.
  4. The system is committed to providing consistent communication among providers to ease transitions across system elements and outside providers and agencies.
  1. Educational Affiliations
  2. The system is the home of the Cleveland Clinic Lerner College of Medicine and is committed to the education of these medical students. The system also collaborates with other institutions of higher learning in order to prepare students for health care professions.
  3. Violations of Code
  4. The Ethics Council is available to review allegations regarding violation of the system’s Code of Ethical Business and Professional Behavior.
  5. Reports of any findings or recommendations of an Ethics Council review shall be forwarded to the Medical Operations Council for action.

Approved by Ethics Council: February 16, 2000

Reviewed/Revised: May 2005 (Eric Kodish, M.D., Chair CCHS Ethics Council)

Approved by CCHS Medical Operations Council: October 12, 2000, May 24, 2005