Code of conduct jan 2015

Code of Conduct: Standards of conduct
• We provide care according to
relevant laws and regulations and
using our mission as our guide.
• We provide emergency medical
care to and stabilize all patients
regardless of their ability to pay.
The Emergency Medical
Treatment and Active Labor Act
(EMTALA) guides how we make
decisions.
We provide high quality patient care

• We will not delay emergency medical treatment based on
someone’s financial condition. We also do not admit,
discharge or transfer patients with emergency medical
conditions based on their ability or inability to pay.

• We inform patients of other care options whenever
Fairview cannot provide the care a patient requests.
Fairview will transfer the patient to another facility if
needed and if appropriate for the patient’s condition.

• We know a patient’s personal, spiritual and cultural
beliefs affect recovery. We provide care in response to
patients’ requests or needs as long as that care is within
our ability, mission and philosophy, and is consistent with
all laws and regulations.

• We encourage patient involvement in care. We explain:
 the condition and care we recommend;
 potential positive and negative results of the care;
 any potential problems related to recovery;
 potential consequences if the patient refuses the
recommended care or if the patient doesn’t cooperate with
the recommended care plan; and any other care options.

• We handle prescription drugs and controlled substances
properly. Only authorized people handle these
substances.

• We provide a written copy of the
patients’ rights when a patient is
admitted to a Fairview hospital.
We make sure the statement is
appropriate for the patient’s age
and language. We also post the
statement of patient rights in
public areas of our hospitals and
care settings.
We honor patients’ rights

• We respect the right to dignity and privacy in all areas of
our patient care environment. This includes patient
rooms, emergency areas and waiting rooms.
• We treat anyone making decisions for the patient when
the patient cannot make decisions for him or herself with
the same respect and dignity we show the patient.
We honor patients’ rights

• We treat the information we
receive with dignity and respect.
We maintain the confidentiality of
patient, employee, physician and
health system information.
• We access information only when
we need to know it to carry out
our job responsibilities.
• We follow state and federal
privacy regulations.
We protect confidentiality

• We collect information about our patients that allows us to
serve them well. We do not share or discuss this
information unless it is necessary for the care of the
patient, for payment purposes or is required by law.
Patients can expect their personal information to be
released only to those who need it and are allowed by
law or with the patient’s written permission.

• We are all responsible to protect patient information from
unauthorized use. The rules that talk about sharing health
records are complex. Contact your supervisor if you have
any questions about sharing information from any part of
the patient record.

• We follow all laws related to the
conduct of our business and do
not and will not knowingly violate
laws.
• We insist on correct billing to all
payers.
• We do not knowingly provide
false or fraudulent claims.
We follow all laws

• We accurately document the services we perform.
Anyone who contributes to medical records provides
accurate information and does not destroy any
information. Physicians who treat patients at our sites of
care provide timely, complete and accurate information.
We follow all laws

• We hire subcontractors who have the necessary skills for
the work.
• They also must know the proper processes and
procedures to ensure correct and accurate billing.
We follow all laws

• We copy and use copyrighted material in accordance with
our own policy and with copyright law. We also follow all
guidelines outlined in our license with the Copyright
Clearance Center.
• We act in accordance with our tax exempt status. As a
tax exempt organization, Fairview operates exclusively
for charitable purposes. We serve the public good rather
than the private interest and our actions reflect this.
We follow all laws

• We accept patient referrals and
admit patients based only on the
patient’s medical needs and our
ability to provide the necessary
services.
• We do not pay for referrals or
accept any kind of payment for
referrals we make. We follow all
federal anti-kickback laws.
We manage referrals ethically

• We do not discuss Fairview
business with a competitor,
customer or business partner.
Examples of unacceptable
conversations are talking about
how our prices are set or sharing
the terms we have with a supplier.
We protect Fairview information and assets

• We can and do work with people and organizations
outside of Fairview on quality standards and common
regulatory issues. For this work, we share information. As
a part of these conversations, we don’t discuss
competitive issues and information.
We protect Fairview information and assets

• We always act in the best interest
of Fairview and the patients and
families we serve.
• We do not let outside activities or
personal interests influence—or
even appear to influence—our
ability to be objective.
We manage conflicts of interest

• We disclose any relationships that look like they could be
a conflict of interest.
• If there’s any question, we disclose these relationships to
the Corporate Compliance Department.

• A conflict of interest may arise if:
 You become employed by a competitor of Fairview, in any
capacity, while you are still employed by Fairview.
 You accept gifts or payments from someone seeking to do
or doing business with Fairview.
 You, or a family member, own a company, in part or
completely, that competes with Fairview or provides services
or supplies to Fairview.
 You consult for a competitor, customer or supplier of
Fairview.

• We do not ask for or give gifts, meals, entertainment or
other goods or services. Some jobs within Fairview
require entertaining with business partners. In these jobs,
entertainment must be reasonable, appropriate and relate
directly to the conduct of Fairview business.

• We do not accept gifts for personal use of more than
minimal value from any Fairview stakeholder. We do not
accept any gift that may affect or appear to affect our
relationships with others doing business for or as
Fairview.

• We create a work environment
where everyone is treated with
fairness and respect. Each of us
is responsible for how we treat
one another and for our role in
fulfilling our mission, achieving
our vision and living our values.
We nurture a healthy work environment

• We demonstrate our core values of dignity, integrity,
service and compassion. It is who we are, and it is a
basic expectation of our performance. In addition, to
achieve our vision and be an industry leader, we need
everyone who is a part of Fairview to lead. We need each
person to exhibit capabilities in four core areas: people
leadership, business leadership, strategic leadership and
functional leadership. These four areas are further
described by Fairview behaviors that each person is
expected to exhibit—regardless of role.

• We study and learn from all adverse events and patient
or staff safety issues. It is safe for everyone to talk about
real and potential risks to staff and patient safety, to
support each other when errors occur and to recognize
and coach behavior that places the team or the patient at
risk.

• We encourage and support diversity in all levels of our
organization. We strive to create a setting that celebrates
differences. We consider diversity laws, regulations and
policies as a minimum standard.
• We do not discriminate against any individual based on
his or her race, color, religion, sex, national origin, age,
disability, sexual orientation or veteran status. We are an
equal opportunity workforce.

• We maintain a workplace free from the influence of
alcohol and illegal drugs.
• We do not use, possess, transfer or sell alcohol or illegal
drugs on any land owned by Fairview. We do not report
for work or operate any Fairview vehicle or equipment
while under the influence of alcohol or illegal drugs.

• We represent Fairview honestly and ethically in all
interactions. This includes interactions with employees,
governmental agencies, providers, suppliers and anyone
else who may do business with Fairview. We make
thoughtful, honest and accurate statements in both
written and verbal communications. We also follow all
communication and information release policies and
guidelines established by Fairview to ensure the security
of our information and assets.
We represent Fairview honestly and ethically

• Please share your concerns when you
believe the standards of conduct have
been violated. Even when you are not
sure what is right, we want to hear from
you. Each Fairview team member can
feel comfortable and safe asking
questions and reporting concerns. He
or she will be treated with dignity and
respect and should not fear retaliation.
Sharing concerns

• We recommend you go to your supervisor, manager or
other trusted leader for clarification of anything included
in the Code of Conduct.
• There are ways to anonymously share concerns about
behaviors or incidents that conflict with the standards
outlined in this Code of Conduct. We take all issues
seriously. We investigate, and, when needed, take
appropriate action.
Sharing concerns

• The Corporate Compliance Program assists members of
the Fairview team to follow all relevant laws and
regulations. Corporate compliance staff:
 enforce standards of behavior
 create policies
 provide training and education
 monitor and audit our compliance with the standards
 offer ways to report concerns
 investigate concerns
Fairview’s Corporate Compliance Program

• When there is a violation, Fairview takes action to correct
the issue. Actions can include: refunding overpayments,
notifying the appropriate government agency, disciplining
employees and making system-wide changes to prevent
a similar issue in the future.
Fairview’s Corporate Compliance Program

I have received my own copy of the Fairview Code of
Conduct. I will read it, and I agree to act according to the
standards described here. I understand that following these
standards is required for my employment or continued
affiliation with Fairview. I understand that signing this
document will not diminish any existing employee rights I
may have through a collective bargaining agreement.
Code of Conduct: My pledge to Fairview
Pledge

Code of conduct jan 2015

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Code of conduct jan 2015