In search of social enterprise: a fable

Hospital and health care delivery has tightened from former times of plenty. It has also moved strongly toward "the business of caring." The first of these trends forces hospital decision makers to make trade-off choices they were not previously required to make. Among the many usual bases for making these decisions--political, financial, and medical--is the basis of ethics. The second trend forces community hospitals to examine the real purpose and meaning of their status as not-for-profit institutions. Both trends place on managers in the field the need to make clear the professional values on which they operate. This fable contains five different scenarios for the year 1985--each one plausible while also occult. But no two or more of these could simultaneously exist. While clearly a story, many of the specifics are real, notably those described in "End V." This is a different kind of article than most, and it has a specific purpose: to be used as the basis of discussion concerning the institutional and professional values of hospitals and their executives. This fable argues that it is both possible and important to raise the ethical component of decision making and management.