Ethical Leadership: Fostering an Ethical Environment & Culture ...

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Part II: Introduction to Ethical Leadershipthe environment and culture in which they work. In organizations with a strong ethicalculture, the frequency of observed ethical misconduct is dramatically reduced.[50] Forthis reason, we believe that fostering an organizational environment and culture thatmakes it easy for employees to “do the right thing” is the key to ethical leadership.What Is an Ethical Environment and Culture?Research has shown that certain features of an organization’s environment and culturepredictably affect ethical practices in a positive way.[51]Characteristics of an ethical environment and cultureIn an organization with a healthy ethical environment and culture, virtually everyone:• appreciates that ethics is important• recognizes and discusses ethical concerns• seeks consultation on ethics cases when needed• works to resolve ethics issues on a systems level• sees ethics as part of quality• understands what is expected of him or her• feels empowered to behave ethically• views organizational decisions as ethical• When nearly everyone in an organization appreciates that ethics is important,employees focus on doing the right thing, for the right reasons—even in the faceof competing demands on people’s time and attention. Ethics isn’t viewed simplyas adherence to rules or a way to detect and punish legal violations, but as a wayof talking about what’s important and building trust to promote the organization’smission.[52] Employees conform to ethical practices not because they’re afraidof punishment, but because they’re committed to the organization’s mission andvalues and to putting them into practice. Empirical evidence indicates that if leadersdemonstrate that they don’t care about ethical behavior, employees will avoidraising concerns for fear of being rebuked.[53] But when the environment reinforcesorganizational values, employee performance and commitment, integrity, andcommunication are all enhanced.[54,55]• When nearly everyone in an organization recognizes and discusses ethicalconcerns, staff members recognize that ethics is relevant to everyday workplaceinteractions. In such a context, ethical concerns can be raised and addressed early,thus avoiding potentially difficult and harmful problems later on. Although some maythink that discussion of ethics is a bad sign in an organization (because it conjuresup images of misconduct or wrongdoing), in fact just the opposite is true.[56,30,57]In the best health care organizations, employees tend to discuss ethics a lot. Studiesindicate that talking about ethical concerns, especially when they first arise, canhave positive effects on organizational performance.[11,58]14
Part II: Introduction to Ethical Leadership• When nearly everyone in an organization seeks consultation about ethicalconcerns when needed, vexing concerns can be effectively resolved. When theethics consultation service is accessible and helpful, staff, patients, and familiesknow that their concerns will be taken seriously and addressed. When organizationsdon’t have an internal mechanism for resolving ethical concerns, individuals may feelfrustrated, helpless, unsupported, or even compelled to take their concerns outsidethe organization, for example, to Congress or the media. Not only does effectiveethics consultation improve satisfaction for patients, families, and staff; it also canhelp to reduce utilization of wasteful or unwanted treatments.[9,12] For example, onerecent multicenter study showed that ethics consultations were not only viewed ashelpful by the great majority of requesters, but also reduced hospital days and useof nonbeneficial life-sustaining treatments among dying patients.[9]• When nearly everyone in an organization works to resolve ethics issues ona systems level, staff members at all levels apply systems thinking to addressongoing organizational systems and processes that give rise to ethical uncertaintyor conflict. When organizations encourage systematic approaches to ethics issues,employees seek “upstream” solutions to keep the “downstream” problems fromarising. They’re attentive to ethics quality gaps between the organization’s currentpractices and best practices and seek ways to reduce those gaps.• When nearly everyone in an organization sees ethics as part of quality, staffmembers recognize that ethics is just as essential to health care quality as technicalcompetence and customer service.[20] They also recognize that problems cansurface either as quality issues or as ethics issues—and that quality issues oftenimplicate ethics issues and vice versa. In a strong ethical environment, leadersensure that performance measures include expectations for ethical practice and thatthe organization’s system of incentives and rewards are aligned with its mission andvalues.• When nearly everyone in an organization understands what’s expected of himor her with respect to ethical practice, it’s easier for staff to know and do the rightthing. Employees understand that leaders expect high ethics quality, want to knowabout ethical problems in the organization, and hold everyone to the same (explicit)standards. Individuals don’t find themselves in ambiguous, ill-defined situationsthat can lead to misjudgment or mismanagement. Empirical evidence indicates thatcorporate scandal and misconduct are more likely if leaders foster an environmentin which things are left unsaid: Employees can interpret the silence to indicatethat there are things leaders don’t want to know about, or even tacitly approve.[19]If leaders send mixed signals about their expectations for ethical practice—forexample, by saying one thing but implying another through their actions—employeesare likely to misinterpret what they are being asked to do. Making expectations clearprovides the guidance employees need to do the right thing.• When nearly everyone in an organization feels empowered to behave ethically,staff members are confident they’ll be supported when they do the right thing. Whenemployees feel that they can’t do what they know is right or they perceive thatethical practice isn’t rewarded while unethical practice is acceptable (or evenrewarded), they often experience moral distress, a major cause of employeeburnout.[13] When the organization demands unquestioning obedience to authorityand discourages employees from voicing ethical concerns, ethical behavior is15
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