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

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