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

Part III: The Ethical Leadership CompassPoint 4: Support Your Local Ethics ProgramA leader who is committed to ethics is also likely toconsider an investment in ethics programs, policies,and structures to be an important way to demonstratethat commitment.[66]Finally, leaders should demonstrate their commitment to ethics by supporting their localethics program and its activities. Unless leaders support—and are perceived to support—the formal ethics programs and structures in a facility, those programs can’t succeed. Butsimply by supporting ethics related programs and initiatives, leaders can have a hugeimpact on outcomes.[51]Support your local ethics programKnow what your ethics program is and what it doesChampion the programSupport participation by othersKnow what your ethics program is and what it doesAll VA leaders should be able to explain to others the fundamental concepts ofIntegratedEthics (described in Part I of this primer), including the iceberg concept and therole of each of the three core functions (ethics consultation, preventive ethics, and ethicalleadership). Leaders should also know who is responsible for the various components ofIntegratedEthics, and when and how to contact them.In particular, leaders should know that the role of the facility’s ethics consultation service isto respond to specific ethics questions. Such questions might be about an individual patient(e.g., “What should we do with Mr. X, who refuses to be transferred to the nursing home?);an individual employee (e.g., “Is it ethically acceptable for Dr. Y to date Nurse Z?”); aspecific policy or other document (e.g., “Does this policy from the research office raise anyethical concerns?”); or a general topic in clinical, organizational, or research ethics (e.g.,“What practical methods are recommended for allocating scarce resources?). The ethicsconsultation service serves as a resource when expert information or ethical analysis isneeded.Leaders should also know that the role of the facility’s preventive ethics team is toaddress ethics quality gaps on a systems level. That is, preventive ethics applies qualityimprovement methods to produce measurable improvements in the organization’s ethicspractices by implementing systems-level changes that reduce disparities between currentand ideal practices. Examples of ethics quality gaps that might be appropriate for preventiveethics include:• clinicians are failing to discuss advance directives with patients• researchers are not fully informing subjects about study protocols• managers are “gaming” financial performance measures• staff believes that the organization discriminates against pregnant employees37