Being a Healthcare Leader is Never Easy

Preventing medical harm, responding to medical harm, and worrying about the capability of one’s colleagues, rank among medical leaders’ foremost moral concerns. In the case of medical harm they know that they have important work to do, and no matter how well they do it they cannot change what has already happened which translates to medical leaders patching things together, repairing, and attempting to prevent the same harm from happening again.

While the question of morality and ethics arises from medical harm, it isn’t the only factor in which leadership must weigh ethical behavior. Bureaucracy, finance, infrastructure, buildings, cultures, and more weigh in on leadership’s morality. The goal is to build ethical organizations through moral decisions and behaviors throughout the healthcare industry. 

For instance rationing of services due to the impact of the global medical trade and the escalating expectations has brought about the ethical issue of weighing individual good with the collective good. In response America has swayed away from the fee-for-service and health insurance plans towards a managed care health package. These plans approach healthcare as a process with efficiency in scale, rationalization, managerial control, and incentive. However, this approach has created a rise in ethical debate over support, choice, entitlement to care, and life itself. 

Ultimately the goal is to set ethical standards, but the intention is to model them. Such behavior can create an environment where good decisions are made according to a set of rules and regulations, thereby making ethical dilemmas less of an issue because the guidelines are in place. Ethical standards should promote better care by eliminating errors committed by physicians and practitioners because they are now acting under a set of guidelines established by their medical community.  In addition the promotion of ethical standards raises the public’s opinion of the medical field, increasing trust and donations. Good organizational ethics helps a healthcare organization comply with state and federal regulations and should be applied toward medical research.

There are seven basic principles normative to Healthcare Ethics. These principles are generally accepted among those in the industry and can be incorporated into any organization's culture. They are: 

• Do no harm; 

• Benefit the patient;

• Care for the population’s health at-large;

• Be efficient by balancing things like cost and benefit;

• Honor patient wishes while balancing public health;

• Consider the concept that all people have the right to equal access to healthcare; and 

• Consider the individual's needs in comparison to the public health needs.

At the pinnacle of company cultural ethics lies moral courage. It requires commitment to the aforementioned ethical principles despite potential risks, such as reputation, isolation from colleagues, retaliation, shame, anxiety, and termination. Moral courage enables leaders to behave in an ethical manner when doing so is not easy. Morally courageous individuals are prepared to make difficult decisions and face confrontation when they are resolved to do the right thing despite the consequences. Healthcare leadership needs to articulate, encourage adherence to, and act upon shared values while providing an environment in which morally courageous behaviors are welcomed and expected. 

To develop moral courage, leadership can implement strategies that open the conversion about ethical principles and systems, case studies, role modelling, and practice opportunities to use the new moral decision-making skills they have learned. Moral courage can be disrupted however by certain circumstances. Being aware of them can help avoid poor decision making. Common disruptors are:

• Company cultures that stifle discussions regarding unethical behavior and tolerate unethical acts,

• Willingness of the individual to compromise standards in order to avoid consequences,

• Unwillingness to face the difficult challenge of addressing unethical behavior,

• Indifference to ethical values,

• Apathy of bystanders,

• Group think that supports tolerance of unethical behaviors,

• Tendency to redefine or justify unethical behavior.

Ethical behavior in healthcare organizations can decrease the likelihood that a leader will engage in inappropriate conduct by encouraging mechanisms for enhancing ethical leadership behavior. These mechanisms include accountability and moral competence. Accountability and moral competence are two affecting factors to promoting morally courageous leadership. 

In addition to external accountability, high self-accountability has a positive impact on ethical behavior. When leadership exemplifies the ethical behavior they wish to see in their staff, they typically see higher rates of ethical behavior in their team, so it would behoove leaders to cultivate a higher self-accountability outlook. Research has also determined that ethical behavior in part is due to the information and knowledge the individual has therefore ethical education is important to creating a morally courageous work culture.

Health professionals are called on daily to make explicit and implicit decisions that extend beyond the objective and practical, moving into the ethical and moral realms. Making appropriate decisions in these circumstances for all involved requires the ability to weigh ethical matters for the individual, the organization, the community and self. For this reason, moral and ethical teaching, parameters, and culture of an organization become an important facet for healthcare leaders. 

“Healthcare executives have an obligation to act in ways that will merit the trust, confidence and respect of healthcare professionals and the general public. Therefore, healthcare executives should lead lives that embody an exemplary system of values and ethics.” ACHE Code of Ethics