An Executive-Driven Ethical Culture
Healthcare Management EthicsAn Executive-DrivenEthical CultureWilliam A. Nelson,PhDJohn Donnellan,FACHEHealthcare executives play a key role insetting the tone for ethics.An organization’s culture plays a significant role in providing an identityto staff members and shaping theirbehavior. The culture encompassesmany elements including shared values and beliefs, implicit and patterned assumptions that influencestaff decisions, and observable characteristics such as dress, rituals andcommunication. Culture is a keydriver in establishing and maintaining an ethical organization because ofits effect on staff members’ actions.may be persuaded of the need forcultural change.An ethics-grounded culture needs tobe a top priority for healthcare executives because of its importance toquality care and, ultimately, the organization’s success overall. The culturecan never be taken for granted andmay need periodic renewal.Improving the ethical cultureis not easy, it takes time, and itwill not happen by accident. Itrequires thoughtful, dedicatedfocus that actively involves healthcare leadership. There are fundamental components of an anizational structure, includinga formal ethics program; andleadership behavior—that canaddress these issues and serve asbuilding blocks for an organization’s ethical framework.Today’s healthcare executivesshould review, reflect and, whenneeded, foster changes to their organizations’ cultures. Conduct anhonest, systematic review of yourown executive behaviors and yourorganization’s ethical culture. Thiscan be done by using ACHE’s EthicsSelf-Assessment, available in theEthics area of ache.org and once ayear in Healthcare Executive, and bytalking openly and honestly withyour organization’s ethics committee, senior leadership and staff. You44Healthcare ExecutiveNov/dec 2009An ethics-grounded cultureneeds to be a top priority forhealthcare executives becauseof its importance to qualitycare and, ultimately, theorganization’s success overall.Mission, Vision and ValuesA healthcare organization mustbegin by establishing or reviewingthe statement of values upon whichthe organization’s mission andvision are grounded. Those valuesmust be clearly communicated toall employees, early and often,beginning with the interviewingprocess, reinforced during employeeorientation and regularly acknowledged during performance reviews,public ceremonies, celebrations andawards. The statement of valuesshould reflect the organization’scommitment to integrity, transparency and safety in addition to quality and efficiency.The mission, vision and valuescannot be simply words in a document. The document should meetthe expectation of all staff members.In addition, employee positiondescriptions and performance evaluations need to be aligned with organizational values. For example, theorganization should place an emphasis on error reporting, patient disclosure and identification of safetyvulnerabilities that is equal to theemphasis it places on achievingquality, utilization and financial targets. Staff should be acknowledged,rewarded and celebrated whenbehaviors exemplify organizationalvalues. Leaders of healthcare organizations should consider celebratingactions taken by individuals or unitsthat may not have achieved anintended objective, but that exemplify an unwavering adherence tothe organization’s values.
Mission, Vision and Values Checklist: Have your mission, vision andvalues been recently updated? Are all employees aware of theorganization’s mission, visionand values? Are the mission, vision and values integrated into all employees’position descriptions and performance reviews? Do clinical and administrativedecisions reflect the organization’s mission, vision andvalues?An Effective Ethics ProgramHealthcare executives must ensurethat an effective formal ethics program infrastructure exists to bothproactively promote ethical practicesand clarify ethical uncertainty whenneeded. The ethics program shouldbe system oriented and integratedinto daily life at the organization.Executives need to support trainingof members of the organization’sethics program. And ethics programleaders in turn should provide educational offerings to staff, patients andtrustees that are designed to reinforceorganizational values, teach waysto resolve situations in which a conflict between observed behaviorsand institutional values occurs, anddiscuss, through the use of actualcase studies, how ethical conflictswere brought forward and addressedin the organization.Effective Ethics Program Checklist: Does leadership openly and publicly support the ethics program? Are ethics activities integratedinto the organization? Have ethics committee membersbeen trained to address clinicaland organization issues? Do all staff members have accessto the ethics program? Are recurring ethical issues identified and addressed? Is staff moral distress acknowledged and addressed at everylevel in the organization?Executive ActionThe final component in buildingan ethical culture is having administrative and clinical leaders demonstrate an unwavering commitmentto the importance of ethics. LindaTrevino, PhD, of The PennsylvaniaState University, noted in a 2005presentation that executive ethicalleadership includes the leader’sThe ethics mechanism should beavailable to address a broad array ofissues beyond clinical questions. Forexample, it should have the capacityto address questions about resourceallocation, organizational strategyand community mission. Executivesshould not only support ethics programs but openly use them in theirdecision making.The challenge to leadership is toalign the activities of the organization’s ethics program or committeewith the organization’s values andother programs such as patientsafety and quality improvement.The ethics program should be madeclear to patients, staff, stakeholders,trustees and the community servedand be responsive to their needs.Healthcare Executivenov/dec 200945
Healthcare Management Ethicsbehavior (moral person)—includingtraits, personal morality and valuesbased decision making—and theleader’s ability to direct followers’behavior (moral manager), includingrole modeling and how the leaderrewards and disciplines and communicates the importance of ethics.Being a model for ethical behaviorsis set in day-to-day actions and decisions. Lynn Sharp Paine, in a 1994Harvard Business Review article (vol.72, no. 2), challenged managers to“acknowledge their role in sharpening organizational ethics and seizethis opportunity to create a climatethat can strengthen the relationshipsand reputations on which their companies’ success depends.” Paineargues the need for organizations todesign an ethical framework that is“ no longer a burdensome constraint but the governing ethos ofthe organization.”A key component in role modeling isopenly discussing ethics and using theorganization’s ethics resources. Whenmanagerial performance targets arebeing determined or resource allocation and financial strategy is beingdecided, are the decisions made withinthe context of organizational values?When executive leadership establishesand embarks on new capital and strategic projects, such as an expansion ofradiation oncology or the constructionof a new emergency facility, is thedecision reached using an ethicallyguided decision-making process? Or isit considered simply in the frameworkof a business decision? The use of anethically guided decision-making process will assist the organization whenmaking a public announcement aboutthe decision and answering questions46Healthcare ExecutiveNov/dec 2009that inevitably will be raised about lostopportunities (e.g., not to pursueexpansion of home- and communitybased services).It is easy to publicly proclaim howdecisions are reached following aprocess that ensures consistencywith values. However, the true testof a leader’s adherence to organizational values often comes in themost difficult of times—for example, the leader’s willingness to publicly disclose activities such asfraudulent reporting, billing inaccuracies or safety violations. The JointCommission requires healthcareorganizations to conduct intensiveinvestigations of actual or potentialsystem failures that harm or mighthave harmed patients. Is leadershipwilling to take the additional step ofwidely disclosing the error, the analysis and the findings?Ethics Leadership Checklist: Do clinicians’ and administrativeexecutives’ actions reflect adherence to the organization’s values? Does leadership openly talkabout the importance of ethics? Are executive decision-makingprocesses and decisionstransparent? Do healthcare executives consultwith the organization’s ethicscommittee? Do healthcare executives serve asrole models regarding ethicalbehavior and traits?An ethics-driven culture is central toquality care. When unethical behaviors or even ethical uncertaintyexists, the quality of care can bediminished. Staff members aredemoralized and less effective. Theorganization’s culture is a complexdynamic that has evolved over timeand includes both formal (policies,staff selection, decision processes,etc.) and informal (rituals, dress,daily employee relations and behavior, language, etc.) systems.Healthcare executives play a key rolein setting the tone for building,maintaining and, when needed,changing policies so the organization’s culture becomes moregrounded in ethics. Just as the current culture did not happen by accident or overnight, enhancing theculture will not just happen bychance—it requires attention,thoughtful review, careful planningand clear leadership. The benefits toan organization of having an ethicalculture make the effort worth it. sWilliam A. Nelson, PhD, is director,Rural Ethics Initiatives, and associateprofessor of Community and FamilyMedicine at Dartmouth MedicalSchool in Hanover, N.H. He alsoserves as advisor to the ACHE EthicsCommittee and as faculty at theACHE annual ethics seminar; programs also can be arranged on-site.For more information, please contactACHE’s Customer Service Center at(312) 424-9400 or visit ache.org.Dr. Nelson can be reached atwilliam.a.nelson@dartmouth.edu.John Donnellan, FACHE, is theRobert Derzon Visiting Professor ofHealth and Public Service at NYU/Robert F. Wagner Graduate Schoolof Public Service and the formerdirector of VA New York HarborHealthcare System. He can be reachedat john.donnellan@nyu.edu.
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Simplifying Healthcare Throughoutthe Care CycleIntegrated Systems Improve Experiences, Value for Patients and Providers.“Our goal is to provide the highest qualityprocedure that we can and in a very timelyway. The sooner and more efficiently we canget patient information into the hands of thecaregiver, the more the quality of careimproves for the patient.”Tom LonerganExecutive DirectorHeart and Vascular Institute, Hoag HospitalNewport Beach, Calif.Focusing on the Patient ExperienceThe Radiology Department at Oregon Health SciencesUniversity (OHSU) in Portland was looking for consistentconnectivity with its systems that would make it easierfor staff to work across different platforms as theytreated patients while moving from one area of the facility to another. Because OHSU is such a large campus—the imaging department alone is located in eightbuildings and 15 locations—the organization needed asolution to bring its radiology and oncology functionscloser together, even if they couldn’t physically be nearerAs the healthcare field moves into a new era, rethinking theto one another.process by which patient care is delivered can help meet thechallenges of the future. With a more integrated approach,OHSU worked with Philips to ensure the computer userproviders can realize greater efficiencies and deliver moreinterfaces its staff members were working from at variousvalue throughout the complete cycle of care.campus facilities—and at different points in a radiologypatient’s care cycle—connected with one another. That way,Philips Healthcare provides the means for providers to do justvaluable patient data were available where and when medi-that. It believes that healthcare can be simplified with a clearcal staff needed it.focus on the needs of the people involved in the care cycle—clinicians and their patients. Philips uses the entire care cycle as“As staff move from radiology to oncology, etc., all the usera lens through which to identify how its products and servicesinterfaces now look the same, so it makes it easy for staff tocan best contribute to the most efficient and appropriate deliv-slide between one area and another,” says Erwin Schwarz,ery of healthcare for patients, while aiming to reduce costs.director of Radiology, OHSU. “It also makes it much easierfor them to utilize the equipment more effectively. And itAnd Philips focuses on the major health issues that patientsreally helps expedite and improve outcomes because deci-increasingly face, including congestive heart failure, lung andsions about patient care are made in real time.”breast cancers, and coronary artery disease. It addressesthese disease states with an eye toward continuity and inte-Because Philips products and systems enable users to workgration across all the phases of care.from a variety of locations, patient care is not interrupted.Advertorial sponsored by Philips Healthcare
Patients at OHSU have noticed this smoother flow in the care(such as its electronic medical record and its accounting andthey receive at various points in their treatment.billing departments) and that it was Web enabled.For example, because the computer systems can be accessed“We didn’t want to build an island unto ourselves,” saysanywhere in the radiology department, the department’sLonergan. “We wanted to build a network within our Heart andchoice to place its PET (positron emission tomography)/CTVascular Institute that was fully integratable but also fully com-scanner in its Radiation Oncology Department did not resultpatible with the hospital’s broad-based networks and systems.”in the interruption of patient care or patient flow. In fact, itenhanced the patient care experience.Lonergan says the committee approached all equipment purchases with integration in mind. “If it wasn’t going to work“These patients are used to going to the Radiation Oncologywith everything, we weren’t going to implement it,” he says.Department, and the staff at the front desk of that depart-Lonergan explained that one of the reasons Hoag chosement sees these patients on a regular basis, so they build aPhilips as the vendor to partner with on this initiative wasrapport with them,” says Schwarz. “Now when they comebecause of its open architecture, meaning it works well withfor their treatment they’re coming to one place, so it givesexisting Philips equipment the hospital had and equipmentthe appearance to the patient that it’s all one unified servicefrom other vendors.line instead of multiple silos in the care process.”Though the project is still ongoing, Hoag’s Heart andContinuity and CardiologyVascular Institute, and the hospital overall, has already seenApproximately five years ago, Hoag Hospital in Newportimprovements, including increased efficiency of its electro-Beach, Calif., developed a vision for its Heart and Vascularcardiogram (EKG) management system.Institute: total integration—from start to finish in the careprocess—and an institutewide system network.“We had an old system that was very labor intensive andinvolved lots of paper,” says Lonergan. “Now we have a fully“We wanted a wireless environment and structured report-electronic system. Our physicians can interpret EKGs froming and to try and eliminate paper,” says Tom Lonergan,anywhere in the world.”executive director, Heart and Vascular Institute. “Those werethe keystones that were driving us as well as total integra-Lonergan says future plans include linking the system to ation with physician offices and our remote clinics.”second hospital that is not yet open, furthering the ultimategoal of complete integration. “The closer you get to theTo achieve those goals, the Heart and Vascular Instituteavailability of patient information, the better decisions you’reformed a collaborative committee with the hospital’s infor-going to make, the better patient outcomes you’re going tomation technology (IT) department. The hospital even hasget and the lower costs you’ll have,” he says. “That’s thetwo full-time CV-IT (cardiovascular-IT) employees who reportholy grail.”to the Heart and Vascular department. The committee,which has been meeting every week for the five-and-a-halfFor more information, contact Todd Doucette, senior direc-years since the project began, wanted to ensure the systemtor, Marketing, Philips Healthcare, at (978) 659-4577 orworked with the hospital’s overall networks and systemstodd.doucette@philips.com.Advertorial sponsored by Philips Healthcare
organizational structure, including a formal ethics program; and leadership behavior—that can address these issues and serve as building blocks for an organiza-tion’s ethical framework. Mission, Vision and Values
private sectors is ethical hacking. Hacking and Ethical Hacking Ethical hacking can be conceptualized through three disciplinary perspectives: ethical, technical, and management. First, from a broad sociocultural perspective, ethical hacking can be understood on ethical terms, by the intentions of hackers. In a broad brush, ethical
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Malaysian setting and ethical principles in counseling practices. The main objective of this paper is to apply the code of ethics and ethical principles in solving ethical issues. The impending conclusion and implication will also be discussed. Keyword: Code of ethics, Ethical Principles, Counselor, Board of Counselor, Counseling 1. Introduction
as a whole, weaker perceptions of ethical culture co-incide with increases in observed misconduct. When the American workforce has a more positive percep-tion of the ethical cultures of their workplaces, obser-vations of misconduct decline. Weaker Perceptions of Ethical Culture Coincide with Increases in Observed Misconduct 100% 80% 60% 40% 20% 0
Awareness of ethical issues is a necessary precondition of ethical decision-making. Butterfield, Treviño, and Weaver (2000) defined moral awareness as "a person's recognition that his . 2013)7, making it all the more difficult for employees to report misconduct and actively contribute to a strong ethical focus. Each of the five areas of .
An essential difference between folk culture and popular culture is the speed at which diffusion occurs. 9 *a. True b. False (p. 32) 44. Popular culture is synonymous with mass culture. a. True *b. False (p. 32) 45. Mass culture refers to the consumption of culture, while popular culture refers to
Hacking Concepts 1.10 What is Hacking? 1.11Who is a Hacker? 1.12 Hacker Classes 1.13 Hacking Phases o Reconnaissance o Scanning o Gaining Access o Maintaining Access o Clearing Tracks Ethical Hacking Concepts 1.14 What is Ethical Hacking? 1.15 Why Ethical Hacking is Necessary 1.16 Scope and Limitations of Ethical Hacking
Key Technology Trends That Raise Ethical Issues Ethical issues long preceded information technology. Nevertheless, information technology has heightened ethical concerns, taxed existing social arrangements, and made some laws obsolete or severely crippled. There are four key technological trends responsible for these ethical stresses and they .
