Friday, February 8, 2008

More Ethics/Less Jail

If ideals don’t motivate organizational leaders to care about touchy-feely matters like “ethical culture” and “ethical climate,” prudence will.

Since 2004, in the aftermath of Enron and other corporate scandals, the Federal Sentencing Guidelines have asked organizations to “promote an organizational culture that encourages ethical conduct and a commitment to compliance with the law.” If a corporation is found guilty of a crime, sentences for its leaders may be mitigated if it has a compliance and ethics program that meets Sentencing Guidelines standards.

Less ethics/more jail. More ethics/less jail. That formula captures attention!

Some years ago, I and some colleagues were excited when a prominent organization asked us to help them develop an ethics program. We proposed an ideals-centered design. They weren’t interested. When we began to see newspaper stories about accounting lapses, we understood that they were really looking for a form of the Monopoly “get out of jail” card.

But even for the most values-oriented leaders, it isn’t obvious how to develop a truly ethical culture. The sentencing guidelines threat has created a mini-industry of off-the-shelf “ethics training” programs. Consultants will help organizations develop “ethics codes” and “values statements.” But in my experience, if health professionals believe these actions are driven by prudential concerns, the culture becomes more cynical and less ethical.

So what should values-oriented leaders do? Two recent stories about how health organizations deal with Pharma provide great examples.

1. SMDC Health System in Minnesota was formed by the integration of St. Mary’s Medical Center and the Duluth Clinic. St. Mary’s was founded in 1888. The Duluth Clinic started in 1934. The organization they formed by joining has as its mission bringing “the soul and science of medicine to the people we serve.”

SMDC decided to take conflict of interest seriously. In a “Clean Sweep” program the staff purged itself of all of the pens, coffee mugs, and other pharmaceutical advertising trinkets that had accumulated over the years. 18,718 items were shipped to Cameroon. (Since the branded products advertised on the purged items are not available in Cameroon, shipping them rather than burning them was deemed acceptable.)

2. From Danny Carlat’s excellent blog on CME I learned that Memorial Sloan Kettering Cancer Center in New York decided to forgo commercial sponsorship for its internal CME and the 15 – 20 external conferences it puts on each year. This wasn’t easy to do. Commercial sponsors provided 25% of Sloan Kettering’s CME budget. Adapting to the new conditions required a lot of changes and involved a lot of people. The CME programs are using more internal speakers. The external programs have been moved out of hotels to on-site space. Program managers have had to find clever ways to reduce costs and increase revenues.

These are good examples of putting values into action and “educating” staff in meaningful ways. Professionals don’t like going to meetings where speakers exhort them to be good and not to succumb to conflicts of interest. Cleaning pens and cups off of our desks and bringing a brown bag to a CME session are likelier to strengthen the ethical climate of our organizations. It is better to walk the ethics walk, even in small steps, then to swim in an ocean of ethics talk.

Hats off to SMDC and Sloan Kettering!

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