Friday, December 4, 2009

A Practical Approach to Organizational Ethics

I've been meeting with a number of organizations to help them develop new ways to deal with the ethical dimensions of their activities. They've asked for practical pointers on how to get started. I've presented this list of six:

  1. Understand two meanings of "should." Even the most collegially managed organizations have an underlying heirarchy. "Higher levels" can tell "subordinates" what they should do. Ethics is about values - what we should do. One reason organization are uneasy about formal ethics activities is fear that ethics folks would feel empowered to tell the organization what it should do in the managerial sense of "should," supplanting the CEO and Board. This isn't a question about the organization's commitment to values, but rather a question of who is in charge. We need to understand the distinction between the "managerial 'should'" and the "ethical 'should'."

  2. Ensure managerial authority. If the CEO isn't "Chief Ethics Officer," organizational ethics activities will be a waste of time. Explicit endorsement and support from senior leadership is a requiremnt. An organizational ethics committee wouldn't have influenced Enron!

  3. Ensure moral authority. Managerial authority comes via delegation. Moral authority comes from the respect pertinent others have for those who take the lead in organizational ethics activities. To be effective, organizational ethics activities require both managerial sanction and moral authority.

  4. Ensure appropriate leadership skills. Organizational ethics consultation isn't an academic activity. Analytic and conceptual skills are required, but they have to play out with a wide range of people inside and often outside of the organization. Facilitation, relationship management, and solid understanding of the full range of organizational function are also crucial leadership skills for organizational ethics. To conduct effective organizational ethics activities in hospitals, group practices, and health plans, it's necessary to be comfortable dealing with both clinical and administrative matters and personnel.

  5. Apply stakeholder theory. Here's how the excellent AMA Institute of Ethics publication "Organizational Ethics in Healthcare" defines stakeholder theory:

    "The core thesis of stakeholder theory is the normative
    claim that the interests of all the parties involved in any
    transaction ought to be considered in determining how
    to act ethically. In order to determine how an organization
    ought to act in a particular situation, it is necessary first to
    identify each of the parties (individual and collective)
    with whom the organization interacts and what each
    party has at stake. Second, one must ask how the
    organization ought to act in relation to each party, and
    then how the organization’s several obligations to these
    parties ought to be ranked, both in general and in the
    situation at hand

    Faith-based organizations use guidance from their creed in dealing with complex ethical questions, but secular organizations typically find ethical reasoning that draws on the perspectives of its stakeholders more comprehensible and persuasive. Except in the rare situation in which a secular health organization embraces an ethical credo from outside of the organization, the stakeholder approach is most effective.

  6. Monitor and adapt as needed. In an ethics class the analytical conclusion is the end point. But organizational ethics consultation isn't a classroom exercise. Well-managed organizations apply a quality improvement approach to all of their activities, including organizational ethics. It's great to make a timely decision, but greater yet if that decision works on the ground. If it doesn't it needs to be tweaked.

I'll probably modify this list of pointers over time, but for the moment these six have been useful in a range of settings.


Roy M. Poses MD said...

You might find this post (and the article to which it links) on organizational ethics policies from the European U4 Anti-Corruption Resource Center useful:

Jim Sabin said...

Hi Roy -

Somehow I missed your post on the organizational ethics article. Thank you for bringing it to my attention. I'll probably write something about it in the next couple of weeks. Unfortunately the author's website is currently unavailable and I'd like to visit it before I write about the article.

Readers - if you haven't yet visited Roy's "Health Care Renewal" blog you've been missing a real treat! It's one of the very best health blogs.