In an era of increasing scrutiny on healthcare organizations, the board has a critical role in creating and maintaining an ethical organizational culture.

This is the second in a two-part bulletin series looking at the board's role in creating and maintaining a strong 'ethical architecture' within their organization. Our first bulletin on ethical frameworks, and ethical audits can be found here: The Board's Role in Creating an Ethical Culture - Part 1: Ethical Frameworks and Audits.

In this bulletin we provide guidance and tips on how to develop an effective, resilient 'ethical architecture'.

Building Effective Ethical Architecture

The appropriate mix of policies, procedures and programs will vary by organization. Ethical audits, for example, might not be necessary or financially feasible for all organizations. However, strong ethical cultures tend to be supported by an architecture that exhibits common features:

  • Focus on positive outcomes sought. This is easier than it sounds. But a 'compliance mind set' that focusses on legal rules and punishments for breach of those rules will not generally inspire strong ethical leadership. An over-focus on rules and penalties can also become a barrier to organizational innovation—encouraging risk avoidance rather than thoughtful risk-taking As Lynn Smith Paine writes, "Even in the best cases, legal compliance is unlikely to unleash much moral imagination or commitment. The law does not generally seek to inspire human excellence or distinction […] managers who define ethics as legal compliance are implicitly endorsing a code of moral mediocrity for their organizations." [i].
  • Customized. It is tempting to use off-the-shelf policies, etc. but there is significant value in customizing them. Individuals are much more likely to read, understand and put into action the words on a page if they speak to their experience. In addition to providing specific and relevant examples from the day-to-day operations of the organization, provide guidance to navigate the grey areas, including by:
      1. articulating the values that should guide ethical decisions in difficult cases; and/or
      2. providing employees avenues and options to seek guidance from their superiors.
  • Consistent and appropriate consequences. In setting consequences, make sure that the expectations are realistic. The severity of the consequence should match the seriousness of breach. Consequences should not discourage first-time offenders from admitting mistakes in order to learn from them.
  • Ongoing engagement to reinforce expectations. It is easy to underestimate the importance of ongoing training and dialogue about ethical issues to reinforce existing policies, procedures and frameworks. Ethics should be reiterated through ongoing board and professional development training and should likely be an explicit part of the hiring process and performance review of employees (from CEO on down). Managers should be explicitly accountable for their role in setting the ethical tone for employees they manage. Regular, meaningful review of such policies and procedures (including soliciting confidential employee feedback on what is working and what is not) is a critical maintenance function.

This is the second in a two-part bulletin series. Our first bulletin on ethical frameworks and ethical audits can be found here: The Board's Role in Creating an Ethical Culture - Part 1: Ethical Frameworks and Audits.

*A similar version of this bulletin series was published in the February 2017 issue of Boards, the official publication of the Ontario Hospital Association's Governance Centre of Excellence*