There are few industries where ethical concerns for both consumer well-being and organizational management culture are as pronounced as they are in health care in general, and health and human services specifically. This was the focus of my session, Creating An Ethical Environment: Best Practices In Building A Culture Of Ethics, at The 2017 OPEN MINDS Executive Leadership Retreat. At its most fundamental, ethical leadership is about leading while maintaining respect for the ethical beliefs, values, dignity, and rights of others—there are five ethical models for determining appropriate conduct through personal actions and relationships:
- Utilitarian—This approach strives for solutions with the most good (or least harm); considers impact to all key parties and tries to create balance in what’s gained and lost. An example is the “just-war” theory.
- Rights-based—This approach focuses on protecting and respecting rights of others, and giving them as much self-determination as possible. An example is the Declaration of Independence.
- Fairness/Justice—This approach attempts to treat everyone equally or equitably; if there is inequality, it must be logically and morally defensible. An example if The Gettysburg Address.
- Common Good—This approach puts aside questions of independence and self-interest in favor of fostering healthy relationships and communities. An example of the common good is public health and safety.
- Virtue-based—This approach concentrates on moral character and maximizing human potential (however those are defined); typically emphasizes characteristics such as honesty, compassion, and integrity. An example is Benjamin Franklin and Thirteen Virtues.
Building an ethical foundation with these models in mind (and leaders will want to use all of them in greater or lesser degrees depending on the situation) is important for building culture and instilling stakeholder trust that decisions are being made with the proper amount of gravity. This concept was illustrated by my co-presenter, John Sheehan, President and CEO, Harbor Behavioral Health, and his use of the “TRUSTED” model.
The “TRUSTED” model defines Harbor’s culture (employee behavior)—Team Player; Responsive and Respectful; Understanding; Safe; Talented; Executes; Dedicated. A strong culture removes the silos often found in organizations, improving communication and collaboration, focusing on efficiency, and improving productivity. The key to this is that leadership must “live it”, or the culture loses its grounding. Mr. Sheehan noted:
There are so many theories on ethics, and as a leader you have to wade through lots of diverse opinions to find the right thing to do for your organization’s mission, vision, and values. At the end of day, what we try to focus on is the customer. That’s why we exist— to find and keep satisfied customers. The culture is what drives our ability to be successful in meeting those customer needs.
As a leader in health care today, you are managing a lot of change and you really need to define a common language, internal standards of behavior, and continuous performance measurement. Start with a discussion about how things are currently done, or even how decisions are made— there has to be a framework that emphasizes communication and continuous improvement. And remember, you get as a leader what you reward, and you get as a leader what you tolerate. If you state this is our vision and values, you better live it. If you put something into place as a culture, you better not do it for six months and then give up because it’s too hard. Real change takes a long time and it comes down to trust. Trust is what ethics are about. It’s trusting that this organization is striving to make the right decision and do the right thing all the time – and we are committed to learning from our mistakes.
As the culture gets healthy, the people who are on board will push the process forward, and those who are resisting the positive change will stick out and eventually leave. The organization starts to police itself.
You really need to think about eliminating the barriers that are keeping your customers from being satisfied, or even better delighted, by the service they receive. Often making the customer happy isn’t about adding something, it’s about eliminating things from the process and customer experience that are “muda” (waste) and don’t bring value. One of the big wins the “TRUSTED” model brought us is that we tied it into Six Sigma, where working in effective teams that find ways to “do something less” keeps us out of constant crisis and our staff out of “hero mode”—and in this environment that is very valuable. If you can find a way to do it better for the customer do it better—and often that simply means doing less of something. This is the real foundation of the triple aim.
For more on building your human capital, join James Stewart, President & CEO, Grafton Integrated Health Network & Institute Chair on February 15 at The 2017 OPEN MINDS Performance Management Institute, for his session, “Building The Human Talent You Need To Succeed With Value-Based Reimbursement.”