The Imperative of a Moral Compass-Driven Healthcare Organization

Abstract

ORGANIZATIONAL ETHICS, A branch of the broader healthcare ethics arena, is often seen as theoretical, with limited connection to what is deemed the real world of today's healthcare organizations. The feature articles by John J. Donnellan Jr., FACHE, and Ruth W. Brinkley, RN, FACHE, differ. Both authors live or have lived in that real world of executive leadership, where they addressed the many challenges in healthcare management and leadership. They focus on the importance of ethics and values in healthcare organizations from the perspective of healthcare executives. Donnellan is a recently retired director of large, multifacility, metropolitan Department of Veterans Affairs hospitals, and Brinkley is the CEO of a growing healthcare system. The authors come to an overlapping conclusion that ethics and values hold a central place in the life of an organization-that ethical behavior and practices are integral to delivering high-quality patient care and ensuring the healthcare organization's success.The content of the articles is significant, but so is the fact that they are both written from the viewpoint of leaders who guide complex organizations. For Brinkley and Donnellan, ethics and values are not thought of so much as window dressing or slogans as they are foundational to healthcare organizations; they set the direction for the organization's culture and approach to patient care and, ultimately, are key contributing factors to the success of the organization.THE IMPORTANCE OF INDIVIDUAL AND ORGANIZATIONAL COMMITMENT TO ETHICAL PRINCIPLESThe essential premise of both feature articles is that ethics principles and values form the foundation of healthcare organizations. The principles, expressed in the organization's mission and values statements, should be considered living documents for today's healthcare organizations.Basic ethical principles form healthcare's common morality, which ensures value for services rendered. These principles include (i) respecting patients through shared decision making, truthful communication, and the maintenance of confidentiality; (2) acting in the patient's best interest alone by providing only beneficial interventions and care; (3) avoiding harm, such as that from the use of nonbeneficial procedures and the lack of an efficient and safe system of care; and (4) treating patients in a fair and equitable manner.The organization's mission and values statements should be tied to those guiding principles. To strengthen the ties, the organization's values need to be integrated with its culture. That integration ensures that clinical and administrative practices consistently reflect back to the organization's values as demonstrated through an efficient and effective structure and delivery system. As Exhibit 1 indicates, the movement from the outer ring, representing common morality, ultimately influences the core, representing the quality of the clinician-patient encounter. Therefore, the core mission and organizational values are the moral compass guiding all clinical and administrative decisions and actions.This model reflects what organizational ethics are: the moral compass that Donnellan and Brinkley address in their articles- the alignment between the organization's stated mission and values and the actual day-in, day-out decisions and actions of staff on behalf of the organization and patient care (Gibson et al. 2008). The strength of the organization is contingent on how that mission and the stated values are consistently lived out in all the organization's activities.The importance of a values-based organization cannot be underestimated. This type of organization is needed for the following reasons:* To meet patients' expectations. Patients expect to receive care, directed toward their best interests, in a manner that reflects respect.* To ensure high-quality care. Organizational values reflect the Institute of Medicine's six quality aims: safe, effective, efficient, patientcentered, timely, and equitable care (Committee on Quality of Health Care in America 2001). …