Wanted: Morally Courageous Leaders

Abstract

COLE EDMONSON, FACHEThe GREATEST risk of silence is that eventually we become morally blind and deaf to difficult issues that arise in healthcare (Bird 1996). The specter of such a risk calls for highly ethical and moral leadership, especially in a system in desperate need of transformation. The choice to take the easy path, instead of the moral one, is unacceptable, whether for clinicians or healthcare executives. As the authors of the feature articles in this issue describe, achieving financial success and high-quality care delivery for any organization without a morally centric philosophy is at best a short-term and unsustainable approach.THE POWER OF A MORAL COMPASSThe concept of the moral compass in healthcare is based on four guiding points: (1) integrity, (2) responsibility, (3) compassion, and (4) forgiveness. Having the ability to visualize this compass creates a sense of direction toward an inspired vision. Healthcare organizations guided by leaders with a strong moral compass operate within a framework of humility and intellectual curiosity that is grounded in doing the right thing.Morals do not shift or change with time; rather, they are constant. The major difference between morals and ethics is that morals are personal characteristics of individuals and ethics involves a structure that is more applicable to systems and may be dependent on a number of external variables. Recognizing the difference between these two concepts can help executives understand how moral characteristics of individuals play out in the social context of ethical codes and systems.Some readers may easily miss the warning that Ruth W. Brinkley, FACHE, expresses in her article, so it is worth repeating here: Leaders must be ever mindful that their personal moral compass also serves as the moral compass of the companies they lead. This notion is cautionary in that leaders in healthcare, in general, have little formal training in broad ethical principles or in ethics frameworks that can be applied across business, clinical care, quality, safety, and service domains. More often, these leaders receive training only in compliance and business ethics; issues related to bioethics, for example, are absent from their training.Ethics Training and the Moral CompassWe see this trend in the nursing profession. A study by Grady and colleagues (2008) found that just 57 percent of nurses reported having any level of ethics education in their professional programs. Considering that nurse leaders represent the largest portion of all leaders in healthcare, a clear gap exists between the ideal state, in which moral and ethical leaders are able to draw on a knowledge base of ethics training in their practice, and the current state of practice.Jameton's (1984) seminal work frames the concept of moral distress as arising when one knows the morally right thing to do but cannot act on that knowledge because of organizational constraints. According to Jameton, moral issues are defined not by the scientific how-to but by the question of ought-to. For example, deciding how to provide care is different than deciding for whom the care should be provided.Jameton (1984) further notes that nurses act as the moral center of healthcare and provide the image and inspiration of ethical care and compassion. Corley (2002) found that nurses act as moral agents in the healthcare system, and as a result, patients, nurses, and the organizations in which they work all benefit. These moral acts lay the foundation for increasing nurse retention, promoting patient comfort, relieving patient suffering, and enhancing the reputation of the organization (Edmonson 2010).Can healthcare leaders who act in a morally courageous manner in difficult situations similarly affect these stakeholders? I hope and believe so.IS YOUR ORGANIZATION A HIGHLY RELIABLE MORAL ORGANIZATION?Many hospitals and health systems seek to become high-reliability organizations (HROs), in which what should happen does happen, and what should not happen does not. …