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ethics by MEgAN-JANE JOHNSTONE

Organisational and leadership ethics Over the past two decades organisational and leadership ethics have been increasingly drawn into the public spotlight, largely due to a number of spectacular failures in the corporate sector.

The health care sector, which has had its own string of high profile organisational and leadership failures has likewise found the ethics of its leaders and organisations under intense public scrutiny (for example: the King Edward Memorial Hospital - Douglas Inquiry, WA 2001; Campbelltown and Camden Hospitals - Walker Inquiry, NSW 2004; Bundaberg Hospital - Morris Inquiry, QLD 2005).

Failures exemplified by the above and other less spectacular cases (often made public via ‘one off’ media reports on misdiagnoses, delayed treatment, drug errors, hospital wait times etc.) have had a number of worrying consequences. Notable amongst these have been: a resounding crisis of ethics in the health care organisations (HCOs) concerned; and a concomitant collapse (or at least un- dermining) of public and employee trust and confidence in HCO integrity.

It is not just ‘spectacular failures’ that have eroded the public’s trust in HCOs. Stakeholder trust in HCOs has also been lost incrementally over the decades due to the: • slow erosion by market forces impinging on

the delivery of patient care; • tensions between access, cost, quality and

safety of patient care; and • fragmentation versus the integration of

health care services (Magill and Prybil 2004).

A question of nursing ethics An important question at this time is how the ‘crises of trust’ facing HCOs might best be mitigated? How might the trust of disheart- ened patients and others be regained? And what might the role and responsibilities of nurses be in this regard?

One possible remedy lies in the robust (re)development and implementation of leadership and organisational ethics. Another related remedy is reminding stakeholders of the original purpose of HCOs, notably: to foster and sustain the highly valued social goods of accessible, safe and quality health

care services, which in turn are fundamentally linked to other highly valued social goods like, ‘restoring health, preventing diseases, alleviating suffering, respect for persons, protecting the vulnerable, and social justice’ (Pijnenburg and Gordijn 2005, p 142).

There is increasing recognition that ethics is crucial to the survival, viability, sustainability and growth of HCOs (Spencer et al 2000). Moreover, a strong ‘moral compass’ is essential if HCOs are to achieve their intended purpose. Realising a HCO’s intended purpose, however, requires a strong commitment to both leader- ship ethics and organisational ethics.

Leadership ethics Leadership ethics is distinct from other albeit related sub-fields of ethics such as business ethics, medical ethics, and nursing ethics. In contradistinction to these other sub-fields, leadership ethics is a relatively new field of inquiry that has as its focus a set of ethical issues distinctive to the field of leadership, hence the notion ‘leadership ethics’. A distinguishing feature of leadership ethics is the profound relationship that exists between ethical leadership and effective leadership.

Among the core responsibilities of ethical- effective leaders is the responsibility to lead the development of organisation ethics, eg. by: • formulating and articulating, through

democratic processes, organisational ethi- cal standards and policies;

• facilitating repeated, regular and effective communication of ethical standards and policies; and

• ‘walking the talk’ (Ciulla 2004; Spencer et al 2000).

Organisational ethics Organisational ethics is inextricably linked to leadership ethics (and vice versa) and con- cerns critical questions of integrity, responsi- bility and decision making. At its most basic, it entails a comprehensive framework that involves ‘the creation and implementation of processes, procedures and policies that seek to ensure the performance of an organisation or institution is consistent with its funda- mental purpose(s) or ethical aims’ (Gallagher and Goodstein 2002, p435). Its focus is on both treatment and non-treatment decisions (eg. the allocation of scarce resources; staff establishment and skill mix; organisation of patient care services; infrastructures to deal

with ethical issues such as institutional ethics committees; guidelines and protocols etc.). In either case, decision makers ‘take on issues prospectively and recognise that they and their HCO may be called on to account for their decisions’ (Gallagher and Goodstein 2002).

Role of nurses Regaining the trust of a sceptical patient or community will require much more than merely ‘blu-tacking’ a charter of patient rights to the walls and doors of HCOs. And engaging employees and other constituents in realising the ultimate purpose and goals of HCOs will require much more than merely disseminat- ing standards and statements concerning organisational ethics (these will have only dubious value unless accompanied by a thor- ough development process and a system for assuring they are known and used). What is required to redress the status quo is for nurses in all areas and levels of practice (not just the ‘official’ leaders) to actively support the demo- cratic development and implementation of processes, procedures and policies that seek to ensure the just and meaningful realisation of organisational and leadership ethics.

In the ultimate analysis organisational and leadership ethics is everybody’s responsibili- ty, not just that of an elite few. This is because leadership ‘is not a person or a position’ but rather ‘a complex moral relationship between people, based on trust, obligation, commit- ment, emotion, and a shared vision of the good’ (Ciulla 2004).

RefeReNCeS

Ciulla, J.B. 2004. Ethics, the heart of leadership, 2nd edn. Praeger: Westport, Connecticut.

Gallagher, J. and Goodstein, J. 2002. “Fulfilling insti- tutional responsibilities in health care: organisation ethics and the role of mission discernment,” Business Ethics Quarterly, 12(4):433-450.

Magill, G. and Prybil, L. 2004. “Stewardship and in- tegrity in health care: a role for organisational ethics,” Journal of Business Ethics, 50:225-238.

Pijnenburg, M. and Gordijn, B. 2005. “Identity and moral responsibility of health care organisations,” Theoretical Medicine and Bioethics, 26:141-160.

Spencer, E., Mills, A., Rorty, M. and Erhane, P. 2000. Organization ethics in health care. Oxford University Press: New York.

MEgAN-JANE JOHNSTONE is Professor of nursing in the school of nursing anD miDWifery at Deakin university in victoria. Professor Johnstone has extensive interest anD exPertise in the area of Professional ethics in nursing

may 13 volume 20 number 10 AUSTRALIAN NURSING JOURNAL 39

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