Ethical Self-Assessment Paper

Ethics Self-Assessment

Purpose of the Ethics Self-Assessment

Affiliates of the American College of Healthcare Executives agree, as a condition of membership, to

abide by ACHE’s Code of Ethics. The Code provides an overall standard of conduct and includes

specific standards of ethical behavior to guide healthcare executives in their professional

relationships.

Based on the Code of Ethics, the Ethics Self-Assessment is intended for your personal use to assist

you in thinking about your ethics-related leadership and actions. It should not be returned to ACHE

nor should it be used as a tool for evaluating the ethical behavior of others.

The Ethics Self-Assessment can help you identify those areas in which you are on strong ethical

ground; areas that you may wish to examine the basis for your responses; and opportunities for

further reflection. The Ethics Self-Assessment does not have a scoring mechanism, as we do not

believe that ethical behavior can or should be quantified.

How to use this self-assessment

We hope you find this self-assessment thought-provoking and useful as a part of your reflection on

applying the ACHE Code of Ethics to your everyday activities. You are to be commended for taking

time out of your busy schedule to complete it.

Once you have finished the self-assessment, it is suggested that you review your responses, noting

which questions you answered “usually,” “occasionally” and “almost never.” You may find that in

some cases an answer of “usually” is satisfactory, but in other cases such as when answering a

question about protecting staff’s well-being, an answer of “usually” may raise an ethical red flag.

We are confident that you will uncover few red flags where your responses are not compatible with

the ACHE Code of Ethics. For those you may discover, you should use it as an opportunity to

enhance your ethical practice and leadership by developing a specific action plan. For example, you

may have noted in the self-assessment that you have not used your organization’s ethics

mechanism to assist you in addressing challenging ethical conflicts. As a result of this insight you

might meet with the chair of the ethics committee to better understand the committee’s functions,

including case consultation activities, and how you might access this resource when future ethical

conflicts arise.

We also want you to consider ACHE as a resource when you and your management team are

confronted with difficult ethical dilemmas. In the About ACHE area, you can access an Ethics Toolkit,

a group of practical resources that will help you understand how to integrate ethics into your

organization. In addition, you can refer to our regular “Healthcare Management Ethics” column in

Healthcare Executive magazine, and you may want to consider attending our annual ethics seminar.

Please check one answer for each of the following questions.

Almost Never/Occasionally/Usually/Always/Not Applicable

I. Leadership

I take courageous, consistent and appropriate management actions to overcome barriers to achieving my organization’s mission.

Almost Never Occasionally Usually Always N/A

I place community/patient benefit over my personal gain.

Almost Never Occasionally Usually Always N/A

I strive to be a role model for ethical behavior.

Almost Never Occasionally Usually Always N/A

I work to ensure that decisions about access to care are based primarily on medical necessity, not only on the ability to pay.

Almost Never Occasionally Usually Always N/A

My statements and actions are consistent with professional ethical standards, including the ACHE Code of Ethics.

Almost Never Occasionally Usually Always N/A

My statements and actions are honest even when circumstances would allow me to confuse the issues.

Almost Never Occasionally Usually Always N/A

I advocate ethical decision making by the board, management team and medical staff.

Almost Never Occasionally Usually Always N/A

I use an ethical approach to conflict resolution.

Almost Never Occasionally Usually Always N/A

I initiate and encourage discussion of the ethical aspects of management/financial issues.

Almost Never Occasionally Usually Always N/A

I initiate and promote discussion of controversial issues affecting community/patient health (e.g., domestic and community violence and decisions near the end of life).

Almost Never Occasionally Usually Always N/A

I promptly and candidly explain to internal and external stakeholders negative economic trends and encourage appropriate action.

Almost Never Occasionally Usually Always N/A

I use my authority solely to fulfill my responsibilities and not for self-interest or to further the interests of family, friends or associates.

Almost Never Occasionally Usually Always N/A

When an ethical conflict confronts my organization or me, I am successful in finding an effective resolution process and ensure it is followed.

Almost Never Occasionally Usually Always N/A

I demonstrate respect for my colleagues, superiors and staff.

Almost Never Occasionally Usually Always N/A

I demonstrate my organization’s vision, mission and value statements in my actions.

Almost Never Occasionally Usually Always N/A

I make timely decisions rather than delaying them to avoid difficult or politically risky choices.

Almost Never Occasionally Usually Always N/A

I seek the advice of the ethics committee when making ethically challenging decisions.

Almost Never Occasionally Usually Always N/A

My personal expense reports are accurate and are only billed to a single organization.

Almost Never Occasionally Usually Always N/A

I openly support establishing and monitoring internal mechanisms (e.g., an ethics committee or program) to support ethical decision making.

Almost Never Occasionally Usually Always N/A

I thoughtfully consider decisions when making a promise on behalf of the organization to a person or a group of people.

Almost Never Occasionally Usually Always N/A

II. Relationships

Community

I promote community health status improvement as a guiding goal of my organization and as a cornerstone of my efforts on behalf of my organization.

Almost Never Occasionally Usually Always N/A

I personally devote time to developing solutions to community health problems.

Almost Never Occasionally Usually Always N/A

I participate in and encourage my management team to devote personal time to community service.

Almost Never Occasionally Usually Always N/A

Patients and Their Families

I use a patient- and family-centered approach to patient care.

Almost Never Occasionally Usually Always N/A

I am a patient advocate on both clinical and financial matters.

Almost Never Occasionally Usually Always N/A

I ensure equitable treatment of patients regardless of socio-economic group or payor category.

Almost Never Occasionally Usually Always N/A

I respect the practices and customs of a diverse patient population while maintaining the organization’s mission.

Almost Never Occasionally Usually Always N/A

I demonstrate through organizational policies and personal actions that overtreatment and undertreatment of patients are unacceptable.

Almost Never Occasionally Usually Always N/A

I protect patients’ rights to autonomy, clinical efficacy, and full information about their illnesses, treatment options, and related costs.

Almost Never Occasionally Usually Always N/A

I promote medical record confidentiality and do not tolerate breaches of this confidentiality.

Almost Never Occasionally Usually Always N/A

Board

I have a routine system in place for board members to make full disclosure and reveal potential conflicts of interest.

Almost Never Occasionally Usually Always N/A

I ensure that reports to the board, my own or others’, appropriately convey risks of decisions or proposed projects.

Almost Never Occasionally Usually Always N/A

I work to keep the board focused on ethical issues of importance to the organization, community and other stakeholders.

Almost Never Occasionally Usually Always N/A

I keep the board appropriately informed of patient safety and quality indicators.

Almost Never Occasionally Usually Always N/A

I promote board discussion of resource allocation issues, particularly those where organizational and community interests may appear to be incompatible.

Almost Never Occasionally Usually Always N/A

I keep the board appropriately informed about issues of alleged financial malfeasance, clinical malpractice and potential litigious situations involving employees.

Almost Never Occasionally Usually Always N/A

Colleagues and Staff

I foster discussions about ethical concerns when they arise.

Almost Never Occasionally Usually Always N/A

I maintain confidences entrusted to me.

Almost Never Occasionally Usually Always N/A

I demonstrate through personal actions and organizational policies zero tolerance for any form of staff harassment.

Almost Never Occasionally Usually Always N/A

I encourage discussions about and advocate for the implementation of the organization’s code of ethics and value statements.

Almost Never Occasionally Usually Always N/A

I fulfill the promises I make.

Almost Never Occasionally Usually Always N/A

I am respectful of views different from mine.

Almost Never Occasionally Usually Always N/A

I am respectful of individuals who differ from me in ethnicity, gender, education or job position.

Almost Never Occasionally Usually Always N/A

I convey negative news promptly and openly, not allowing employees or others to be misled.

Almost Never Occasionally Usually Always N/A

I expect and hold staff accountable for adherence to our organization’s ethical standards (e.g., performance reviews).

Almost Never Occasionally Usually Always N/A

I demonstrate that incompetent supervision is not tolerated and make timely decisions regarding marginally performing managers.

Almost Never Occasionally Usually Always N/A

I ensure adherence to ethics-related policies and practices affecting patients and staff.

Almost Never Occasionally Usually Always N/A

I am sensitive to employees who have ethical concerns and facilitate resolution of these concerns.

Almost Never Occasionally Usually Always N/A

I encourage the use of organizational mechanisms (e.g., an ethics committee or program) and other ethics resources to address ethical issues.

Almost Never Occasionally Usually Always N/A

I act quickly and decisively when employees are not treated fairly in their relationships with other employees.

Almost Never Occasionally Usually Always N/A

I assign staff only to official duties and do not ask them to assist me with work on behalf of my family, friends or associates.

Almost Never Occasionally Usually Always N/A

I hold all staff and clinical/business partners accountable for compliance with professional standards, including ethical behavior.

Almost Never Occasionally Usually Always N/A

Clinicians

When problems arise with clinical care, I ensure that the problems receive prompt attention and resolution by the responsible parties.

Almost Never Occasionally Usually Always N/A

I insist that my organization’s clinical practice guidelines are consistent with our vision, mission, value statements and ethical standards of practice.

Almost Never Occasionally Usually Always N/A

When practice variations in care suggest quality of care is at stake, I encourage timely actions that serve patients’ interests.

Almost Never Occasionally Usually Always N/A

I insist that participating clinicians and staff live up to the terms of managed care contracts.

Almost Never Occasionally Usually Always N/A

I encourage clinicians to access ethics resources when ethical conflicts occur.

Almost Never Occasionally Usually Always N/A

I encourage resource allocation that is equitable, is based on clinical needs and appropriately balances patient needs and organizational/clinical resources.

Almost Never Occasionally Usually Always N/A

I expeditiously and forthrightly deal with impaired clinicians and take necessary action when I believe a clinician is not competent to perform his/her clinical duties.

Almost Never Occasionally Usually Always N/A

I expect and hold clinicians accountable for adhering to their professional and the organization’s ethical practices.

Almost Never Occasionally Usually Always N/A

Buyers, Payors and Suppliers

I negotiate and expect my management team to negotiate in good faith.

Almost Never Occasionally Usually Always N/A

I am mindful of the importance of avoiding even the appearance of wrongdoing, conflict of interest, or interference with free competition.

Almost Never Occasionally Usually Always N/A

I personally disclose and expect board members, staff members and clinicians to disclose any possible conflicts of interests before pursuing or entering into relationships with potential business partners.

Almost Never Occasionally Usually Always N/A

I promote familiarity and compliance with organizational policies governing relationships with buyers, payors and suppliers.

Almost Never Occasionally Usually Always N/A

I set an example for others in my organization by not accepting personal gifts from suppliers.

Almost Never Occasionally Usually Always N/A

After you’ve completed the self-assessment:

Now that you have finished the self-assessment, you will want to review your responses, noting

which questions you answered “usually,” “occasionally,” and “almost never.” You may find that in

some cases, an answer of “usually” is satisfactory , but in other cases, such as when answering a

question about protecting staff's well-being, an answer of “usually” may raise an “ethical red flag.”

You will note that the instrument does not have a scoring mechanism; this is intentional. We do not

believe that ethical behavior can or should be quantified.

We are confident that you will uncover few red flags and that if you do, you will willingly and

appropriately address them. We also want you to consider your professional society as an additional

resource when you and your management teams are confronted with difficult ethical dilemmas. You

should find our regular “Healthcare Management Ethics” column in Healthcare Executive magazine

a useful resource as well as ACHE’s Ethical Policy Statements. In addition, you may wish to refer to

the Ethics Bibliography, which we have compiled for your use. Finally, you may want to consider

attending our annual ethics seminar.