Leadership and Ethics in the Healthcare Industry - Essay Example

Leadership and Ethics in the Healthcare Industry (Essay Introduction Ethical behaviour is a critical issue that has raised concern across all professional spheres in the modern society. Instances of unethical behaviour can be witnessed today in the arena of politics, banking, legal system, academics, sports and entertainment. The healthcare sector too is not immune to the malady of unethical practices. The epidemic of unethical conduct has plagued the healthcare professionals across the globe. Whether engaged in clinical practice, pedagogy, research or administration, they fall prey to ethical dilemmas day in and day out. The ethical dilemmas in healthcare environments are further aggravated by factors like inadequate number of physicians to attend to patients, shortage of support staff, consolidation of healthcare organizations, downsizing and cost-cutting measures, and above all ineffective leadership. (Murray, 2010) The response of an individual to such ethical crisis is determined by their prior experiences with unethical behaviour, their individual personality traits, their ethical values and their knowledge of ethical principles (Clancy, 2003). Very few articles in today’s healthcare literature have addressed the issue of ethical leadership in the healthcare industry. This essay looks forward to providing a valuable insight into the twin concepts of leadership and ethics, enumerating the various approaches to ethical leadership and enlisting the criteria for assessing leader, with reference to the healthcare industry. 2. Background 2.1. The Concept of ‘Leadership’ Leadership is defined as the ability to influence a group towards the achievement of goals.The trends in leadership studies reveal a plethora of the different aspects of leadership and yet there is no universally accepted definition or model of a leader. The first dominant framework on leadership was the Trait Theory or the “Great Men” Theory which was proposed in the early twentieth century. The theory considers personality, social, physical or intellectual traits to differentiate leaders from non-leaders. This theory ascribes conventional qualities like ambition and energy, honesty and integrity, self-confidence, intelligence and knowledge to leaders and holds that leaders are born, not made. Mid-twentieth century saw the rise of the Behaviourist school of leadership which emphasized on the actions and dominant behaviour of the leaders and highlighted the leaders’ behaviour on the job, use of authority and task-relationship orientation. Later, scholars such as Fred Fiedler realised that a leader must match his/her situation and leadership style should vary depending on the situation and context. This gave way to a third phase of leadership studies, known as the Contingency school, which focussed on task structure, leader-member relationship and power position. (Shoup, 2005) Later James McGregor Burns brought about a marked transition through his classification of the transactional and transformational leader. He defined transactional leader are one who superficially deals with a situation by hovering around the edges of the problem and transformational leader as one who sees a problem as an opportunity to change the world through his visionary ideas and experiments. (Polelle, 2008) 2.2. The Concept of ‘Ethics’ Ethics is an important subject for professionals from all fields of occupational practices. It is generally believed that ethics are learned from personal experience, from peers and from participation in the workplace culture. Ethics and leadership are two elements that go hand-in-hand and therefore a leader must always exhibit an ethical behaviour. Jan E. Allman, in her fellow paper, says that: “In comparing a manger to a leader we find that the two have very different characteristics. A manager will have subordinates, where a leader will have followers… The manager will follow the constraints and rules of the governing body to the letter while the leader will see the practice as ever changing, and the rules that govern the practice and staff must be moulded and changed to meet the correct needs of the practice.” (Allman, 2012) Hence we may conclude that all medical practices and all healthcare institutions today are starving for inspired ethical leaders. The theories on leadership ethics can be broadly classified into two categories: theories on leader’s behaviour and theories on leader’s character. The behaviour-related theories can further divided into theories that put emphasis on the outcomes or consequences of leader’s actions and theories that put emphasis on the duty of leaders. The emphasis on outcomes may be in the form of Ethical egoism, Utilitarianism or Altruism. Ethical egoism is the approach followed by leaders who are driven by a notion of how they and their organisation can be most benefitted. Utilitarianism is based on the motto of seeking maximum benefits for the maximum number of people. Altruism refers to leader behaviour that is concentrated on the welfare of others and carries a positive ethical implication. On the other hand, the approach based on emphasis on duty, also known as the deontological approach, deals with the rules and norms governing the actions of the leaders. It not only evaluates the outcome of leader behaviour, but also judges whether the behaviour itself is ethical or unethical. For example, the virtues like being just, truthful, respectful of others, impartial and true to one’s words are all regarded as good and ethical, irrespective of their potential outcome. (Northouse, 2012, chapter 14) 3. Ethical Leadership in Healthcare The popular idea of healthcare ethics is more than often confined to the graver issues like treatment of terminal illnesses, euthanasia and informed consent. These issues, though central to the concept of hospital health care ethics, do not encompass all aspects of ethics that apply to the medical profession. Today health care ethics have gone beyond the obvious parameters to include organisational ethics as well. Margaret R. McLean, Director of Health Care and Biotechnology Ethics at The Markkula Center for Applied Ethics, has enumerated five core values of health care ethics system: “respect, compassionate service, simplicity, advocacy for the poor, and inventiveness to infinity”. (The Markkula Center for Applied Ethics website) These five core elements should ideally form the basis for ethical decision making in a hospital setting. Besides, Kirk O. Hanson, Center Executive Director of The Markkula Center for Applied Ethics, has also listed down few vital guidelines for healthcare institutions on managing organizational ethics in their premises. He observes that the framework of leadership and ethics at the workplace can have a lasting impact on various organisational activities such as financial reporting, handling of employees, purchasing practices, safeguard of patient and employee privacy, and commitments to social justice. Hanson believes that hospitals need to learn about ethical behaviour and apply the same to create and foster a healthy ethical culture, as he feels that “lessons learned about ethics by business organizations are now badly needed in the health care industry”. (The Markkula Center for Applied Ethics website) 4. Approaches to Ethical Leadership in Healthcare Hanson puts forward three main approaches to ethical leadership that can be followed by health care organisations: Compliance method, Ethical exhortation method and Values management method. Under the compliance method, the organisation lays down the acceptable code of conduct, the minimum ethical standards and the penalties levied for violation of the norms. This method however aims at only the lower level employees and facilitates the day-to-day activities and decisions. It does not offer adequate guidance for taking the tough ethical decisions. And moreover, it carries a negative implication by suggesting that the organisation expects only the minimum ethical conduct. The method of ethical exhortation focuses on training of employees on work ethics and subsequent reinforcement of ethical behaviour through frequent persuasion. This method too is not efficient enough as it offers negligible guidance in complex ethical situations. Besides, it leads to the illusion that “employees are to pay the short-term cost of acting ethically”. (The Markkula Center for Applied Ethics website) In contrast to the former two approaches, the values management method offers a more effective and efficient solution to the issues of ethical compliance at workplace. This approach aims at managing the moral values and integrity of employees. It defines the organisational culture and values, highlights the shared goals and aspirations and does not rely explicitly on pinpointing a list of minimum ethical standards. According to Hanson, the leaders who adopt this approach “educate, model ethical behaviour, and reward those who abide by organizational values and standards.” (The Markkula Center for Applied Ethics website) 5. Examples of Situations demanding Ethical Leadership Yukl (2006) has provided a set of eight criteria that may be used in assessing leaders and also in weighing the behaviour of ‘ethical’ and ‘unethical’ leaders against each criterion. The eight criteria are: a. Use of leader power and influence b. Handling diverse interests of the multiple stakeholders c. Development of a vision for the organization d. Integrity of leader behavior e. Risk taking in leader decisions and actions f. Communication of relevant information operations g. Response to criticism and dissent by followers h. Development of follower skills and self confidence (Yukl, 2006, chapter 14) Based on these parameters, we may now analyse the behaviour of professionals in healthcare from the fields of administration, teaching, research and clinical practice. For example, if the hospital is undergoing financial crisis and looking forward to downsizing its operations, the consequence will be large-scale layoffs. Keeping in mind the convenience and quick effectiveness of this measure, a not-so-ethical administrative leader will be quick in adopting it by virtue of his power. But an ethical leader will consider both the pros and cons of such a measure, which may be beneficial at large for the hospital, but will wreak havoc on the employees who will be eventually rendered jobless. Similarly, a senior doctor in a teaching hospital should be open to criticism, feedback and suggestions from his interns. He should see criticism as a positive avenue for self-improvement as opposed to an unethical leader who will retaliate to criticism through discouragement, suppression or punishment. A medical researcher must make a complete disclosure about the positive and negative effects of the treatment procedure he is working on, rather than using deception and distortion to cloud the perception of his evaluators. A practising surgeon should be willing to take the personal risk associated with carrying out a difficult surgery rather than stepping back from the surgery due to the fear of risking his professional reputation and career. 6. Conclusion and Recommendations This essay has pointed out that being aware of the significance of work ethics and being conscious of the various factors that strengthen or hamper those ethics is very important for all the physicians, nurses, teachers and researchers in healthcare. Such awareness would help them adhere to their ethical values and uphold ethical environment in situations when they face serious ethical challenges at workplace. Today there is a crucial need for creating and retaining healthcare professionals who not only understand the importance of ethical leadership in the workplace but also are eager to take requisite action whenever ethical standards are being compromised. Hence it is very imperative that all healthcare professionals respect and encourage their peers who dare to stand up for their ethics and rebel against unethical conduct even when the rest are hushed or differ in opinion. (Singer, 2001) Professional healthcare organizations should support their members in taking measures that aim at creating and sustaining an ethical ambience at the workplace. They should execute protection schemes for those who attempt to raise their voice against unethical conduct in the workplace. The need for moral steadfastness should be addressed and the method of following the same should be taught at all levels of medical education and even continuing education programs. Comprehensive training should be imparted to all healthcare providers on strategies that help one to act boldly when their ethics are compromised. Healthcare organisations should highlight the importance of ethical leadership in their job descriptions, strategic alignments and performance appraisals. (Murray, 2010) It is high time that the healthcare industry produced true leaders with a strong ethical foundation, leaders who possess the courage and integrity to stick to those values, even if it requires them to put their professional success and organisational relationships at stake, in keeping with the motto: "Stand up for what is right even if you stand alone." -- Suzy Kassem References: Allman, J.E. (2012). “Are You a Manager or a Leader - ACMPE Fellow Paper”, Medical Group Management Association. Retrieved from: http://www.mgma.com/practice-resources/publications/fellow-papers/2012/are-you-a-manager-or-a-leader-acmpe-fellow-paper-2012 Clancy, T. (2003). “Courage and today’s nurse leader”. Nursing Administration Quarterly, 27(2), pp. 128 – 132. Murray, J.S., (2010) "Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk". The Online Journal of Issues in Nursing Vol. 15, No. 3. Retrieved from: http://nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and-Distress/Moral-Courage-and-Risk.html “Medical Ethics Meets Organizational Ethics”. (2007). Ethics Homepage, The Markkula Center for Applied Ethics. Retrieved from: http://www.scu.edu/ethics/practicing/focusareas/medical/organizational.html Northouse, P. G. (2012). Leadership: Theory and practice. Sage Publications. Polelle, M.R. (2008). Leadership: Fifty Great Leaders and the Worlds They Made, Westport: Greenwood Press Singer, P.A. et al. (2001). “Clinical Ethics Revisited”. BMC medical Ethics 2:1. Retrieved from: http://www.biomedcentral.com/1472-6939/2/1/ Shoup, J.R. (2005).A Collective Biography of Twelve World-class Leaders, Maryland: University Press of America Yukl, G. A. (1989). Leadership in organizations. Pearson Education India. Read More