Transcript Presentation Title - Providence Health Care

Organizational Ethics
Thomas D. Maddix, CSC, D.Min.
Vice President, Mission, Ethics & Spirituality
Holy Family Hospital | Mount Saint Joseph Hospital | St. Paul’s Hospital | St. Vincent’s Hospitals: Brock Fahrni, Langara, Heather | Youville Residence | Marion Hospice
Organizational Ethics
“We saw nothing not because there was
nothing, but because we had trained
ourselves not to see.” Richard Garry, a
character in Colm Toibin’s novel, The Story of
the Night
Any organization of work--industrial, service,
blue or white collar-can be described as a
psychostructure that selects and molds
character. Michael Maccoby, The Gamesman
Definitions
•
Disciplined process for incorporating ethical
reflection and practices into the life and work of
an organization.
•
Organizational Ethics is the intentional use of
values to guide the decisions of a organization.
Providence Health Care, Vancouver
•
Organizational ethics examines the ethics of the
(health care) organization as a whole.
Definitions
•
It asks: What is the organization's ethical
responsibility to patients and families, the wider
community, employees, and other stakeholders?
• Organizational ethics considers the actions of
individuals insofar as the organization they
represent is affected by—or shares
accountability for—their conduct. E-ethics park
Ridge Centre
Definitions
•
Has to do with the identity and the integrity of the
organization itself—with who the organization is and
becomes and with what the organization does. The
organization's character and behavior, these are the
concerns and the scope of organizational ethics.
(Ron Hamel, PhD Health Progress, Dec.2006)
•
It requires that the organization's values permeate the
organization at all levels and in all areas—from
executive leadership to housekeeping; in planning,
budgeting, and all other decisions; in policies,
procedures, and practices; in internal and external
relationships. Ron Hamel, Ph.D Health Progress, Dec. 2006
Common organizational ethics
issues include:
1. Business and Service Plans (mergers, partnerships,
contracts with providers, marketing etc.)
2. Quality and Safety Issues
3. Employee Rights and Responsibilities
(compensation, bargaining, diversity, harassment,
privacy)
4. Role in the Community (advocacy, investment
policies)
5. Resource Allocation
6. Work Restructuring
Issues continued:
7.
8.
9.
10.
11.
12.
Charitable fundraising
Disagreement over treatment decisions
Access to care
Business development
Disclosure of risk
Business and Professional Integrity
(performance review/management; conflicts of
interest; incentives; hiring and promotion
13. Other????
Ethics Agenda requires:
1.
People with knowledge, character and skills
2.
Experiences that impart knowledge, provide
experience and touches the souls of
individuals and groups.
3.
Tools that outline a decision-making process,
publications/documents that enhance the
discussion of key issues and
codes/guidelines.
Ethics Agenda requires:
4. Becoming clear about what ultimately drives
our decision-making demands knowing the
fundamental difference between the
espoused and the operative values of an
organization. (Gordon Self…unpublished paper, 29
December 2008)
5. “A deliberate choice and use of criteria rather
than letting these operative values comes from
external pressure or emerge amorphously from
a general context of corporate culture.” Charles
McCoy, p. 241, Management of Values
Ethics Agenda requires:
6. A culture which
•
Places ethical issues on the agenda
•
Provides a safe place to discuss conflicting
ethical concerns
Has a process for handling ethics disputes
•
The Root of Moral Conflict within
organizations: Where we are coming
from . . .
1.
Perceptions different…often the same
value
2.
Different ways of seeing the same
issue/experience
3.
Different educational and vocational
environments
4.
Different metaphors/images that shape
our images of a moral issue
The Root of Moral Conflict within
organizations: Where we are coming
from . . .
5.
Different images of ourselves, of others,
of society, of the natural world and
whatever God or centre of loyalty that
provides us with integrity.
6.
Different worldviews, ideologies or
stories that provide our
lives/organizations setting and viewpoint.
7.
Different life experiences
Visible
“Explicit”
“In-awareness”
Roles
Skin Colour
Behaviour
Needs
Values
Hopes
Interests
Worldview
Intentions
Assumptions
Perceptions
Beliefs
Individual
Experiences
History
Fears
Unresolved Personal
or Group Traumas
“Implicit”
Group/Cultural
History
“Out of awareness”
Invisible
Feelings
The Root of Moral Conflict within
organizations: Where we are coming
from . . .
8.
9.
These experiences/ lenses give us eyes
to see some things but not others.
To begin to address ethical issues,
important to “know where we are
coming from,” and “where in the world
we are”…as moral interpreters,
evaluators, decision-makers and actors.
The Root of Moral Conflict within
organizations: Where we are coming
from . . .
10.
Stanley Hauerwas has stated, “moral
behaviour is an affair not primarily of
choice but of vision.”
11. To see is to behave
12.
Morality is based on who we are as
viewers and our interpretation of what is
going on.
Institutional Contexts of Doing
Ethics
1.
An institution: any significant or
established practice, relationship or
organization (The way we do things around
here!”)
2.
“Organizations become institutions as
they are infused with value, that is, prized not
as tools alone but as sources of direct
personal gratification and vehicles of group
identity.” Philip Selznick p. 67 in Management of
Values by Charles McCoy
Institutional Contexts of Doing
Ethics
3.
The organizations/institutions provide us with
places
–
–
–
–
–
to be
to see
points of contact with ethical questions
points of view for moral/ethical insight
context by which we live our ethical vision
Leaders and Culture - What’s
important
• What leaders pay attention to, measure
and control on a regular basis.
• How leaders react to critical incidents and
organizational crises
• Observed criteria by which leaders
allocated resources.
Leaders and Culture continued
• Deliberate role modeling, teaching and
coaching.
• Observed criteria by which leaders allocate
rewards and status.
• Observed criteria by which leaders recruit,
select, promote, retire and ostracize
organizational members.
Ron Hamel, quoting from work done by the VA
in the USA.
Fear and the impact on
Organizations and Ethical Dialogue
Fear of:

failing

being misunderstood

losing our position
Fear Continued

job loss

failure

image or status loss

not living up to expectations-self/others
Fear continued
• protects us from what may challenge or change
us
• loss of control . . . Relationships
• loss of identity
• conflict
Fear continued
• looking foolish in front of our
peers…results in a paralysis of self,
others and organization
• our ignorance and prejudices exposed
• People disengage and ‘deferential
thinking’ becomes the norm (Gordon Self,
ibid)
Roles in organizations can:

Corrupt us badly as our uncritical loyalty to
them does (puppets or parrots)

Give us leave to dehumanize others

Dehumanize ourselves
Roles in organizations can:

Keep us in line and prompt us to discharge
obligations that we might otherwise neglect.

Facilitate communication, helpfulness and
productivity.

Ethical Responsibility in institutional
life…requires paying attention to the
implications of ethical behaviours for specific
roles.
Moral Character in Organizations:
1.
Occurs when an organization is committed
to values and shapes it future and life
according to them.
2.
The basic values or beliefs that guide the
culture at either the conscious or
unconscious life give “character” to the
culture.
3.
Corporation/organization is a moral agent
Moral Character in Organizations:
4. Decisions made within the context of the
organization impacts the lives of many people.
5.
The Boeing Company says, “Ethics should be
approached as a system issue and not as a
problem of ‘bad individuals.’”
6.
Yet, there are individuals around the table
making decisions…
Key Points for us to consider:
1.
We live in institutions and institutions live in us
2.
Moral and ethical development occurs not
only for the individual but also for the
community and organization
3.
Moral/Ethical responsibility means being
responsible people but also making our
organizations more responsible.
Key Points for us to consider:
4.
5.
We need to learn how systems,
structures, cultures and institutional
character can be changed.
Only to the extent that we hear other
voices and see from other vantage points
can we see around the blinders that our
personal (inner and outer) locations impose.
Key Points for us to consider:
6. For us to “do ethics,”---to reflect critically
on the character and action of ourselves and
our communities—we must recognize ‘where
we are” and “where we come from.”
Concluding Considerations:
Organizational integrity doesn't just happen.
Achieving and maintaining it require sustained
attention and ongoing efforts. It is hard work…To
the extent that who the organization claims to be
is not expressed in what it does in its daily
activities, there is something lacking at its core. It
lacks "wholeness."
Ron Hamel, Ph.D Health Progress,
Dec. 2006
Concluding Considerations:
Authenticity and integrity or inner harmony are
related to the choices
made on the basis of who we are and what we
love.
Jean S. Bolen, MD, The Ring of Power