e-Ethics APRIL 2003
What Is Organizational Ethics?
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Most ethical inquiry, as in clinical
or professional ethics, concentrates
on the moral responsibility of
individuals. In contrast, "organizational
ethics" examines the ethics of
the healthcare organization as a
whole. 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.
Critics object that the very notion
of organizational ethics is wrong-headed.
After all, don't individuals
make decisions, carry them out, and
bear ultimate accountability?
1
An
ethical focus on "the organization"
can provide individuals an "out"—a
way to evade personal responsibility.
This point is important. Yet in everyday
conversation we routinely treat
organizations as responsible parties.
It is, for example, common and
appropriate for Advocate associates—
and for patients, families, and
the public—to ask or comment about
what "Advocate" is doing or will do
in some area of concern.
Furthermore, individuals are
influenced by organizational culture.
Every organization has its culture,
and usually subcultures as well.
These shape individuals' perceptions
and actions. The existence of such
influences does not absolve individuals
of responsibility, but the cultural
environment can make it easier or
more difficult for each person to live
out the organization's "official" norms
and values. The attitudes and practices
that develop within organizational
culture are never fully aligned
with formally stated values, policies,
and expectations. Organizational
ethics helps organizations identify
and rectify the disparities. It aims to
promote a climate in which individuals
consistently experience moral
support from the organization. In the
end, organizational ethics encompasses
both the individual's responsibility
for conduct as a representative
of the organization and the responsibilities
of the organization as a whole,
2
including its obligation to support—
and certainly not to hinder—
associates in living out its values.
In health care, organizational
ethics raises questions such as these:
How should the organization
address actual or potential conflicts
of interest on the part of those (at all
levels) who represent the organization?
In light of its mission, what is
the healthcare organization's respon-sibility
to its employees? What may
it rightfully expect of them? What
are the ethical dimensions of recruiting,
hiring, compensating, disciplining,
and dismissing employees, or
undertaking workforce reductions?
3
In the clinical arena, how does
the organization protect "the integrity
of clinical decision making" from
actual or perceived effects of compensation
agreements or financial
risk-sharing arrangements?
4
What is the organization's moral
basis for deciding which health services
to offer or expand, and which
ones to reduce or discontinue?
What are the ethical founda-
tions for compliance with various
regulations, such as the HIPAA Privacy
Rule? Are there ethical reasons to
exceed what regulations require?
How does the organization
choose its partners? What should it
expect of current or potential partners,
such as vendors or donors?
What are the organization's obligations
to those partners?
What is the appropriate relationship
between the healthcare organization's
interests and the interests of
patients and families, the public,
associates, and other stakeholders?
Does the organization have a
social responsibility to manage its
investments according to ethical
investment criteria that supplement
the standard expectation of maximizing
return on investment?
These questions only begin to
suggest the range of concerns that
organizational ethics considers.
They encompass areas that an organization's
mission and values will
also address. In Advocate, there are
substantial affinities between organizational
ethics and implementation
of Advocate's faith-based Mission,
Values and Philosophy (MVP).
Organizational ethics can support
mission implementation in many
ways. For example, it continually
assesses the "fit" between what the
organization says in its mission and
values and what actually happens in
practice. When inconsistencies
emerge, the task of organizational
ethics is to understand them and
suggest practical ethical remedies.
Further, there may be a need to
interpret the faith-based organizae What tion's values and show concretely how
they can guide practice. Central organizational
values are usually stated broadly.
They are often subject to varying,
even conflicting, interpretations.
5
Organizational ethics explores the meanings
of these values and suggests how
associates may apply them when conflicts
arise.
The concerns of organizational
ethics include areas that are subject to
law and regulation. Today healthcare
organizations address many legal concerns
through "corporate compliance"
programs. In Advocate, corporate compliance
falls under the mantle of the
Business Conduct program, which also
considers a range of other concerns.
Not only do organizational ethics
and corporate compliance programs
share important interests, but their
approaches can complement each other
significantly. Because the primary purpose
of corporate compliance is to promote
conformity with laws and regulations,
compliance programs have tended
to "emphasize rules, monitor employee
behavior, and discipline misconduct."
6
They have focused on avoiding legal
wrongdoing and reporting potential
instances of wrongdoing to appropriate
parties within the organization.
Organizational ethics recognizes that
fidelity to law is essential to a healthy
moral climate. At the same time, it
stresses that the organization's moral life
begins but does not end with obeying the
law. Organizational ethics challenges
organizations and associates to recognize
ethical needs and opportunities that may
have been overlooked in the past—to
expand their moral vision and imagination. It identifies moral concerns that lie
beyond the scope of regulations, and it
offers ethical analysis in areas where the
moral map is still being drawn. Within
Advocate, the fact that Business Conduct
seeks to blend corporate compliance with
an emphasis on Advocate's MVP suggests
that there can be significant synergies
between Business Conduct, MVP
implementation, and organizational ethics.
It is possible to recast the earlier
description of organizational ethics in
Advocate-specific terms. Organizational
ethics can be defined as the effort to
identify, promote, and attain moral excellence
in all aspects of Advocate's life and
activities. By this reckoning, the scope
of organizational ethics is broad, its aim
ambitious. Yet a faith-based organization
with Advocate's Mission, Values and
Philosophy can hardly aspire to less.
1. Van Rensselaer Potter, "Individuals Bear
Responsibility," Bioethics Forum 12, no. 2 (1996):
27-28.
2. Philip J. Boyle, Edwin R. DuBose, Stephen J.
Ellingson, David E. Guinn, and David B.
McCurdy, Organizational Ethics in Health Care:
Principles, Cases, and Practical Solutions (San
Francisco: Jossey-Bass and AHA Press, 2001), 16.
3. Ed Giganti et al., "A New Social Contract,"
Health Progress, September-October 1995, spe-cial
section.
4. See Standard RI.4.4, Comprehensive
Accreditation Manual for Hospitals (Oak Brook
Ter race: Joint Commission on Accreditation of
Healthcare Organizations, 2003). The standards
can be accessed electronically through the
"Bookshelf" in Advocate Online. Go to the "Joint
Commission Manual" link, and click on the
"Patient Rights and Organization Ethics" section.
5. Boyle et al., 76.
6. Ann E. Mills and Edward M. Spencer,
"Organizational Ethics or Compliance: Which Will
Articulate Values for the United States' Healthcare
System"? HEC Forum 13, no. 4 (2001): 331.
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