Guidelines for organizational ethics

Health Progress, Jul/Aug 2001 by Magill, Gerard, Prybil, Lawrence

The Goal Should Be "Virtuous Organizations" with a "Community Covenant"

In recent years, health care organizations have worked so hard to achieve fiscal responsibility that they have sometimes constrained services and reduced access. The result has been a backlash of public distrust. However, a more ethical approach to the delivery of care can help such organizations regain the respect of skeptical patients and disheartened communities. To further that end for Catholic health care, this article will suggest a practical approach to organizational ethics.

We realize, of course, that the principles and practices of organizational ethics already influence daily behavior in health care to some degree. Unfortunately, however, health care leaders have many fewer resources in organizational ethics than they have in, for example, biomedical ethics. In this article, we hope to focus on organizational ethics in a way that will provide guidelines for organizations committed to high standards of ethical conduct, patient care, and community service.

TOWARD A VIRTUOUS ORGANIZATION

Organizational ethics and biomedical ethics are related, though distinct, fields in health care ethics. Biomedical ethics deals with ethical issues concerning biomedicine, clinical services, and patient care. Organizational ethics, by contrast, deals with value-related issues concerning an organization in the broadest sense: mission, vision, sponsorship, governance, and leadership. (The term, as we use it, encompasses what some writers allude to as "business ethics" and "corporate ethics.") Organizational ethics is related to, but broader than, compliance programs, which typically try to ensure that organizations abide by legal and regulatory requirements. At its best, organizational ethics seeks to foster a virtuous organization, in which ethical principles inspire appropriate decision making and moral behavior among all its personnel.

We believe that an approach to organizational ethics aimed at fostering a virtuous organization will influence behavior among personnel more effectively through general guidelines than through explicit rules; when it comes to nurturing responsible and ethical conduct, persuasion works better than prescription.

A virtuous organization respects the resources entrusted to it by its community.1 Sound stewardship requires a Catholic health care organization to treasure the heritage it has received from its community as the necessary context for the prudent use of its limited resources. It encourages the organization's sponsors, faithful to their Catholic identity and mission, to conduct operations in an ethical manner. Stewardship enhances the organization's commitment to the community, on one hand, and the community's trust in the organization, on the other. This reciprocity could be described as Catholic health care's community covenant. By nurturing this community covenant, the ministry can rebuild and strengthen the community's trust in health care in general.

Indeed, a Catholic health care system or hospital that is considering an initiative in organizational ethics should, first, aim at creating a virtuous organization, and, second, do this by fostering among personnel a sense of stewardship that respects the community covenant. Such a foundation in stewardship cannot help but positively influence decision-making processes and standards of conduct for personnel throughout the organization.

BASIC COMPETENCIES FOR ORGANIZATIONAL ETHICS

Any initiative in organizational ethics will require basic organizational competencies.

A Sense of the Reciprocity between Sound Stewardship and the Community Covenant

This competency is at the very foundation of organizational ethics. Perhaps the most basic meaning of stewardship in Catholic health care is the passing on from one grateful generation to another of Christ's healing ministry. The notion of stewardship highlights the church's traditio, a Latin word for "the act of handing over." Of course, this obligation also implies fiscal responsibility. Yet one of the greatest dangers the ministry faces today-especially as it struggles in the most competitive market it has ever seen-is a tendency to focus so strongly on fiscal propriety that it compromises its basic mission of healing care. One could rephrase a well-known biblical warning by asking: What purpose is accomplished if the ministry gains all the fiscal stability in the business world, but loses its soul in the process?

The primary meaning of stewardship requires Catholic health care to act as an ecclesial ministry, serving and nurturing its communities as sacramental expressions of God's biblical covenant with humankind, as revealed in Scripture and honored in church tradition.2 The great biblical covenant fundamentally entails a relationship of trust. Hence the community covenant is a basic relationship of trust between Catholic health care organizations and the communities they serve. Building such trust is a serious challenge these days, as public opinion surveys increasingly show. The work must be done, nevertheless. Stewardship calls on the ministry to enhance trust in the communities it serves. Trust is the necessary condition for fostering the community covenant required by an ecclesial ministry. Resource management and fiscal responsibility are critical elements of stewardship. But trust provides the foundation for organizational ethics in health care.