What Counts More for Organizational Ethics – Infrastructure or Leadership?

This is a trick question. The answer is – both. In my view, infrastructure and leadership pretty much tie.

Albert Schweitzer’s teaching – “example is not the main thing in influencing others…it is the only thing” – is my starting point for thinking about organizational ethics. The key question for developing an organization’s ethical culture is how to harness the power of “example.”

The American College of Healthcare Executives (ACHE) has developed and disseminated a 53 question ethics self-assessment tool. It well organized and easy to use. (Also see the posting about the excellent ACHE ethics decision-making process.) Here are some questions I especially liked:

* My statements and actions are honest even when circumstances would allow me to confuse the issue
* I demonstrate that my organization’s vision, mission, and value statements are living documents
* I ensure equitable treatment of patients regardless of socioeconomic group or payor category
* I promote Board discussion of resource allocation issues, particularly those where organizational and community interest may appear to be incompatible
* I demonstrate that incompetent supervision is not tolerated and make timely decisions regarding marginally performing managers
* My staffing plan minimizes the need for sudden layoffs or other crisis-driven responses to external financial factors

To my reading, the first two questions address personal leadership, the last two focus on management systems, and the middle two are betwixt and between. By my count 31 of the 53 questions are primarily about promoting ethics via personal example while 22 emphasize promoting ethics via the values embodied in infrastructure. ACHE is wise in solidly emphasizing both.

While I was writing this posting my email chimed and a Los Angeles Times story titled "Health Insurer Tied Bonuses to Dropping Sick Policy Holders" appeared. In our system of competing insurance programs insurers must monitor for fraud. But setting numerical goals for disenrollments and paying bonuses for financial savings creates a powerful counter-example to the insurer's (Health Net) self-definition as "people helping people to be healthy, secure, and comfortable."

Nurturing a positive ethical climate is a delicate process. Personal integrity on the part of leadership is necessary but not sufficient. Infrastructure must support and reinforce the values that executives endorse and model. Organizations become ethically admirable through a combination of inspiring leadership and obsessive attention to the ethical "lessons" taught by structures and systems.