Relying on the components of an ethical culture--mindfulness, voice, respect, tenacity and legacy--has helped Scripps Health in San Diego operate with integrity.
|Victor Buzachero||Jack Gilbert|
As a legal report published by the Society for Human Resource Management points out, “It is irrational to implement any compliance or ethics program without first considering the company culture.” (See “Compliance Is Not Enough: Law Enforcement Looks to a Company’s Ethical Culture,” by Dov Seidman, in the October/November 2004 issue of SHRM Legal Report.)
Revised federal guidelines that govern the severity of sentences for ethical misconduct convictions indicate that the appropriate approach for companies must be to promote an organizational culture that encourages ethical conduct and maintains a commitment to legal compliance (Jeffrey M. Kaplan, “The New Corporate Sentencing Guidelines,” Ethikos Journal, July/August 2004).
Health care leaders need to ensure that the critical elements of an ethical culture are reflected in the practical, values-based decision tools in the hands of employees. Doing so helps strengthen the cultural disciplines that are critical to living the vision, mission and values of an organization. Collaborative action through the use of decision tools builds shared accountability for ethical outcomes. And when the cultural disciplines are strengthened, so is the effectiveness of the values-based decision framework. All of this strengthens the ability of an organization to live its vision, mission and values.
The Five Disciplines of an Ethical Culture
How do you know whether your organization’s culture fosters organizational and personal integrity? An ethical culture is expressed through five disciplines (or everyday practices) that you can observe and nurture. When these disciplines are strengthened, so is ethical decision-making.
The five ethical disciplines of an ethical culture are mindfulness, voice, respect, tenacity and legacy:
Mindfulness is the private voice of your personal ethical wisdom--your inner sense of what is right and wrong. It is the self-awareness that brings ethical dilemmas and issues to your awareness; an early signal, like a sense of calm or comfort with a decision, or, conversely, a nagging doubt that something could be “off” with a decision.
Voice is the public voice of ethical wisdom. It brings mindfulness into open conversation and enables ethical issues to be explored in a constructive spirit in many forums, including: meetings, informal conversations, everyday work, employee surveys or other forms of communication. Voice is shared mindfulness; it leverages the collective ethical wisdom in the organization.
Respect is listening to others with generosity rather than suspicion--with a commitment to understanding and to valuing differing views. It strengthens your ability to work on ethical issues as colleagues, not critics, irrespective of different views.
Tenacity is being unstoppable in the quest for ethical behavior and ethical decision-making. It is the shared commitment to see difficult conversations through to their resolution no matter what, such as: harnessing rather than avoiding problems, addressing fundamental issues and grappling with ambiguous situations.
Legacy is making ethical decisions in a spirit of stewardship, understanding the implications and the consequences of your behaviors and decisions for those who will follow--including fellow employees, patients, their families, your own families, your community and society at large. It is acting in keeping with the long view, personally and organizationally, consistent with vision, mission and values.
The Scripps Health Values-Based Decision Framework
Scripps Health in San Diego has developed a values-based decision framework that reflects the five ethical disciplines in a practical and repeatable framework. It is a two-part framework designed to assist employees and leaders in making decisions individually and collectively that are aligned with Scripps’ mission and the collective values of the people in the system. The figure below shows the steps in making a values-based decision at Scripps Health.
Notice that this framework contains all the disciplines of an ethical culture: mindfulness, voice, respect (in Step 7), tenacity (in working through every step to completion) and legacy (in Steps 3 and 6).
All executives and managers in the Scripps system are trained in this framework. They have found it offers multiple benefits, including:
- It has provided a guide for employees about how to discern a path forward when there is a conflict of interest.
- It has heightened transparency of values-based decisions for employees as well as for other stakeholders in the community and in the media by providing greater transparency to decisions.
- It has affirmed the importance of Scripps’ values.
In one example, the organization decided to offer financial relief to employees earning below a threshold hourly rate by taking a lower deductible from their paychecks. This was in recognition that an equal deductible for all creates a greater hardship for low-wage earners.
This decision was driven by the Scripps value that “we demonstrate complete respect for the rights of every individual” and was made without regard to market practice. Not only were the low-wage earners appreciative of the financial relief, but higher wage earners also expressed appreciation, even though they had to take on a larger deductible to compensate. For those employees, living the organization’s values meant a great deal.
In another instance, the decision-making framework was used to evaluate whether to close a visible patient service during the financial turnaround of an underperforming system hospital. The leadership team of the hospital assessed community needs and the stakeholders that were impacted, and it was able to close the service and redeploy the people and resources to other services that met greater community needs, all with full support of the stakeholders. The action was a major element in the success of the financial turnaround.
In short, ethical training and compliance programs alone will not strengthen everyday ethical decision-making unless they leverage the disciplines of an ethical culture. Practical, values-based decision tools that do so not only create values-based decisions but also help strengthen the ethical culture that is critical to having an organization live its vision, mission and values every day.
Victor Buzachero is senior vice president, human resources, at Scripps Health in San Diego. Jack Gilbert, Ed.D., F.A.C.H.E., is president of New Page Consulting Inc. in Del Mar, Calif. He is also the author of Strengthening Ethical Wisdom: Tools for Transforming Your Health Care Organization (AHA Press, July 2007) and will be a speaker at the 2007 AHA and Health Forum Leadership Summit, July 22 to 24 in San Diego.
Steps to Making a Values-Based Decision at Scripps Health
Individual Steps (1 to 4)
“Is it appropriate to_______________________?
2. Ask yourself:
- Are there Scripps policies and procedures that address this issue?
3. Identify and analyze options that:
- comply with the law and Scripps’ policies;
4. Implement and monitor the decision.
If the decision is still unclear after the individual steps:
Collective Steps (5 through 9)
Consider a more “consultative” decision-making process by seeking assistance from a situational advisor or advisory group.
5. Review and reconfirm the options:
- Define the decision needed, identify the decision-maker and review options.
6. Discuss the related values:
- Which values are relevant?
- Allow each person to reflect and express his or her opinion in light of personal and organizational beliefs.
8. Discuss the best option and agree on an action plan for the final decision:
- Articulate consensus.
9. Implement and monitor the decision.
Copyright © 2006 by Scripps Health. All rights reserved.
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This article first appeared in the on June 26, 2007 in HHN Magazine online site.