32 Healthcare Management FORUM Gestion des soins de santé – Spring/Printemps 2007

What is organizational ethics?Organizational ethics is an emerging

area in health care management. Healthcare organizations have tended to focuson the ethical issues faced by clinicians inthe direct delivery of clinical care (i.e.,clinical ethics) or by researchers in theconduct of clinical research (i.e., researchethics). Organizational ethics is con-cerned with the ethical issues faced by

managers and board members and the ethical implications oforganizational decisions and practices on patients, staff, andthe community.1 Recent emphasis on ethics in health servic-es accreditation and health care leader certification is con-tributing to a search for leading practices in organizationalethics. However, there remain significant gaps in knowledgeabout what ethical issues health care leaders are facing orhow organizational ethics can be approached in practice.

What organizational ethics issues are health care leaders facing? Recently, the University of Toronto Joint Centre for

Bioethics conducted a large study to find out what organiza-tional ethics issues health care leaders are facing and whatstrategies they are using to address these issues. The studyinvolved over 160 one-on-one interviews with board mem-bers, chief executive officers, managers, and clinical leadersin 13 health care organizations in the metropolitan Torontoarea.1 A number of key organizational ethics issues emergedthrough the interviews, many of which will be familiar tohealth care managers and board members across Canada.

Resource allocationHealth care organizations are struggling with increasing

costs, accountability agreements, and consumer demand.How should priorities be set to ensure that resources areallocated fairly and appropriately to meet the community’shealth needs? Experience shows that there are no “simplesolutions” to address the reality of limited information, mul-tiple stakeholder interests and values, and competing sys-tem goals.2 Moreover, the “politics” of funding can ofteninterfere with the ethics of public accountability. These fac-tors underscore the importance of fair processes to reachpublicly defensible decisions, to engage stakeholders con-structively, and to establish and sustain trust under difficultcircumstances among managers, staff, patients, and thecommunity.3,4,5

Business developmentHealth care organizations draw funding from a number of

sources, including revenues from business developmentactivities. But are all revenue-generating opportunities ethi-cally appropriate? Some business opportunities may bequestionable if they run counter to the patient care mission.For example, questions are sometimes raised about whetherhealth care organizations send a mixed message abouthealth and health care when they offer “fast food” options intheir cafeterias. These concerns may be well-founded. In arecent U.S. study, Sahud and colleagues6 found that outpa-tients in a hospital with a McDonald’s outlet rated thehealthiness of McDonald’s food more highly than outpa-tients in hospitals without a McDonald’s outlet and weremore likely to believe the hospital was supported financially

Organizational ethics and the management of health care organizations

Jennifer L. Gibson, PhD, University of Toronto Joint Centre for Bioethics

Your questions answeredethicsHealth care leaders, consultants, public servants and health care organizations regularly face a broad range of ethical conflictsor questions. As health care leaders, we must strive to ensure that “an ethics-focused culture” is imbedded in our organizationsand professional practices. To do so “is the result of ethical leadership, continuous reflection and planning, ongoing monitor-ing, and accessible, competent ethics resources.” (American College of Healthcare Executives, Ethics Toolkit. Available at:www.ache.org. Accessed January 10, 2007)

In 2006, the CCHSE adopted a new Code of Ethics and a process to deal with alleged breaches of the Code.As part of our commitment to the Code, we have started a new ethics column in the journal to provide prac-tical advice to help health care leaders.

We hope that this new column and other ethics resources available through the College will help health careleaders promote and clarify ethical standards of practice throughout their organizations and professionalpractices.

We welcome your comments and invite you to send your ethical dilemma to ethics@cchse.org.

David Kay, CHE, FACHEChair, CCHSE Ethics Committee