Creating an Ethical Culture Within the Healthcare Organization

March 1992
August 1995 (revised)
November 2000 (revised)
November 2005 (revised)
November 2010 (revised)
November 2011 (revised)

Statement of the Issue

The number and significance of challenges facing healthcare organizations are unprecedented. Growing financial pressures, rising public and payor expectations, consolidations and mergers, patient safety and quality improvement issues, and healthcare reform have placed healthcare organizations under great stress—thus potentially intensifying ethics concerns and conflicts.

Healthcare organizations must be led and managed with integrity and consistent adherence to professional and ethical standards. The executive, in partnership with the board, and acting with other responsible parties such as ethics committees, must serve as a role model and foster and support a culture that not only provides high-quality, cost-effective healthcare but promotes the ethical behavior and practices of individuals throughout the organization.

Recognizing the significance of ethics to the organization’s mission and fulfillment of its responsibilities, healthcare executives must demonstrate the importance of ethics in their own actions and seek various ways to integrate ethical practices and reflection into the organization’s culture. To create an ethical culture, healthcare executives should: 1) support the development and implementation of ethical standards of behavior including ethical clinical, management, research and quality-improvement practices; 2) ensure that effective and comprehensive ethics resources, including an ethics committee, exist and are available to develop, propagate and clarify such standards of behavior when there is ethical uncertainty; and 3) support and implement a systematic and organizationwide approach to ethics training and corporate compliance.

The ability of an organization to achieve its full potential will remain dependent upon the motivation, knowledge, skills, and ethical practices and values of each individual within the organization. Thus, the executive has an obligation to accomplish the organization’s mission in a manner that respects the values of individuals and maximizes their contributions.

Policy Position

The American College of Healthcare Executives believes that all healthcare executives have a professional obligation to create an ethical working environment and culture. To this end, healthcare executives should lead these efforts by:

  • Demonstrating and modeling the importance of and commitment to ethics through decisions, practices and behaviors;
  • Promulgating an organizational code of ethics that includes ethical standards of behavior and guidelines;
  • Reviewing the principles and ideals expressed in vision, mission and value statements, personnel policies, annual reports, orientation materials and other documents to ensure congruence;
  • Supporting perspectives and behaviors that reflect that ethics is essential to achieving the organization’s mission;
  • Using communications throughout the year to help foster an understanding of the organization’s commitment to ethics;
  • Communicating expectations that behaviors and actions are based on the organization’s code of ethics, values and ethical standards of practice. Such expectations should also be included in orientations and position descriptions where relevant;
  • Ensuring that individuals throughout the organization are respected and expected to behave in an ethical manner;
  • Fostering an environment where the free expression of ethical concerns is encouraged and supported without retribution;
  • Ensuring that effective ethics resources, such as an ethics committee, are available for discussing and addressing clinical, organizational and research ethical concerns;
  • Establishing a mechanism that safeguards individuals who wish to raise ethical concerns;
  • Seeking to ensure that individuals are free from all harassment, coercion and discrimination;
  • Providing an effective and timely process to facilitate dispute resolution;
  • Using each individual's knowledge, skills and abilities appropriately; and
  • Ensuring a safe work environment exists.

These responsibilities can best be implemented in an environment in which each individual within the organization is encouraged and supported in adhering to the highest standards of ethics. This should be done with attention to the organization’s code of ethics and appropriate professional codes, particularly those that stress the moral character and behavior of the executive and the organization itself.

Approved by the Board of Governors of the American College of Healthcare Executives on November 14, 2011.

Related Resources

American College of Healthcare Executives Ethics Toolkit