American Association of Healthcare Executives

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Approved by the Board of Governors Dec. 5, 2022.

Statement of the Issue

The American College of Healthcare Executives recognizes that impairment is a significant problem that crosses both societal and professional boundaries. For healthcare executives, impairment can be defined as a condition that limits or diminishes a healthcare executive’s ability to perform his or her responsibilities and duties in accordance with the prevailing professional standards and expectations. Some examples of causes of impairment include alcoholism, substance abuse, chemical dependency, mental/emotional instability, cognitive impairment and illness.

Impaired healthcare executives affect not only themselves and their families, but they also have a significant impact on their profession, their professional society, their organizations (including colleagues, patients, clients and others served), their communities and society as a whole. Impairment can lead to misconduct in the form of incompetence and unsafe or unprofessional behavior, which can result in substantial costs associated with loss of productivity and errors in judgment.

The impaired healthcare executive can damage the public image of his or her organization of employment. Public confidence in the organization diminishes if it appears that the organization is not being managed with consistently high standards of professional and ethical practice. This lack of public confidence may cause the community to deem the organization unworthy of its support.

Society expects healthcare executives to practice the standards of good health that they advocate for the public. Impaired healthcare executives diminish the credibility of the profession and its ability to manage society’s healthcare when they are not appropriately managing their own personal health.

Policy Position

The preamble of ACHE’s Code of Ethics states, "Healthcare executives have an obligation to act in ways that will merit the trust, confidence, and respect of healthcare professionals, staff and the general public. Therefore, healthcare executives should lead lives that embody an exemplary system of values and ethics.”

ACHE believes that healthcare executives who are impaired for any reason should refrain from assuming responsibilities that they may not be able to discharge effectively. Whenever there is doubt, they should seek appropriate assistance in performing their responsibilities.

Therefore, all healthcare executives have an ethical and a professional obligation to:

• Maintain personal health that is free from impairment.
• Engage in an honest assessment of their abilities to lead successfully. This can include seeking feedback from others about their performance, being cognizant of poor outcomes related to their performance and seeking assistance, whenever there is uncertainty, in understanding whether impairment exists.
• Refrain from all professional activities if impaired.
• Expeditiously seek treatment if impairment occurs.
• Follow organizational procedures for reporting and addressing impairment in clinicians and other staff.

Additionally, healthcare executives should have an organization-wide mechanism that prevents, reviews, addresses and supports impaired executives. In establishing such a mechanism, healthcare executives should:

• Review applicable legal and/or ethical obligations to report the impairment to ensure compliance with federal and state requirements (such as those required by licensing boards) and/or professional organizations.
• Review the organization’s process for addressing impaired clinicians and determine if there ought to be a separate mechanism focusing on healthcare executives or whether the existing mechanism should be the same for all employees.
• Ensure that it develops and implements a confidential avenue for reporting potentially impaired executives.
• Ensure that it provides a process to assess whether the executive is impaired and allow for timely intervention to ensure executives receive appropriate course of action, such as urging or requiring the impaired colleague to expeditiously seek treatment and to refrain from all professional activities while impaired.
• Ensure that it encourages organizational support for healthcare executives in need of help.

Healthcare executives' support for previously impaired staff, includes:

• Recognize that individuals who have successfully received treatment for impairment and are no longer deemed impaired should be considered for employment opportunities for which they are qualified.
• Assist recovering colleagues when they resume their professional activities.
• Urging the community to provide information and resources for assistance and treatment of alcoholism, substance abuse, mental/emotional instability and cognitive impairment as needed and as appropriate.
• Raising the awareness of key stakeholders (such as employees, governing board members, etc.) on impairment issues and the resources available for assistance.

Policy created: February 1991
Last revised: December 2022

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