Organizational Ethics

In Health Care
An Overview


Philip Boyle, Ph.D.
Vice President,
Mission & Ethics

www.CHE.ORG/ETHICS
What is organizational ethics?
What is unique to OE?
The nature of organizationstheir ecology
How to study organizations?
What is unique about
organizations?
healthcare organizations?
RC organizations?

Definitions
Applied ethics family resemblances
Business ethics
Management ethics
Corporate Ethics
Institutional Ethics
Organizational Ethics


Definitions
Nash: The study of how personal moral norms
apply to the activities and goals of a commercial
enterprise. It is not a separate moral standard,
but the study of how the business context poses
its own unique problems for the morals person
who acts as agent of the system.

Boyle, et al. Focus on the choices of all
individuals in an organization and on the choices
of the organization as organization in bring
fulfillment to individuals and the community
Definition
OE evaluates of moral choices of
individuals and the organization itself in
pursuit of the organizations mission.
OE focuses on organizations as moral
agents.
OE also examines decision-makers
inside and outside the organization
Moral agency of institutions

Are we drinking the cool aid?

In what ways are organizations moral
actors?

Moral agency of institutions
Philosophersit is not a moral agent

Theologiansit is a moral agent

Mediatorsit acts as IF it were a moral
agent; helpful analogy
Moral Agency of Organizations
Legal
19
th
century property
1978 Pinto criminal behavior
1978 Corporation have free speech rights
1991 Sentencing guidelines
2010 Citizens Untied v. Fed Elction
Commission
Moral Agency of Organizations
Sociologyplain language
Organizations exist after an individual dies

Said to hire and fire

Said to pursue missions that override the
mission of any individual

Its actions are not reducible to actions of
employees

Moral Agency of Organizations
Moral
Held accountable
Praised and Blamed
Decision makingnot on impulse
Acts in rational ways--policies
Creates culture
Case of Len
35-yr-old level 3 sex offender
Drunk & raped minor at age 19
Enters St. Dymphna Clinic after + drug screen
Alerts local division of justice per Megans law
Police alert schools and they inform families
Discuss
Whats the issue?
Who is responsible?
Moral Ecology
Cell
Individuals
Groups
Regional Ecosystems
Ecosystem
Biosphere
Individual acts
Moral agents
Departments
Institutions
Organizations
Healthcare system
Moral Ecology
Advantages
Honesty--clear about
perspective
Which level is more
important?
Disadvantages
Other levels obscured
Can obscure
differences between
organizations
The Actors & Risks
Sponsorsclear role
Boards--clear process
Managers
Senior managementdiscretion
Middle
Financeconflicts of interest
HRhiring firing, promotion
Marketingtruth in advertising
Developmentnature of gift acceptance
Environmental servicessafety
IS--confidentilaity
The Actors & Risks
Employeescommon risks of agent-
principle relationships
Consumers/patientsparticipation &
appeal
Purchasers/vendorsnature of
cooperation

Range of issues
Across all organizations
Discretion and control
Resource allocation
Conflicts of interest
Organization specific
Home health v. acute
Department specific
Finance v. development

How to study organizations?
Rational systems
Formalexamines policies
Natural systems
Informalexamines real practices
Open systems
External systemsexamines liability, laws,
regulations, etc.

How to study
Formal
Personnel arranged in a hierarchy of authority
Those in policy making higher positions are
regarded as professional managers
Most relations can be described as principle-
agent relationships
Division of labor with each position having
limited authorized actions
Following policies and procedures
Products are joint outputs

How to study
Formal Risks
Joint output--mission substitution
Hierarchy --expert imperialism
Clear roles--dithering, stalling,
obstruction
Managerial expertise--incompetence

How to study
Informal
Culture is the glue of the organization
Values and beliefs of all participants and includes the
internal and external interpretation of those beliefs
Informal unstated ways of acting
Difference between policy and actual practice
Moral psychology
Wendy Carlton: In our Professional Opinion:
Charles Bosk: Forgive and Remember
Danial Kahneman and Amos Tversky Judgment under
Uncertainty: Heuristics and Biases;
Michael Davis: The Challenger Disaster
Jerome Groopman: How Doctors Think
Uniqueness of health care organizations
What distinguishes healthcare from others kinds
of organizations?
Opportunistic rapidly changing
Any organizations that participates in
healthcare: Purchaser/Vendor/Provider
Industrialization process: use of industrial
techniques for predictable outcomes
Move from a medical professional to
managerial professional

Uniqueness of organizations

What is unique about RC organizations?

What is unique about RC education?

What is unique about RC health care?
God is Love #31-33
Mechanisms to address OE
Values based discernment process
Subcommittee of ethics committee
Ad hoc groups
Senior management team
Mission Effectiveness Committees
Conclusions
Moral agency of organizations
How to study
Formalpolicies
Informalpractice
Overlap between clinical and
organizational ethics
Dig in with low hanging fruit
Different mechanisms