BUILDING ORGANIZATIONAL ETHICS CAPACITY
AT YOUR HEALTH CARE INSTITUTION:
PRINCIPLES AND CASES
Philip Boyle, Ph.D.
Catholic Health East
What are the Essential Characteristics that Distinguishes Healthcare Organizational
Ethics from Clinical Ethics?
I. The nature of organizations
An ecological perspective which includes:
 Examining an organization formally (e.g., policies) and informally (e.g., the gap
between what policy and what actually happens in an organization;
 Examining every level of the ecology e.g., individual relations, departmental
relations, managed executives, boards, and stakeholders).
 Conscience awareness of level of analysis
II. How to study organizations
Formal
o Personnel arranged in a hierarchy of authority
o Those in policy making higher positions are regarded as professional managers
o Most relations can be described as principle-agent relationships
o Division of labor with each position having limited authorized actions
o Following policies and procedures
o Products are joint outputs
Informal
o Culture is the glue of the organization. It includes the values and beliefs of all
participants and includes the internal and external interpretation of those beliefs
o Informal unstated ways of acting
o Difference between policy and actual practice
o Moral psychology
Wendy Carlton: In our Professional Opinion: The Primacy of Clinical Judgment over
Moral Choice; Charles Bosk—Forgive and Remember Danial Kahneman and Amos
Tversky Judgment under Uncertainty: Heuristics and Biases; Sandy Tannenbaum;
Michael Davis: “The Challenger Disaster”
III. The nature of health care organizations
Determine what makes healthcare organizations different 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
IV. Purpose of Ethics
o Conflict resolution
o Pragmatic: legal liability
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Ethics is good business
Integral human flourishing
V. Family resemblances between business ethics and organizational ethics
Is business ethics a subset of organizational ethics, or vice versa?
Business ethics
Corporate ethics (assumes incorporation/ bureaucratic structure)
Management ethics (focus on a particular actor(s))
Institutional ethics (a single institution, suggests place)
Organizational ethics
Business ethics definition: “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.” (Laura Nash) This definition focuses on the
person as moral agent.
My definition of organizational ethics: The study of integral human fulfillment of persons
and the organization as part of a community in the pursuit of a mission/goal. It includes
the study of the moral choices of individuals and institutions and considers individuals
and organizations moral agents.
Is it just projecting the moral life of an individual onto an organization?
1) Legal: Shift from a corporation being an inanimate being to being a person
 19th Century – Corporation as a grant or privilege of the state to a right to be a
business possessed by an individual
 20th – corporations were charged with a criminal act-Pinto
 1978 US Supreme Court Rights of Free Speech
 1991 Sentencing guidelines – encourage corporate compliance by establishing
codes of conduct, compliance programs, ombudsmen
2) Sociological references/ordinary 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
 Organizations are praised and blamed – tobacco industry
3) Moral argument: Characteristics of moral agents – responsibility
 Held accountable—it caused the problem – medical errors
 Rule following – externally, socially imposed rules
 Decision-making: they do not decide on impulse
 They are trustworthy
 Rationality – they had purposes, missions; they can be evaluated about whether
they met them
 Shapes culture; organizations that reward and punish create different kinds of
cultures, and culture can take on a life of its own existing over time
Characteristics of organizational ethics mechanisms
Structures
o Committee or subcommittee
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Using existing management structures
Ad hoc committees for specific issues CHE system-wide
Mission effectiveness committee St. Joseph’s Atlanta
Expanding compliance function BayCare
Inter-institutional committees Mercy SEPA
Ethicists council e.g. Mercy St. Louis
Processes
o Scope of jurisdiction and authority
o Goal setting and evaluation
o Reporting and accountabilities
o Measurable outcomes: structures, processes, quality improvement
o Membership
o Values-based decision-making
Priority setting
o Identifying and translating existing mechanisms
o Semi-structured interviews to identify anxieties
o Examining key policies to determine gaps with practice
o Quick hits
File: pboyle/organizational ethics/Lourdes ho.doc
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