As a non-profit healthcare organization, in an environment of primarily private healthcare systems, the ability to continue to provide healthcare to those in need and subsequently to those who typically lack the means to pay, is challenging. Non-profit healthcare is what some call ‘cradle-to-grave healthcare’ (Feigenbaum, 2018). Each day, the health system where I am employed is faced with raising funds through donations to assist with the cost of the newest medical technology, addressing reduced reimbursement rates from government-funded healthcare programs and recruiting volunteers to supplement our labor pool. That is in part to today’s new normal of, we are all being asked to do more, with less. This has led to concerns from employees that are related to their ability to conduct ethical reasoning; while treating and caring for patients, and delivering the necessary respect, and compassion for others – especially the most vulnerable and sickest patients.
Culture matters to an organization’s success. Combine that with the definition of ethical leadership, as defined by the Ethisphere Institute – Companies that proactively engage with the communities they service, impact or operate in. LG Health’s mission is ‘To advance the health and well-being of the communities we serve.’ Firms who have historically received accolades for their ethical cultures include those that have:
LG Health can check almost every one of these boxes, for representation of an ethical culture. That doesn’t mean we can rest on our laurels or divert focus from the topic of an ethical culture – challenges have presented themselves in the form of recent employee engagement survey responses.
Lancaster General Health employees take great pride in the work that they do and the role they play in the community; despite some uncertainty about the recent UPHS (University of Pennsylvania Health System) acquisition and what effects it may have in the future. However, the latest employee engagement scores have uncovered an uptick in disengagement and a need for managers to re-prioritize efforts with a focus on staff support. The Ethisphere Institute (2018) has seen it has become increasingly common for companies to include specific ethics-related questions in employee surveys, whether that be the general employee engagement survey or a standalone ethics and compliance survey.
The uptick in disengagement has been supported by several key drivers including, ‘Over the past year, I have never been asked to do something that compromises my values; and Abusive behavior is not tolerated at my organization.’ This is indicative that aside from the UPHS integration concerns, employees need leader moral support and guidance. Often, compromises don’t feel like choices at the time, but they are, and they lead to common crises and challenges that are disastrous for the individual and their organization (Forbes, 2012). A potential origin for this top impact driver is the fresh adoption, by the healthcare system of a Lean Process Improvement initiative.
The Lean Process Improvement initiatives have given employees a strong sense of empowerment, frontline employees are seeking greater manager support and have expressed burnout concerns. This has led to feedback that ‘Managers would benefit from a focus on stress and burnout so they can re-prioritize safety concerns and better connect with staff’. Using lean methods to squeeze more from each employee can discourage workers, reverse positive motivation, create critical safety and judgement errors and undermine leadership (Shpak, 2018). Could evaluations made to change processes involve decisions between a good and bad alternative? Is the issue presented about more than what is legal or what is most efficient? Both questions create a framework for ethical decision making.
Cuilla, the dynamic author of Ethics, The Heart of Leadership, indicates that ethics explore the dynamics between leaders and followers in business and argues that power and authority in today’s world stem not from coercion, but from trust, commitment and shared values. Think about a normal workday for yourself. You are juggling a great many tasks that require a large amount of attention. Maintaining this balancing act keeps you focused outward, rather than inward and on yourself, and it’s easy to lose sight of what’s really important to you – your core values and beliefs (Bradberry and Greaves, 2009). As quoted by the Emotional Intelligence authors, before you know it, you find yourself doing and saying things that deep down you don’t feel good about or believe in. These behaviors have manifested themselves in the survey responses received from LG Health’s employees. As leaders, we must first help identify what is a good and what is a harm. Then, we need to support the staff in making good ethical decisions that do not subject our patients to safety issues, incorrect procedures or lack thereof, or even death.
The employee engagement scores are visual exhibits of stress and burnout, with an underlying indication that many are questioning what contribution they have made to the organization at the end of each workday. Schawbel (2017) reports that full-time employees work an average of 47 hours per week, with technology the leading cause for expansion of the workday, and is the culprit for more than 50% of annual employee workforce turnover. One of the key opportunities and engagement strategies will include investing in stress and burnout for frontline clinical staff – this will be a mandatory course requirement. The training will be delivered in classroom, on-line and at the elbow.
And, as the engagement has begun to stagnate, the perception of manager support is declining. We will need to upskill our leaders. Workforce 2020 is a great example of AT&T’s initiative to invest $1 billion into training and development programs for 100,000 employees. This focus of upskilling and retention will not only provide the appropriate sets of skills for the healthcare system, but also reduce future replacement costs for attracting replacement staff. Integral to this training will be a re-orientation to social awareness as a foundational skill. This ability to accurately understand emotions in other people and what is really going on with them is a social competence required by all great leaders. Practicing this aptitude will lead to servant leadership which will trickle into proficiencies like – seeing things from the perspectives of others; creating an environment of encouragement and adding value to others’ worlds. To make a change in other people carries with it an enormous ethical burden and responsibility (Northouse, 2016).
It will be critical to also develop and utilize a written plan to manage and administer ethics and compliance program training and communication resources. Periodic transmissions of LG Health’s standards, procedures and other aspects of our values and compliance systems will need to be scheduled, and adherence to delivery, measured. These include the five Be’s – be compassionate, be present, be empowered, be collaborative and be accountable. The communications plan should be a cross-functional collaboration between clinical and non-clinical staff. Discussions of ethics at internal meetings, company-wide emails and introductions to the confidential reporting resources available to LG Health employees are just three ways we will involve employees in compliance and ethics-related messaging. Announcements to employees shall also include references to other compliance resources such as – Internal Audit Department, Human Resources and Risk Management and Safety teams.
A continued dis-connect with staff who have expressed that their values have felt compromised and that abusive behavior is tolerated within our healthcare organization will have detrimental effects on our ability to continue as the leader in improving the health and well-being of our communities. We do this not only because it’s our mission, but also because it’s the right thing to do.
If only given limited authority to make improvements, to the concerning drivers delivered on the recent employee engagement survey, the focus will need to be directed at those who see their healthcare role at LG Health as nothing more than a paycheck; and those who tend to be the most vocal, actively detracting others from a quality workplace. The emphasis will be on managerial staff ethical conduct in the hopes that it can become a competitive differentiator for LG Health in today’s uber-competitive healthcare environment. Our leaders must establish a value-base that clearly defines the expected behaviors for their direct reports. This will reinforce our healthcare system’s mission to serve the communities in which we are located and improve the metrics that were indicative of a decline in leadership support for the frontline.
The nucleus of the manager training will be ethics policies and procedures and the application of the same in a uniform and standardized (Lean principle) way. We will develop an effectiveness measure for the training and have available to all managers’, workplace techniques to answer employee questions. The completion of this training will become a ‘check-box’ on the annual performance evaluation for those with supervisory responsibilities within the healthcare system. These training results should produce employee feedback that denote acknowledgement and effort from leadership to address problems.
Managers who remain untrained will not be able to deliver on our healthcare organization’s vision of ‘delivering on the promise of a healthier future’. This prophecy is not only applicable to the community, but also to our employees. We must keep the best interests of our organization and our employees in mind. By managing integrity, we can quickly react to, and properly adjust to, failures in conduct or poor decision-making.
LG Health must be committed to maintaining the highest ethical and compliance standards. It will be critical for the healthcare system to consistently measure and evaluate whether our messaging and education is being impactful, and as follow-up employee engagement surveys are conducted (or in the interim if issues are identified), that we take steps to address immediately. By successfully establishing an ethical tone throughout all levels of the healthcare system, we can create an environment where employees are comfortable voicing concerns and where leaders are trained to develop (and maintain) an environment favorable to asking questions and submitting concerns.
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