An Ethical Culture By Jack Gilbert

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© 2007 New Page Consulting, Inc. All Rights Reserved

Metropolitan Hospital Associations Tucson 2007

Doing the Right Thing Every Day: The Five Disciplines of an Ethical Culture

Jack Gilbert, Ed.D., F.A.C.H.E.President, New Page Consulting, Inc.

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Our Objectives

•To understand the four ethical pathways through which intentions are transformed into performance

•To appreciate two key dynamics that impact everyday ethics: ethical erosion and ethical wisdom

•To examine the five disciplines of an ethical culture and their impact on everyday decision making

•To complete a high level diagnostic of the ethical health of your organization’s culture

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DEFINING ETHICS AND INTEGRITY

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Working Definitions

Organizational Integrity

Personal Integrity

A state of wholeness and peace experienced when our goals, actions, and decisions are consistent with our most cherished values

Producing stronger, sustainable performance through ethical pathways consistent with the vision, mission and values of the organization

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Strengthening Ethics: A Partnership of Goodwill

The organizationtaking action to strengthen

ethical behavior

Employeestaking action

to strengthen

ethical behavior

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THE RELATIONSHIP OF ETHICS AND

PERFORMANCE

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Any Organization Transforms Intentions Into Performance

Intentions: Vision, Mission, Values, Strategy, Goals

Performance: Safety, Quality of Care, Financial Health,

Satisfaction, Retention, Reputation

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Robert Wood Johnson Fred Kilmer

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General Robert Wood Johnson

“We… will continue to succeed if we adhere to

the principles of our credo – first, the serving of our customers, then to

the people in the plant, and then the

management, and then the community, and, finally and last, to the

stockholders.”

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Momofuku Ando

Peace will come when people have

food

Eating wisely will enhance beauty and

health

The creation of food will serve society

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Momofuku Ando

How many individual servings of instant noodles

were eaten worldwide in 2005?

86

Billion

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There Are Ethical Pathways To Performance

Ethical Pathways




EthicalErosion

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ETHICAL EROSION

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Ethical Erosion:An Organization Under Pressure

This was two years of hell. And so I witnessed a slow erosion of focus on values… If you looked at them without regard to their magnitude, and you asked, was this right or wrong? The answer would be wrong and you know it. Okay. But it’s only a little bit wrong…”

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“… and I think in your head, the more you let these little wrongs build up, you start setting these mental precedents that make it easier to slide into doing more and more little things or slightly bigger and then bigger and bigger things.”

Executive in a Large Consulting Firm

Ethical Erosion:An Organization Under Pressure (cont’d)

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Ethical Erosion:The Challenger Disaster

“Small changes regarding [quality and safety standards] — new behaviors that were slight deviations from the normal course of events — gradually became the norm, providing the basis for accepting additional deviance…”

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Ethical Erosion:The Challenger Disaster (cont’d)

“… the responsible organizations proceeded as if nothing was wrong in the face of evidence that something was wrong.”

The Challenger Launch Decision, 1996

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Ethical Erosion and Patient Safety

Figure 1: MEDMARXsm Total Medication Errors, 2004

127 Sentinel Events

3,097 Harmful Events

245,509 Non-Harmful Events

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Ethical Erosion and Patient Safety (Cont’d)

Figure 2: The possible impact on focusing on non-harmful events and reducing them by 25%

95 Sentinel Events2,323 Harmful Events

184,131 Non-Harmful

Events

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Ethical Erosion and Patient Safety: Hidden Events

Sentinel Events

Harmful Events

Non-Harmful Events

Unreported and Unexposed Events

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Common Practice

≠ Ethical Practice

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Ethical Erosion: In Short

Ethical Erosion is characterized by a series of small, even unnoticed, acts that erode ethical behavior with each act providing a foundation for the next more erosive act.

All of which can lead to significant even disastrous adverse organizational and personal consequences.

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Ethical Erosion and Ethical Wisdom Will Impact The Health of Ethical Pathways

Ethical Pathways




EthicalErosion

EthicalWisdom

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ETHICAL WISDOM

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Ethical Wisdom: What is it?

Ethical Wisdom is the individual and collective knowledge, experience, and good sense, to make

sound ethical decisions and judgments everywhere, every day

Ethical Wisdom is already resident in the organization and in those who work in it. You

already have the ethical wisdom you need to guide ethical behavior

Ethical Wisdom doesn’t have to be taught but it does have to be accessed and harnessed.

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THE FOUR ETHICAL PATHWAYS TO PERFORMANCE

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Culture

InfrastructurePersonalIntegrity

Leadership




EthicalErosion

EthicalWisdom

There Are Four Ethical Pathways

2007 American Hospital Association Summit

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THE ETHICAL PATHWAY OF CULTURE

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An Ethical Culture Has Five Disciplines

Mindfulness

RespectTenacity

Voice

Legacy

Intentions Vision, Mission, Values, Strategy, Goals



Culture

Leadership PersonalIntegrity

Infrastructure

EthicalErosion

EthicalWisdom

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An Ethical Culture Has Five Disciplines

•Bringing mindfulness into the public conversation•Shared mindfulness and shared ethical wisdom

MindfulnessMindfulness

VoiceVoice

RespectRespect

TenacityTenacity

LegacyLegacy

•Early awareness through faint signals•The private voice of ethical wisdom

•Working on ethical issues as colleagues, not critics•Respecting and valuing different points of view

•The shared commitment to see difficult conversations through to their resolution

•Being mindful of our values and legacy•Creating a positive legacy for those who will follow

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A HIGH LEVEL ORGANIZATIONAL

DIAGNOSTIC

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Ethical Culture:A High Level Diagnostic for the Organization

0 2 4 6 8 10

0 2 4 6 8 10

0 2 4 6 8 10

0 2 4 6 8 10VoiceVoice

RespectRespect

TenacityTenacity

LegacyLegacy

We know that it is much safer to keep quietabout ethical issues than speak up

We care more about ethics thana lot of other people around here

We bury ethical issues and we avoid public differences

Meeting our financial goals mattersmore than living our values

We are always encouraged to freely shareour ethical concerns and ideas

We freely exchange ideas across all functionson how to strengthen our ethical standards

Ethical issues are healthily debated untilwe have the best possible decision

The impact on our values alwaysshapes our decision-making

Our biggest (numeric) gap: ______________ Our most important gap: ______________

x O

x

x

x

O

O

O

Respect Voice

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A Partnership of Goodwill

The organizationtaking action to strengthen

ethical behavior

Employeestaking action

to strengthen

ethical behavior

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Ethical Wisdom: A High Level Diagnostic for Myself

0 2 4 6 8 10

0 2 4 6 8 10

0 2 4 6 8 10

0 2 4 6 8 10VoiceVoice

RespectRespect

TenacityTenacity

LegacyLegacy

I keep silent when it comes to sharing mythoughts about ethical issues

My biggest concern in my workis self-preservation

It’s not worth fighting for high ethical standards if others are opposed

I’m mostly concerned with doing whatis necessary to get through the day

It is impossible for me not to say anythingwhen I see or sense an ethical issue

I believe the vast majority of people want toact ethically and I relate to them like that

I will fight without stopping until we geta sound ethical decision

My thoughts about a decision always takethe future ethical impact into account

My biggest (numeric) gap: ______________ My most important gap: ______________

0 2 4 6 8 10MindfulnessMindfulness

Others need to point out ethical issuesfor me to become aware of them

I am very sensitive to the internal signalsthat suggest an ethical issue might exist

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Closing Thought: The Lesson of Notre Dame Cathedral

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Jack Gilbert

New Page Consulting, Inc.

1155 Camino Del Mar #402

Del Mar, CA 92014

Tel: 858.350.4277

Fax: 858.225.0176

[email protected]

www.newpageconsulting.com

Economy & Finance

An Ethical Culture By Jack Gilbert