This column last discussed the topic of ethics in 2003. Since that time, nothing has changed the importance of the subject and, in fact, ongoing concerns about corruption in business, politics and elsewhere suggest that it is an ever-increasing concern. This article, the first in a two-part discussion, addresses professional (personal) ethics. The second article considers how the management and human resources skills of Central Service managers influence their employees as the department and healthcare facility address corporate (social) responsibilities within their communities.

What is Ethics?
The concept of “ethics” relates to rules or principles that define “right” and “wrong.” However, the definitions of what is and is not acceptable vary based upon the individual making the determination. Society, through its body of laws, does not take a position on whether something is right or wrong until it is determined to be illegal. Then, something that is illegal is also judged to be unethical. However, something can also be legal (no societal laws have been broken) but still be unethical. Central Service personnel adhere to guidance established by their professional peers and, frequently, codes of ethics established by professions and healthcare facilities are also very important as potential decisions are evaluated and made.

Let’s consider a Central Service manager determining which employee should attend a convention in a desirable out-of-town location. There may be a facility policy relating to factors such as length of employment and ability to improve one’s work as a result of attendance, and these factors can help to narrow the focus of eligibility. However, two staff members with equal qualifications could be selected. One is the personal favorite of the manager who dislikes the second candidate. Which employee should be selected? Does it matter if the favored employee also attended the previous convention and was delegated an enjoyable project? Does it matter if the “grapevine” is suggesting that there are gender, age, racial, or other reasons why the manager appears to be discriminating against one staff member while favoring another employee?

You can begin to see that there are numerous considerations, all of which are important, as this seemingly inconsequential decision is being made. Many of these relate to employee morale and after-the-decision supervisory concerns. However, the ethical aspects of “favoritism” are also very present in the situation. What would you do? Perhaps you need more information, but all managers have had experiences with “right” and “wrong” dimensions of decision-making that tested their ethical beliefs.

While “ethical” conduct is required at all times, in the world of work the difference between “what is right” and what is “wrong” is sometimes difficult to distinguish. Consider these examples:

• A purchasing agent for a healthcare facility receives some “free” tickets to a sporting event from a regular supplier. Does this illustrate a situation where the purchasing agent will benefit without negative consequences? Alternatively, can the purcha ser’s future decisions about product purchases be affected by this “innocent” gift?
• Top-level healthcare department heads are offered (and accept) significant salary increases, while wages for hourly-paid staff are kept minimal because of the facility’s “financial difficulties.”
• Facility administrators increase employee benefits, but then they eliminate some full-time staff, and utilize more part-time workers who do not qualify for the benefits.

People should always make ethical decisions in their personal lives, but the practice of business ethics (the use of ethical judgment by managers as they make decisions affecting their organization) is clearly a critical responsibility of Central Service managers. Professional managers consistently practice ethical behavior, and they just as routinely avoid unethical behavior.

How can the situations noted above -- and numerous others like them -- be addressed “ethically,” and how can (should) the social responsibilities relative to them be considered? The “answer” depends upon the individuals confronted by each specific situation. However, there are some basic ethical principles that managers should follow when they make decisions, and they include:

• Honesty – Don’t mislead or deceive others. Integrity – Do what is right.
• Trustworthiness – Supply correct information, and correct information that is not factual.
• Loyalty to facility – Avoid conflicts of interest and don’t disclose confidential information.
• Fairness – Treat individuals equally; always appreciate diversity.
• Concern and respect – Be considerate of those affected by decision-making.
• Commitment to excellence – Always do the best you can do.
• Leadership – Lead by example.
• Reputation and morale – Work to enhance the facility’s reputation and to improve the morale of employees.
• Accountability – Accept responsibility for decisions once they are made.

Factors that can serve as ethical norms have been identified. For example, Central Service managers should consider one or more of the following as they make decisions:

• Utility – To what extent does a specific act generate benefits for those affected?
• Rights – To what extent are the rights of persons involved respected as decisions are made?
• Justice – Is a decision fair?
• Caring – Does a decision consider the responsibilities that individuals have to each other?

From our discussion to this point, it should be clear that it is easier to state that “Central Service managers must be ethical, and they do so by consistently practicing ethical behavior,” than it is to define exactly what the statement means. A healthcare facility’s culture may support and reward its members for making decisions that reflect ethical concerns or, alternatively, it may provide no benefit to those who do so. In extreme instances, the culture may even reward those who make unethical decisions. Examples: some facilities have ignored protections mandated under Equal Employment Opportunity (EEOC) laws, and others have disregarded the environmental impact of their decision-making.

Codes of Ethics
Many healthcare facilities develop and implement a code of ethics to provide managers with broad statements and guidelines to assist with ethical decision-making. As such, their intention is to provide a framework for decision-making rather than to specify exactly what should (or should not) be done in a specific situation.

Reasons that codes of ethics are developed include:

• To identify a foundation of acceptable behavior.
• To promote standards to guide decision-making.
• To provide a benchmark to evaluate decisions.
• To support the responsibility and obligations that decision-makers have to their constituents and to society.

The most effective codes of ethics exemplify the ethical commitment of the facility, and how it intends to interact with others as it provides products and services to its constituencies. The best codes of ethics are developed specifically for the facility, and they incorporate input from the employees who will be expected to follow them. To do so, managers should identify the employee groups who will be bound by the code of ethics being developed, and they frequently include staff members at all organizational levels. As well, input should be solicited from investors (if applicable), vendors, and, perhaps, even community organizations. Those who assist in the development of an ethics code should understand the facility’s mission, and they should be concerned about its commitment to a positive professional and community image.

The support of top-level leadership is of obvious importance as codes of ethics are developed. They should be reviewed by legal counsel, and formal approval from the highest levels in the facility will be required.

The tactics used to implement and educate staff members about a code of ethics are also important. For example, an exhibit of the code of ethics that is hung on the walls in the manager’s office, and which is used as an introduction for an employee handbook will do little good unless it is incorporated into and actually guides the facility’s culture. Enforcement concerns applicable if or when the code is violated should be addressed. Remember, a code of ethics is important, and its emphasis should last “forever.” However, it is not a “program” which begins and ends at specified times. All staff members should be held accountable for the behavior described in the code of ethics.

Topics that might be included in a code of ethics are listed in Figure 1.

In Conclusion
In this article we have emphasized that the best management decisions are those which incorporate basic ethical concerns. In other words, “good” Central Service managers are ethical, and they deliberate, when necessary, to consider the ethical impact of proposed decisions. However, their need to do so extends beyond their immediate work environment. In fact, the decisions made, words spoken, and actions taken by Central Service managers reflect their concerns for corporate (social) responsibility beyond the walls of their facility. This will be discussed in detail in the second article in this two-part series about the need to assure that one is always “doing the right thing.”