Recommendations for Creating Ethical Organizational culture
1. Develop a code of conduct or credo that emphasizes the values guiding the organization and for which there is no compromise. Listen to the credo of John son and Johnson.. They demonstrated during the Tylenol® contamination incident that these words meant something. Though they lost millions of dollars, the organizational culture put doing the right thing above profits.
2. Develop an organizational ethics committee whose mission is to create whatever infrastructures are necessary to have organizational values at the center of all dealings. The ethical character of the organization, just like that of an individual, needs to amplify integrity. In a moral community, no gap exists between the espoused values and the action. Beyond the executive team, some group has to be responsible for creating the necessary interfaces and polices that continuously and consistently guide the decision making of the organization. If a separate committee is not possible, then the clinical ethics committee authority should expand to include organizational ethics. At the minimum, a monitoring approach that covers pressure points thoroughly and communication conduits that allow timely reporting and correction are imperative.
3. Ongoing educational forums should incorporate education on organizational ethical issues. This would help staff understand the difference between personally held values and those that the organization has developed. For example, the individual nurse may believe that artificial hydration and nutrition always should be given to a patient in a persistent vegetative state, but the organization's values support the autonomous decision of the patient in an advance directive.
4. "Get aggressive about passivity" is not only the title of a Harvard Business Review article (Gentile, 2005), but a phrase that crystallizes the role of each employee in supporting an ethical climate. In this culture, employees would not be ruled by the "bystander effect," where people are aware of wrongdoing but fail to intervene. The terms "diffusion of responsibility" and "bystander apathy" followed the landmark studies attempting to understand the 1964 brutal murder of Kitty Genovese in front of her building in the respectable New York City neighborhood of Kew Gardens (Gansberg, 1964). This young woman was stabbed to death at 3:20 am on March 13, 1964. Her screams for help after several stab wounds awakened 38 of her neighbors and initially frightened away her assailant. No one called the police for over 30 minutes after the initial attack. The studies that followed indicated that people are more likely to help when they were alone. When others are present, people assume someone else will act. In this diffusion of responsibility, professional nurses can discard their individual sense of responsibility, deceiving themselves into believing that something is management's responsibility. Patients can ill afford this passivity. The profession needs nurses with the moral courage to speak up when they encounter an ethical problem. To make such action safer, organization-wide education on conflict resolution and a recognized reporting system are necessary.
5. Establish a clear, published procedure for all individuals to follow when they believe the present practice is irreconcilable with the organization's values and principles of care. This could include a hotline, an ombudsperson, or a credible and trusted person within the organization. Employees will be less fearful of retaliation and more likely to express concerns with an existence of a specific, formal channel for reporting. For greatest impact, reporting channels should allow anonymous communication, keep non-anonymous reporters informed of what action was taken and have an appeal procedure for anyone who felt he or she suffered retaliation for whistle blowing.
