There is much at stake if leaders lack ethical leadership skills — and not just for the people they supervise.

“Organizations fail when ethical principles are not maintained,” says Melissa M. Bottrell, MPH, PhD, CEO of Berkeley, CA-based Ethics Quality Consulting.

When people take on a leadership role for the first time, they often look at things from only one perspective: Their own. “They use that narrow understanding for guiding staff and decision-making,” Bottrell observes.

The problem is ethical leadership requires perspectives of all stakeholders be considered. If managers do not actively encourage staff to offer input, people are going to be reluctant or unwilling to voice concerns. “Middle managers who are not great leaders can themselves be great sources of moral distress for staff,” Bottrell says.

This common problem may become apparent during times of major organizational stress, as is occurring now with COVID-19. “Leaders get focused on the perspectives of those above them,” Bottrell says.

Frontline staff do not realize why decisions are made, so what the organization is doing seems unethical. Managers do not take time to translate the organization’s values and rationales for change. “Staff may disengage from the organization, thereby eroding commitment to the organizational mission,” Bottrell cautions.

Hospitals should consider these solutions:

  • Make ethical principles (and guidance on ethical decision-making) part of required orientation for all managers and supervisors. “The orientation must be interactive and show the impact of ethics on culture and viability of the organization,” Bottrell says.
  • Provide ongoing forums for discussing ethical principles. “All decisions should be made with ethical principles in mind. The best approach to this is to include discussion of ethics in all meetings,” Bottrell says. This includes meetings at the frontline unit level all the way to the boardroom.
  • Give employees easy access to the ethics consultant service. “This service should not be an arm of risk management or the ‘ethics police,’” Bottrell offers.
  • Leaders should round in all departments to discuss directly with staff whatever issues they are experiencing at the moment. Specific questions to ask staff include: What are the issues that keep you up at night? Do you see any ways we could provide care that is safer or that encourages patient autonomy? What do you need to improve your ability to meet the needs of patients and/or staff?
  • Establish a unit-based ethics conversations program. “What seems to work best is to have this program part of the ethics consultation service,” says Robin Cook, co-developer of the Veteran Affairs’ IntegratedEthics program.

To launch the program, long-term care units or ICUs are a good place to start. In those units, ethically complex end-of-life issues are common. Ethicists can start discussions after particularly difficult cases in which there are multiple sides of an ethical issue. “The intent is not to solve the issue, but to explore the various aspects of how staff felt during the situation,” Cook says.

Ethicists may discover something that could have been handled differently that would have provided better communication. “The ultimate goal here is to have ethics as part of the fabric in the organization,” Cook says.