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18 May, 2012 Posted by John G. Self Posted in Healthcare, Leadership
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One Ethical Decision at a Time

Posted May 18th, 2012 | Author: John G. Self

It is easier to do the right thing 100 percent of the time than 98 percent of the time.

That is one of Clayton Christensen’s life’s lessons that was reaffirmed when his Harvard classmate Jeff Skilling went to prison as the result of a thousand little compromises to his ethical values.  Skilling was Ken Lay’s right hand man at Enron.  Christensen, a Harvard professor, is the architect of, and the world’s foremost authority on, disruptive innovation.

Christensen, a Rhodes Scholar and an accomplished basketball player in his younger years, once declined to play in a championship game despite enormous pressure from coaches and players, because, as a devout Mormon, he had promised God he would never play sports on a Sunday.  Later he realized that if he had said yes that time, he would have no standing to say no in the future.  Once you take a stand like that, Christensen believes, you do not have to keep dealing with the same question over again.

Be true to your beliefs, be true to your values, and be consistent.  He believes that Jeff Skilling did not start out to break the law, but over time he ruined his life – death by a thousand ethical compromises that eventually reached a tipping point.

Christensen’s views, expressed in a New Yorker profile entitled “When Giants Fail” speaks to one of the major challenges for healthcare leaders. Day in and day out, CEOs and members of their team deal with ethical issues, big and small.  How they handle these moments of truth shape their leadership brand and determine success or failure.

Here are a few examples of ethical failures that can shape an organization’s culture and its future:

  • A politically powerful superstar surgeon at a major east coast teaching hospital refuses to stop for a “time out” to verify the patient’s identity and the surgical site before starting a case.  No one challenges him on this serious breach of quality and safety because it is easier to look the other way.
  • Residents who are consistently sloppy with prescription practices because they believe if they make an error the pharmacy will catch it. Then are not called on the carpet by their faculty members.
  • Allowing faculty surgeons the flexibility to opt out of being in the surgical suite during a case being performed by residents under their supervision, which is a violation of federal law.  This long-standing practice is so common that the hospital has made an art form out of looking the other way.  Then when another faculty member files a whistle blower lawsuit, the well-known CEO discounts the allegations as a “technical violation.”

Employees see these things.  Lack of action or effort to do the right thing reinforces all the wrong values even though words like quality, safety, ethical standards and transparency are part of the every day conversation in the executive office and at department management meetings.

How widespread are these examples?  It is hard to say.  I would hope not very, but my 30+ years of experience in healthcare leadership pushes me to believe it is more pervasive than we want to know and discuss.

A leader’s brand is never set in concrete.  It is formed every day, one ethical decision at a time.

© 2012 John Gregory Self

© 2017 John Gregory Self

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