1
Metropolitan Hospital Associations Tucson 2007




      Doing the Right Thing Every Day: The Five
          Disciplines...
2
Metropolitan Hospital Associations Tucson 2007


Our Objectives
    •To understand the four ethical pathways
     throug...
3
Metropolitan Hospital Associations Tucson 2007




                DEFINING ETHICS AND
                     INTEGRITY


...
4
Metropolitan Hospital Associations Tucson 2007


Working Definitions

   Personal Integrity
        A state of wholeness...
5
Metropolitan Hospital Associations Tucson 2007


Strengthening Ethics: A Partnership of Goodwill




                   ...
6
Metropolitan Hospital Associations Tucson 2007




               THE RELATIONSHIP OF
                    ETHICS AND
   ...
7
Metropolitan Hospital Associations Tucson 2007


Any Organization Transforms Intentions Into Performance

              ...
8
Metropolitan Hospital Associations Tucson 2007




    Robert Wood Johnson                          Fred Kilmer
        ...
9
Metropolitan Hospital Associations Tucson 2007




                                                 © 2007 New Page Cons...
10
Metropolitan Hospital Associations Tucson 2007




                                                   “We… will continu...
11
Metropolitan Hospital Associations Tucson 2007




                                                   Peace will come
 ...
12
Metropolitan Hospital Associations Tucson 2007




                                                       How many
    ...
13
Metropolitan Hospital Associations Tucson 2007


There Are Ethical Pathways To Performance

                           ...
14
Metropolitan Hospital Associations Tucson 2007




                           ETHICAL EROSION




                     ...
15
Metropolitan Hospital Associations Tucson 2007


Ethical Erosion:
An Organization Under Pressure

               This w...
16
Metropolitan Hospital Associations Tucson 2007


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

            ...
17
Metropolitan Hospital Associations Tucson 2007


Ethical Erosion:
The Challenger Disaster


          “Small changes re...
18
Metropolitan Hospital Associations Tucson 2007


Ethical Erosion:
The Challenger Disaster (cont’d)


          “… the r...
19
Metropolitan Hospital Associations Tucson 2007


Ethical Erosion and Patient Safety



             127 Sentinel Events...
20
Metropolitan Hospital Associations Tucson 2007


Ethical Erosion and Patient Safety (Cont’d)


                 95 Sent...
21
Metropolitan Hospital Associations Tucson 2007


Ethical Erosion and Patient Safety: Hidden Events


                  ...
22
Metropolitan Hospital Associations Tucson 2007




                             Common Practice

                      ...
23
Metropolitan Hospital Associations Tucson 2007


Ethical Erosion: In Short


         Ethical Erosion is characterized ...
24
Metropolitan Hospital Associations Tucson 2007

Ethical Erosion and Ethical Wisdom Will Impact The
Health of Ethical Pa...
25
Metropolitan Hospital Associations Tucson 2007




                         ETHICAL WISDOM




                        ...
26
Metropolitan Hospital Associations Tucson 2007


Ethical Wisdom: What is it?

           Ethical Wisdom is the individu...
27
Metropolitan Hospital Associations Tucson 2007




                      THE FOUR ETHICAL
                        PATHW...
28
2007 American Hospital Association Summit


  There Are Four Ethical Pathways
                                         ...
29
Metropolitan Hospital Associations Tucson 2007




             THE ETHICAL PATHWAY
                  OF CULTURE




  ...
30
Metropolitan Hospital Associations Tucson 2007


An Ethical Culture Has Five Disciplines                               ...
31
 Metropolitan Hospital Associations Tucson 2007


   An Ethical Culture Has Five Disciplines

Mindfulness              ...
32
Metropolitan Hospital Associations Tucson 2007




                         A HIGH LEVEL
                        ORGANI...
33
Metropolitan Hospital Associations Tucson 2007


Ethical Culture:
A High Level Diagnostic for the Organization
        ...
34
Metropolitan Hospital Associations Tucson 2007


A Partnership of Goodwill




                                        ...
35
Metropolitan Hospital Associations Tucson 2007


Ethical Wisdom: A High Level Diagnostic for Myself
                   ...
36
Metropolitan Hospital Associations Tucson 2007


Closing Thought: The Lesson of Notre Dame
Cathedral




              ...
37
Metropolitan Hospital Associations Tucson 2007




                                                   Jack Gilbert
    ...
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An Ethical Culture By Jack Gilbert

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An Ethical Culture By Jack Gilbert

  1. 1. 1 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. © 2007 New Page Consulting, Inc. All Rights Reserved
  2. 2. 2 Metropolitan Hospital Associations Tucson 2007 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 © 2007 New Page Consulting, Inc. All Rights Reserved
  3. 3. 3 Metropolitan Hospital Associations Tucson 2007 DEFINING ETHICS AND INTEGRITY © 2007 New Page Consulting, Inc. All Rights Reserved
  4. 4. 4 Metropolitan Hospital Associations Tucson 2007 Working Definitions Personal Integrity A state of wholeness and peace experienced when our goals, actions, and decisions are consistent with our most cherished values Organizational Integrity Producing stronger, sustainable performance through ethical pathways consistent with the vision, mission and values of the organization © 2007 New Page Consulting, Inc. All Rights Reserved
  5. 5. 5 Metropolitan Hospital Associations Tucson 2007 Strengthening Ethics: A Partnership of Goodwill Employees taking action to The organization strengthen taking action to ethical behavior strengthen ethical behavior © 2007 New Page Consulting, Inc. All Rights Reserved
  6. 6. 6 Metropolitan Hospital Associations Tucson 2007 THE RELATIONSHIP OF ETHICS AND PERFORMANCE © 2007 New Page Consulting, Inc. All Rights Reserved
  7. 7. 7 Metropolitan Hospital Associations Tucson 2007 Any Organization Transforms Intentions Into Performance Intentions: Vision, Mission, Values, Strategy, Goals Performance: Safety, Quality of Care, Financial Health, Satisfaction, Retention, Reputation © 2007 New Page Consulting, Inc. All Rights Reserved
  8. 8. 8 Metropolitan Hospital Associations Tucson 2007 Robert Wood Johnson Fred Kilmer © 2007 New Page Consulting, Inc. All Rights Reserved
  9. 9. 9 Metropolitan Hospital Associations Tucson 2007 © 2007 New Page Consulting, Inc. All Rights Reserved
  10. 10. 10 Metropolitan Hospital Associations Tucson 2007 “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.” General Robert Wood Johnson © 2007 New Page Consulting, Inc. All Rights Reserved
  11. 11. 11 Metropolitan Hospital Associations Tucson 2007 Peace will come when people have food Eating wisely will enhance beauty and health The creation of food will serve society Momofuku Ando © 2007 New Page Consulting, Inc. All Rights Reserved
  12. 12. 12 Metropolitan Hospital Associations Tucson 2007 How many individual servings of instant noodles were eaten worldwide in 2005? 86 Billion Momofuku Ando © 2007 New Page Consulting, Inc. All Rights Reserved
  13. 13. 13 Metropolitan Hospital Associations Tucson 2007 There Are Ethical Pathways To Performance Intentions: Vision, Mission, Values, Strategy, Goals Ethical Ethical Pathways Erosion Performance: Safety, Quality of Care, Financial Health, Satisfaction, Retention, Reputation © 2007 New Page Consulting, Inc. All Rights Reserved
  14. 14. 14 Metropolitan Hospital Associations Tucson 2007 ETHICAL EROSION © 2007 New Page Consulting, Inc. All Rights Reserved
  15. 15. 15 Metropolitan Hospital Associations Tucson 2007 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…” © 2007 New Page Consulting, Inc. All Rights Reserved
  16. 16. 16 Metropolitan Hospital Associations Tucson 2007 Ethical Erosion: An Organization Under Pressure (cont’d) “… 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 © 2007 New Page Consulting, Inc. All Rights Reserved
  17. 17. 17 Metropolitan Hospital Associations Tucson 2007 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…” © 2007 New Page Consulting, Inc. All Rights Reserved
  18. 18. 18 Metropolitan Hospital Associations Tucson 2007 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 © 2007 New Page Consulting, Inc. All Rights Reserved
  19. 19. 19 Metropolitan Hospital Associations Tucson 2007 Ethical Erosion and Patient Safety 127 Sentinel Events 3,097 Harmful Events 245,509 Non-Harmful Events Figure 1: MEDMARXsm Total Medication Errors, 2004 © 2007 New Page Consulting, Inc. All Rights Reserved
  20. 20. 20 Metropolitan Hospital Associations Tucson 2007 Ethical Erosion and Patient Safety (Cont’d) 95 Sentinel Events 2,323 Harmful Events 184,131 Non-Harmful Events Figure 2: The possible impact on focusing on non-harmful events and reducing them by 25% © 2007 New Page Consulting, Inc. All Rights Reserved
  21. 21. 21 Metropolitan Hospital Associations Tucson 2007 Ethical Erosion and Patient Safety: Hidden Events Sentinel Events Harmful Events Non-Harmful Events Unreported and Unexposed Events © 2007 New Page Consulting, Inc. All Rights Reserved
  22. 22. 22 Metropolitan Hospital Associations Tucson 2007 Common Practice ≠ Ethical Practice © 2007 New Page Consulting, Inc. All Rights Reserved
  23. 23. 23 Metropolitan Hospital Associations Tucson 2007 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. © 2007 New Page Consulting, Inc. All Rights Reserved
  24. 24. 24 Metropolitan Hospital Associations Tucson 2007 Ethical Erosion and Ethical Wisdom Will Impact The Health of Ethical Pathways Intentions: Vision, Mission, Values, Strategy, Goals Ethical Ethical Ethical Pathways Erosion Wisdom Performance: Safety, Quality of Care, Financial Health, Satisfaction, Retention, Reputation © 2007 New Page Consulting, Inc. All Rights Reserved
  25. 25. 25 Metropolitan Hospital Associations Tucson 2007 ETHICAL WISDOM © 2007 New Page Consulting, Inc. All Rights Reserved
  26. 26. 26 Metropolitan Hospital Associations Tucson 2007 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. © 2007 New Page Consulting, Inc. All Rights Reserved
  27. 27. 27 Metropolitan Hospital Associations Tucson 2007 THE FOUR ETHICAL PATHWAYS TO PERFORMANCE © 2007 New Page Consulting, Inc. All Rights Reserved
  28. 28. 28 2007 American Hospital Association Summit There Are Four Ethical Pathways Intentions: Vision, Mission, Values, Strategy, Goals Culture Leadership Ethical Ethical Erosion Wisdom Personal Infrastructure Integrity Performance: Safety, Quality of Care, Financial Health, Satisfaction, Retention, Reputation
  29. 29. 29 Metropolitan Hospital Associations Tucson 2007 THE ETHICAL PATHWAY OF CULTURE © 2007 New Page Consulting, Inc. All Rights Reserved
  30. 30. 30 Metropolitan Hospital Associations Tucson 2007 An Ethical Culture Has Five Disciplines Culture Infrastructure Personal Intentions Leadership Integrity Vision, Mission, Values, Strategy, Goals Mindfulness Voice Ethical Ethical Erosion Wisdom Tenacity Respect Legacy Performance: Safety, Quality of Care, Financial Health, Satisfaction, Retention, Reputation © 2007 New Page Consulting, Inc. All Rights Reserved
  31. 31. 31 Metropolitan Hospital Associations Tucson 2007 An Ethical Culture Has Five Disciplines Mindfulness • Early awareness through faint signals • The private voice of ethical wisdom Voice • Bringing mindfulness into the public conversation • Shared mindfulness and shared ethical wisdom Respect • Working on ethical issues as colleagues, not critics • Respecting and valuing different points of view Tenacity • The shared commitment to see difficult conversations through to their resolution Legacy • Being mindful of our values and legacy • Creating a positive legacy for those who will follow © 2007 New Page Consulting, Inc. All Rights Reserved
  32. 32. 32 Metropolitan Hospital Associations Tucson 2007 A HIGH LEVEL ORGANIZATIONAL DIAGNOSTIC © 2007 New Page Consulting, Inc. All Rights Reserved
  33. 33. 33 Metropolitan Hospital Associations Tucson 2007 Ethical Culture: A High Level Diagnostic for the Organization We know that it is much safer to keep quiet We are always encouraged to freely share about ethical issues than speak up our ethical concerns and ideas Voice 0 2 4 x 6 8 O 10 We care more about ethics than We freely exchange ideas across all functions a lot of other people around here on how to strengthen our ethical standards Respect 0 2 x 4 6 8 O 10 We bury ethical issues and we Ethical issues are healthily debated until avoid public differences we have the best possible decision Tenacity 0 2 4 6 x 8 O 10 Meeting our financial goals matters The impact on our values always more than living our values shapes our decision-making Legacy 0 2 4 6 x 8 O 10 Respect Our biggest (numeric) gap: ______________ Voice Our most important gap: ______________ © 2007 New Page Consulting, Inc. All Rights Reserved
  34. 34. 34 Metropolitan Hospital Associations Tucson 2007 A Partnership of Goodwill Employees taking action to The organization strengthen taking action to ethical behavior strengthen ethical behavior © 2007 New Page Consulting, Inc. All Rights Reserved
  35. 35. 35 Metropolitan Hospital Associations Tucson 2007 Ethical Wisdom: A High Level Diagnostic for Myself Others need to point out ethical issues I am very sensitive to the internal signals for me to become aware of them that suggest an ethical issue might exist 0 2 4 6 8 10 Mindfulness I keep silent when it comes to sharing my It is impossible for me not to say anything thoughts about ethical issues when I see or sense an ethical issue 0 2 4 6 8 10 Voice My biggest concern in my work I believe the vast majority of people want to is self-preservation act ethically and I relate to them like that Respect 0 2 4 6 8 10 It’s not worth fighting for high ethical I will fight without stopping until we get standards if others are opposed a sound ethical decision Tenacity 0 2 4 6 8 10 I’m mostly concerned with doing what My thoughts about a decision always take is necessary to get through the day the future ethical impact into account Legacy 0 2 4 6 8 10 My biggest (numeric) gap: ______________ My most important gap: ______________ © 2007 New Page Consulting, Inc. All Rights Reserved
  36. 36. 36 Metropolitan Hospital Associations Tucson 2007 Closing Thought: The Lesson of Notre Dame Cathedral © 2007 New Page Consulting, Inc. All Rights Reserved
  37. 37. 37 Metropolitan Hospital Associations Tucson 2007 Jack Gilbert New Page Consulting, Inc. 1155 Camino Del Mar #402 Del Mar, CA 92014 Tel: 858.350.4277 Fax: 858.225.0176 jack@newpageconsulting.com www.newpageconsulting.com © 2007 New Page Consulting, Inc. All Rights Reserved

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