1 www.mediaethicsinitiative.org How Deep Does the .docx

1 | www.mediaethicsinitiative.org
How Deep Does the Virtual Rabbit Hole Go?
“Deepfakes” and the Ethics of Faked Video Content
Photo: Geralt / CC0
The Internet has a way of both refining techniques and
technologies by pushing them to their
limits—and of bending them toward less-altruistic uses. For
instance, artificial intelligence
is increasingly being used to push the boundaries of what
appears to be reality in faked
videos. The premise of the phenomenon is straightforward: use
artificial intelligence to
seamlessly crop the faces of other people (usually celebrities or
public figures) from an
authentic video into other pre-existing videos. While some uses
of this technology can be
beneficial or harmless, the potential for real damage is also
present. This recent
phenomenon, often called “Deepfakes,” has gained media
attention due to early adopters and
programmers using it to place the face of female celebrities
onto the bodies of actresses in
unrelated adult film videos. A celebrity therefore appears to be
participating in a
pornographic video even though, in reality, they have not done

so. The actress Emma Watson
was one of the first targets of this technology, finding her face
cropped onto an explicit porn
video without her consent. She is currently embroiled in a
lawsuit filed against the producer
of the faked video. While the Emma Watson case is still in
progress, the difficulty of getting
videos like these taken down cannot be understated. Law
professor Eric Goldman points out
the difficulty of pursuing such cases. He notes that while
defamation and slander laws may
apply to Deepfake videos, there is no straightforward or clear
legal path for getting videos
like these taken down, especially given their ability to re-appear
once uploaded to the
internet. While pornography is protected as a form of
expression or art of some producer,
Deepfake technology creates the possibility of creating adult
films without the consent of
those “acting” in it. Making matters more complex is the
increasing ease with which this
technology is available: forums exist with users offering advice
on making faked videos and
a phone app is available for download that can be employed by
basically anyone to make a
Deepfake video using little more than a few celebrity images.
Part of the challenge presented by Deepfakes concerns a
conflict between aesthetic values
and issues of consent. Celebrities or targets of faked videos did
not consent to be portrayed
in this manner, a fact which has led prominent voices in the
adult film industry to condemn
http://www.mediaethicsinitiative.org/
https://pixabay.com/en/binary-code-woman-face-view-1327501/

https://pixabay.com/en/service/terms/#usage
Deepfakes. One adult film company executive characterized the
problem with Deepfakes in
a Variety article: “it’s f[**]ed up. Everything we do … is built
around the word consent.
Deepfakes by definition runs contrary to consent.” It is
unwanted and potentially
embarrassing to be placed in a realistic porn video in which one
didn’t actually participate.
These concerns over consent are important, but Deepfakes
muddies the waters by involving
fictional creations and situations. Pornography, including
fantasy satires based upon real-
life figures such as the disgraced politician Anthony Weiner, is
protected under the First
Amendment as a type of expressive activity, regardless of
whether those depicted or
satirized approve of its ideas and activities. Nudity and fantasy
situations play a range of
roles in expressive activity, some with private contexts and
some with public contexts. For
instance, 2016 saw the installation of several unauthorized—and
nude—statues of then-
candidate Donald Trump across the United States. Whether or
not we judge the message or
use of these statues to be laudatory, they do seem to evoke the
aesthetic values of creativity
and expression that conflicts with a focus on consent to be
depicted in a created (and possibly
critical) artifact. Might Deepfakes, especially those of

celebrities or public figures, ever be a
legitimate form of aesthetic expression of their creators, in a
similar way that a deeply
offensive pornographic video is still a form of expression of its
creators? Furthermore, not
all Deepfakes are publically exhibited and used in connection
with their target’s name,
thereby removing most, if not all, of the public harm that would
be created by their
exhibition. When does private fantasy become a public
problem?
Beyond their employment in fictional, but realistic, adult
videos, the Deepfakes phenomena
raises a more politically-concerning issue. Many are worried
that Deepfakes have the
potential to damage the world’s political climate through the
spread of realistic faked video
news. If seeing is believing, might our concerns about
misinformation, propaganda, and fake
news gain a new depth if all or part of the “news” item in
question is a realistic video clip
serving as evidence for some fictional claim? Law professors
Robert Chesney and Danielle
Citron consider a range of scenarios in which Deepfakes
technology could prove disastrous
when utilized in fake news: “false audio might convincingly
depict U.S. officials privately
‘admitting’ a plan to commit this or that outrage overseas,
exquisitely timed to disrupt an
important diplomatic initiative,” or “a fake video might depict
emergency officials
‘announcing’ an impending missile strike on Los Angeles or an
emergent pandemic in New
York, provoking panic and worse.” Such uses of faked video
could create compelling, and

potentially harmful, viral stories with the capacity to travel
quickly across social media. Yet
in a similar fashion to the licentious employments in forged
adult footage, one can see the
potential aesthetic values of Deepfakes as a form of expression,
trolling, or satire in some
political employments. The fairly crude “bad lip reading”
videos of the recent past that placed
new audio into real videos for humorous effect will soon give
way to more realistic
Deepfakes involving political and celebrity figures saying
humorous, satirical, false, or
frightening things. Given AI’s advances and Deepfake
technology’s supercharging of how we
can reimagine and realistically depict the world, how do we
legally and ethically renegotiate
the balance among the values of creative expression, the
concerns over the consent of others,
and our pursuit of truthful content?
Discussion Questions:
1. Beyond the legal worries, what is the ethical problem with
Deepfake videos? Does this
problem change if the targeted individual is a public or private
figure?

2. Do your concerns about the ethics of Deepfakes videos
depend upon them being made
public, and not being kept private by their creator?
3. Do the ethical and legal concerns raised concerning
Deepfakes matter for more
traditional forms of art that use nude and non-nude depictions
of public figures? Why or
why not?
4. How might artists use Deepfakes as part of their art? Can you
envision ways that
politicians and celebrities could be legitimately criticized
through the creation of biting
but fake videos?
5. How would you balance the need to protect artists (and
others’) interest in expressing
their views with the public’s need for truthful information? In
other words, how can we
control the spread of video-based fake news without unduly
infringing on art, satire, or
even trolling?
Further Information:
Chesney, R., & Citron, D. (2018, February 26). Deep Fakes: A
Looming Crisis for
National Security, Democracy and Privacy? Retrieved March

17, 2018, from
https://www.lawfareblog.com/deep-fakes-looming-crisis-
national-security-
democracy-and-privacy
Farokhmanesh, M. (2018, January 30). Is it legal to swap
someone's face into porn
without consent? Retrieved March 18, 2018, from
https://www.theverge.com/
2018/1/30/16945494/deepfakes-porn-face-swap-legal
Felton, J. (2018, March 13). 'Deep Fake' Videos Could Be Used
To Influence Future
Global Politics, Experts Warn. Retrieved March 17, 2018, from
http://www.iflscience.com/technology/deep-fake-videos-could-
be-used-to-
influence-future-global-politics-experts-warn/
Roettgers, J. (2018, February 21). Porn Producers Offer to Help
Hollywood Take
Down Deepfake Videos. Retrieved March 18, 2018, from
http://variety.com/2018/digital/news/deepfakes-porn-adult-
industry-
1202705749/
national-security-democracy-and-privacy

national-security-democracy-and-privacy
https://www.theverge.com/%202018/1/30/16945494/deepfakes-
porn-face-swap-legal
https://www.theverge.com/%202018/1/30/16945494/deepfakes-
porn-face-swap-legal
be-used-to-influence-future-global-politics-experts-warn/
be-used-to-influence-future-global-politics-experts-warn/
industry-1202705749/
industry-1202705749/
Authors:
James Hayden & Scott R. Stroud, Ph.D.
Media Ethics Initiative
University of Texas at Austin
March 21, 2018
www.mediaethicsinitiative.org
Journal of Organizational Behavior

J. Organiz. Behav. 27, 967–982 (2006)
Published online in Wiley InterScience
(www.interscience.wiley.com) DOI: 10.1002/job.417
* Correspondence to: A
Hall, Room 476, 1841
Copyright # 2006
Leadership development in healthcare:
A qualitative study
ANN SCHECK McALEARNEY*
Division of Health Services Management and Policy, School of
Public Health, The Ohio State
University, Columbus, Ohio, U.S.A.
Summary Challenges associated with leading a $1.7 trillion
industry have created a need for strong
leaders at all levels in healthcare organizations. However,
despite growing support for the
importance of leadership development practices across
industries, little is known about
leadership development in healthcare organizations. An
extensive qualitative study comprised
of 35 expert interviews and 55 organizational case studies
included 160 in-depth, semi-
structured interviews and explored this issue. Across interviews,
several themes emerged
around leadership development challenges that were particularly
salient to healthcare organ-
izations. Informants described how the relative newness of
leadership development practices
in a majority of healthcare organizations contributes to an
overall perception of haphazard
practices throughout the industry. In addition, respondents
noted challenges associated with

developing leaders who would be representative of the patient
community served, and
commented on the pressure to segregate different professional
groups for leadership devel-
opment. Framed by these challenges, I propose a conceptual
model of commitment to
leadership development in healthcare organizations as
influenced by three factors—strategy,
culture, and structure. These, in turn, influence program design
decisions and can impact
organizational effectiveness. In the context of inherently
complex healthcare organizations
where leaders must respond to multiple stakeholders and meet
performance goals across
multiple dimensions of effectiveness, addressing these reported
challenges and consider-
ing the importance of organizational commitment to leadership
development can help
ensure that programs are effectively designed, delivered, and
sustained. Copyright # 2006
John Wiley & Sons, Ltd.
Introduction
A sense of crisis is building about how healthcare organizations
will meet their leadership needs in the
future (Institute for the Future, 2000; Mecklenburg, 2001;
Schneller, 1997). Yet few healthcare
organizations have made substantial investments in developing
their leaders. Although bombarded by
constant and rapid change within the $1.7 trillion industry
(Smith, Cowan, Sensenig, Catlin, & Health
Accounts Team, 2005), healthcare organizations are frequently
slow to adopt best practices from other

industries. Instead, the industry struggles to respond to crucial
needs including reducing unnecessary
medical errors (Kohn, Corrigan, & Donaldson, 1999), increasing
investments in information
nn S. McAlearney, Division of Health Services Management and
Policy, The Ohio State University, Cunz
Millikin Road, Columbus, OH 43210-1229, U.S.A. E-mail:
[email protected]
John Wiley & Sons, Ltd.
Received 30 January 2005
Revised 30 January 2006
Accepted 29 June 2006
968 A. S. McALEARNEY
technologies (Benchmarks, 2002), and addressing the glaring
inequities and disparities in both access
to care and medical treatment (Kerr, McGlynn, Adams, Keesey,
& Asch, 2004; McGlynn et al., 2003;
Smedley, Institute of Medicine, Stith, & Nelson, 2002). This
article addresses the gaps in leadership
development within healthcare organizations and contextual
factors that hamper closing these gaps.
Certain features of healthcare organizations are clearly unique
to the industry (Ramanujam &
Rousseau, 2004). Although physicians play a central role in the

delivery of healthcare services, they are
rarely employed by provider organizations, and are thus
typically outside the purview of traditional
human resources practices and leadership development
initiatives. In addition, the professional norms
and practice standards expected of physicians and other medical
professionals create demands for
continued clinical education and development that the
organization must facilitate, but that are rarely
linked to the education and development priorities of the
healthcare organization itself. Further, the
multiple constituencies of healthcare organizations including
patients, families, insurers, and
regulators that compete to influence healthcare have varied
perspectives about care delivery and its
dynamics, and these divergent views contribute to considerable
complexity around definitions of
organizational effectiveness and impact for healthcare leaders to
interpret.
Challenges for leadership in the healthcare industry
Complexity in the healthcare industry undoubtedly creates
special challenges for leadership and
leadership development, stemming from a combination of both
environmental and organizational

factors. Environmentally, healthcare organizations are faced
with a myriad of regulatory influences
largely out of their control. For example, most hospitals receive
a majority of their reimbursement from
public sources, including the Federally-sponsored Medicare
program and the co-sponsored Federal and
State-funded Medicaid program. Yet these provider
organizations rarely have much power or influence
over reimbursement rates, and reimbursement for both hospital
and physician services may be below
the actual cost of providing care. As a result, hospitals are
challenged to manage fragile budgets and
often shifting reimbursement rates, while needing to deliver
high-quality care regardless of payment
source or adequacy.
Organizationally, healthcare organizations are notorious for
seemingly chaotic internal
coordination. Multiple hierarchies of professionals, on both the
clinical and administrative sides
of the organization, generate special challenges for directing the
organization and coordination of
work in healthcare. Often noted is the cultural chasm between
administrators and clinicians (e.g.,

Friedson, 1972; McAlearney, Fisher, Heiser, Robbins, &
Kelleher, 2005; Shortell, 1992). Even
within clinical ranks, divisions exist associated with
professional distinctions such as between
physicians and nurses, pharmacists and physicians, and so forth.
Such differences create
considerable challenges for leadership as organizations struggle
to manage their varied employed
and contracted worker populations.
Competing organizational priorities create constant challenges
for healthcare leaders charged to
direct and appropriately utilize financial and human resources
to best serve patients, communities, and
other stakeholders and constituents. The needs of multiple
internal and external stakeholders often
conflict. An oft-repeated phrase is the notion of ‘‘no mission,
no margin,’’ reflecting the fundamental
importance of maintaining the healthcare organization’s
financial viability in order to serve the needs of
patients and the community. Though goals may be clearer in
for-profit hospitals or healthcare systems
in which shareholder demands mandate a focus on financials,
such settings still require professional
commitments and face ethical concerns.

Managerial and organizational learning receive relatively little
attention in health care
organizations. Management mistakes in healthcare are rarely
acknowledged or examined as useful
sources of organizational learning (Hofmann, 2005; Hofmann &
Perry, 2005; Jones, 2005; Kovner
Copyright # 2006 John Wiley & Sons, Ltd. J. Organiz. Behav.
27, 967–982 (2006)
DOI: 10.1002/job
LEADERSHIP DEVELOPMENT IN HEALTHCARE 969
& Rundall, 2006; Russell & Greenspan, 2005). For example, the
failed merger between Stanford
and UCSF Medical Center could have been predicted by a
review of both general and healthcare-
specific management literature, yet several years and millions
of dollars later, the two systems
separated to become independent systems once again (Russell,
2000). In healthcare settings, there
is often little attention given to how to improve management
practice, increasing the likelihood that
previous mistakes will be repeated.
Conceptual Background
Healthcare leadership needs

Clinical and organizational challenges combined increase the
need for strong leadership at all levels of
healthcare organizations. Considerable evidence supports the
notion that leaders and their actions
affect organizational results (Fuller, Paterson, Hester, &
Stringer, 1996; Lowe, Kroeck, &
Sivasubramaniam, 1996; Sashkin & Rosenbach, 2001; Smith,
Carson, & Alexander, 1984). In
healthcare organizations, the impact of leaders extends to the
lives and well-being of patients and their
communities. Features of healthcare delivery make these effects
distinct. For example, in contrast to
other customers and consumers, the vulnerability of patients and
the problem of asymmetric
information in healthcare delivery choices are frequently
mentioned as contributors to patients’
position as a unique category of customers (Newhouse, 2002).
The typically dual role of physicians as
both consumers of healthcare resources and controllers of
organizational revenues in their ability to
direct patients and prescribe care, makes leader relationships
with physicians fairly atypical in
comparison with key stakeholder relationships in other
industries.

Further, researchers and authors have recently emphasized that
great leadership must be
transformational, requiring leaders to be able to empower and
motivate their workforce, define and
articulate a vision, build and foster trust and relationships,
adhere to accepted values and standards, and
inspire their followers to accept change and meet organizational
goals on multiple levels (Bass, 1985;
Bennis, 1989; Bono & Judge, 2003; Burns, 1978; Gardner,
1990; House, 1977; House & Shamir, 1993;
Kouzes & Posner, 1993, 1995). Yet a sense of how to best
develop these great, transformational leaders
is far from established, especially in healthcare organizations.
Leadership development practices
Leadership development practices are defined as educational
processes designed to improve the
leadership capabilities of individuals. These practices are rooted
in the traditions of management training
programs designed to improve both individual managerial skills
and job performance (Burke & Day,
1986), and can have important effects on both organizational
climate (Moxnes & Eilertsen, 1991) and
organizational culture (Schein, 1985). Practices in leadership

development are a variant of management
development practices which are defined as interventions that
are intended to enhance effectiveness or
improve organizational culture by facilitating managers’
learning (Gray & Snell, 1985).
Conger and Benjamin (1999) outline four general approaches to
leadership development that include
developing the individual leader, socializing company vision
and values, strategic leadership
initiatives, and action learning (Conger & Benjamin, 1999).
Within organizations, leadership
development practices commonly include activities such as 360-
degree feedback, skill-based training,
job assignments, developmental relationships (e.g., mentoring,
coaching), and action learning (McCall,
Lombardo, & Morrison, 1998; McCauley, Moxley, &
VanVelson, 1998; Revans, 1980). Although
considerable variability exists across organizations and
industries with respect to the balance and
27, 967–982 (2006)
DOI: 10.1002/job

content of leadership development programs, program designs
are generally consistent with the four
basic frameworks outlined above. This consistency presents
opportunities to explore program
development challenges and decisions in a particular set of
organizations, such as healthcare
organizations, rather than focus on program features and details.
Leadership development in healthcare
Anecdotal evidence suggests the healthcare industry lags behind
other industries with respect to
leadership development practices and other human resources
functions, but these issues have not been
systematically investigated. This exploratory study is designed
to improve our understanding of
leadership development practices in healthcare organizations by
asking experts and organizational
representatives to describe their views of leadership
development in healthcare, and to propose future
directions for healthcare leadership development.
Organizational Context
External Environment
The $1.7 trillion U.S. healthcare industry is both extensive and
competitive, with nearly 5,000 hospitals

and 700,000 physicians nationwide. Most markets are
dominated by not-for-profit hospitals and health
systems, yet these healthcare organizations are subject to strong
pressure to adhere to rigorous business
principles in order to remain viable and realize their
organizational missions.
Industry Factors
Several features of the healthcare industry are clearly unique.
For instance, while physicians are rarely
employed by hospitals or health systems, they play a central
role in directing and utilizing
organizational resources, creating challenges for organizational
leaders. Similarly, external influences
from third parties including insurance companies, employers,
and government payers drive strategic
organizational priorities around issues such as cost containment
and quality improvement.
Organizational Factors
Inside healthcare organizations, internal coordination is often
reportedly poor, leading to avoidable,
expensive, and often devastating medical and managerial
mistakes. The cultural chasm between
administrators and clinicians contributes to a sense of chaos,
with workers often identifying more

with their professional peers than with the organization.
Further, human resources functions in
healthcare organizations have historically been limited in scope,
and rarely valued for any strategic
role in contributing to organizational success.
Current Problems Faced
Enhanced focus on strategic priorities in healthcare has
increased organizations’ attention to the
need to develop and improve their human resources capabilities.
Yet, despite evidence from other
industries about the roles and opportunities for leadership
development in organizations, our
understanding of leadership development practices in healthcare
organizations was limited.
Time
This study was conducted in 2003 and 2004, during a period of
rapid change in the healthcare
industry. Intensifying demands for new information
technologies in clinical practice, error
reduction in medicine, and new capabilities among healthcare
knowledge workers increased
pressure to better prepare leaders at all levels in healthcare
organizations.

27, 967–982 (2006)
DOI: 10.1002/job
Methods
Study design
I conducted 35 key informant interviews with individuals
considered experts in healthcare leadership
on the basis of their national reputation, and studied 55
organizations reported to provide healthcare
leadership development training either in-house or as a vendor
to healthcare provider organizations.
The combination of expert interviews and organizational case
studies included a total of 160 interviews
conducted between September 2003 and December 2004. Table
1 shows the characteristics of study
participants across expert interviews and case studies.
I used standard, semi-structured interview guides including
open-ended questions to both frame the
interviews and permit probing for additional information (Miles
& Huberman, 1994) in the expert
interviews and case studies. The original interview guides were
pilot tested with healthcare leaders and

provider organizations in the local area.
This qualitative design (Maxwell, 1996) enabled me to meet the
objectives of my research,
permitting exploration of the different issues that emerged
around the topic of leadership development
in healthcare. A qualitative approach was appropriate for this
study because of the exploratory nature
of my research, and because I suspected that experts’ and
organizations’ perspectives about leadership
development were multidimensional, making them difficult to
examine quantitatively (Miles &
Huberman, 1994). In addition, my use of qualitative methods
enabled me to explore both experiences
and predictions of experts and organizational representatives,
and provided rich information about the
multiple facets of leadership development challenges in
healthcare (Crabtree & Miller, 1999; Miles &
Huberman, 1994). No potential informant contacted refused to
participate in the study. All participants
were assured that their voluntary participation would remain
anonymous.
Expert interviews
Expert key informants were purposely selected based on their

reputation in the healthcare industry
using a snowball sampling technique. The original sample of
key informants was generated by the
industry and academic members of the national Center for
Health Management Research (Seattle,
WA), and the sample was extended by study informants who
were asked to suggest additional experts
Table 1. Study participants
Description Number (%)
Experts interviewed Association leaders 15 (43%)
University faculty 12 (34%)
Industry consultants 8 (23%)
Total 35
Organizational case studies Healthcare provider organizations
43 (78%)
Leadership development program vendors 12 (22%)
Total 55
Organizational case study Executive-level Informant 39 (31%)
informants Director-level Informant 51 (41%)
Manager-level Informant 23 (18%)
Program participant 12 (10%)
Total 125
Total key informants 160
27, 967–982 (2006)

DOI: 10.1002/job
for the study interviews. Experts had a variety of current and
former affiliations, including with
healthcare industry associations, universities, consulting
organizations, and provider organizations.
Data saturation was judged to be reached when informants’
suggestions about key informants were
repetitive, and when no new insights were emerging from the
ongoing data analysis (Morse, 2000).
Interviews were conducted both in-person and telephonically,
using rigorous ethnographic interview
techniques (Spradley, 1979). Interviews lasted 45–90 minutes,
with an average duration of 1 hour,
consistent with the methods suggested for in-depth interviews
(McCracken, 1988). Experts were asked to
describe their own healthcare leadership and leadership
development experiences, and to comment on both
the current status of and program development opportunities for
leadership development in healthcare.
Organizational case studies
Similar to expert informants, organizations were purposely
sampled based on their reported experience

and reputation with leadership development in healthcare. The
original sample was again produced by
the members of the Center for Health Management Research,
and extended based upon conversations
with experts and other organizational informants. Fifty-five
organizations were studied between
September 2003 and December 2004. Five organizations were
studied in person in order to efficiently
complete multiple key informant interviews, while the
remaining organizations were studied using
numerous telephone interviews. One hundred twenty-five
interviews were held as part of the
organizational case studies. These case studies (Yin, 1984)
consisted of interviews with key informants,
in addition to collection and study of documents associated with
the leadership development programs,
and a review of publicly available program information
accessible through formal publication or the
Internet. Interviews lasted 30–90 minutes, with an average of 45
minutes for each interview.
Organizations studied included both healthcare provider
organizations with internal leadership
development activities and external organizations which provide
leadership development programs to

individuals and institutions in the health services industry.
Internal case study organizations consisted
of 43 healthcare systems and individual hospitals which had
reportedly designed and implemented
healthcare leadership development programs, and respondents
included executives, directors,
managers, and program participants. Twelve external case study
organizations included both
healthcare associations and other vendors of healthcare
leadership development programs, with
respondents including individuals leading the organizations and
those developing and delivering
healthcare leadership development programs.
Questions addressed the structure and format of leadership
development program activities,
including approaches to identifying and targeting individuals
and groups for leadership development
opportunities. Similar to the expert interviews, an open-ended
list of questions was used, including
questions probing for more information.
Analyses
A majority of the interviews were audiotaped and professionally
transcribed, with extensive field notes

used in the small number of cases (3) where taping was
infeasible. This process yielded 160 transcripts
and over 1,000 single-spaced pages for analysis.
My analyses used the constant comparative method of
qualitative data analysis (Glaser & Strauss, 1967),
and common techniques to code the data (Constas, 1992; Miles
& Huberman, 1994). Using a grounded
theory approach (Glaser & Strauss, 1967; Strauss & Corbin,
1998), I read transcripts and discussed findings
with my research associates and professional colleagues as the
study progressed. This iterative process
enabled me to explore new themes that emerged in subsequent
interviews and case studies.
27, 967–982 (2006)
DOI: 10.1002/job
I applied a combination of deductive and inductive methods in
my analyses. Prior to coding the data,
I produced ideas about the themes I expected to find, and then
closely read the transcripts to inductively
advance code development. This coding process permitted me to
organize the data into categories of

findings, and allowed me to identify broad themes that emerged
from the data (Miles & Huberman,
1994). I use the term ‘‘theme’’ to identify a cohesive category
of responses, found across experts and/or
across organizations, that aggregates patterns observed in the
data. In addition, throughout the study,
periodic discussions with professional colleagues and my
research associates and an ongoing review of
the literature helped me to validate, compare, and extend my
findings, where appropriate (Glaser &
Strauss, 1967). I used the qualitative data analysis software
Atlas.ti (version 4.2) (Scientific Software
Development, 1998) to support these analyses.
Results
First, six distinct themes emerged from the data concerning the
specific leadership development
challenges for healthcare organizations. Each of the themes was
discussed across informants,
supporting the validity of these findings. A summary of these
leadership development challenges is
presented in Table 2, and below I discuss each theme in greater
detail. Second, I propose a conceptual
model for organizational commitment to leadership development
in healthcare organizations. I present
this model and three propositions in the following pages.

Verbatim quotations have been selected that
are representative of the data.
Table 2. Challenge themes in healthcare leadership development
Challenge Representative comments
Theme 1: Industry lag: The healthcare
industry is very behind
‘‘We’re 15 years behind’’
‘‘I don’t think we are doing very well at all.’’
Theme 2: Representativeness: Need to
make organization
representative of community
and patient population
‘‘Hospital leadership should be a reflection
of the demographics of the community that
the hospital serves.’’
Theme 3: Professional conflicts:
Pressure to segregate different
professional groups for
leadership development
‘‘I do think it divides the organization and
so I don’t know that that’s a good thing to
have your managers divided.’’
Theme 4: Time constraints: Challenge of
freeing time for
program participation
‘‘That’s an hour or two. . .that’s being spent

away from patient care in
a learning environment.’’
Theme 5: Technical hurdles:
Challenges of the
organization’s technical
capabilities
‘‘If I don’t have a sound card then what’s the
use of getting a teleconference or a
videoconference? Because then
I can’t even hear it.’’
Theme 6: Financial constraints:
Challenges associated with
budgets, organization type
‘‘It’s something that’s the first thing that
people cut in a tight budget situation.’’
27, 967–982 (2006)
DOI: 10.1002/job
Challenges of leadership development in healthcare
Theme 1: Industry Lag—The healthcare industry is very behind.
Across informants, many respondents noted that ‘‘healthcare
organizations are 10–15 years behind
other industries in the area of leadership development.’’ This

characterization of the industry as a whole
was consistent, and perhaps reflective of the trouble and delays
healthcare organizations have had
translating other industry practices (e.g., quality improvement
techniques) into their own
environments. As one respondent explained:
‘‘I think they’re learning what industry learned 15 years ago.
You’ve got to develop your own people
and you’ve got to fully pursue it. You’ve got to invest to do it
and you might as well make it a rational
decision that’s matched to the business strategies rather than
having these segmented areas where we
have OD [Organizational Development] doing some things here,
we have nursing development
rolling out God knows what over there. I think they’re really
learning what industry learned. You
know, it’s a classic curve. We’re 15 years behind in quality and
we’re about the same amount of time
behind in training.’’
In addition, there was a sense that commitments to leadership
development by healthcare organizations
were generally rare, and often insufficient. As one individual
reported, ‘‘I think a lot people who get into it

are just going through motions.’’ Another respondent similarly
noted, ‘‘I think that healthcare doesn’t
mandate enough leadership development from their managerial
ranks in general.’’ In contrast, the
importance of senior leadership commitment, the designation of
a highly visible and powerful program
director, and the need to align leadership development activities
with other organizational goals and
strategies may be standard in other industries which have a
longer history of incorporating leadership
development practices, but are only beginning to be recognized
in healthcare.
Theme 2: Representativeness—Need to make the organization
representative of the community and
the patient population.
A second theme that emerged involved the reported challenge of
healthcare organizations to develop
a diverse group of leaders that was representative of both the
patient population and the surrounding
community. As one informant explained, ‘‘As you develop your
management staff I think you have to
look for an opportunity to bring the kind of diversity that’s
necessary for your organization to be
responsive to the needs of the community that you serve.’’

Comments such as this were frequent across
respondents, and reflected the growing industry sensitivity to
the needs of diverse populations, and the
critical issue of disparate healthcare provision in U.S. hospitals
(Kerr, McGlynn, Adams, Keesey, &
Asch, 2004; McGlynn et al., 2003; Smedley, Institute of
Medicine, Stith, & Nelson, 2002).
Theme 3: Professional Conflicts—Pressure to segregate
different professional groups for leadership
development.
Another theme emerged around the issue of bridging the gap
that exists between administrative and
clinical leadership in healthcare organizations. Across the
internal programs I studied, there was
considerable debate about the best way to develop clinician
leaders, with a number of the proposed
approaches having only recently been implemented. For
example, many organizations reported tension
around the issue of nursing leadership development.
Opportunities are growing for nurses to participate
in leadership development programs that are separate from both
organizational programs and other
clinical leadership programs (e.g., the Health Care Advisory
Board’s Nursing Leadership Academy),

yet not all respondents believe this approach is best for the
organization as a whole. As one respondent
27, 967–982 (2006)
DOI: 10.1002/job
…
Doxing and Digital Journalism:
The HuffPost Story on Amy Mekelburg
On May 31, 2018, HuffPost reporter Luke
O’Brien published a story revealing the
identity of the person behind an
infamous Twitter account with over
200,000 followers as 45-year-old Amy
Mekelburg. The in-depth profile was part
of HuffPost’s ongoing investigation into
the most influential anonymous Twitter
and Facebook users that, in the words of
HuffPost reporter Nick Baumann, “spread
hate.” The account, which O’Brien
correctly linked to Mekelburg, is a powerful proponent of far-

right political ideologies and
was active in spreading what many deem as Islamophobic
propaganda and factually untrue
claims. Averaging around 25 tweets a day, the account quickly
gained popularity on social
media, it was endorsed by President Donald Trump and
members of his administration,
making it well-known in conservative circles. O’Brien’s story
quickly became controversial
due to its use of “doxing” (or “doxxing”), the tactic of revealing
the identity and personal
details of the person behind an anonymous online account or
website. By connecting and
publicizing the online actions and words associated with a
specific named individual, online
activists can coordinate with others and use doxing in a
campaign to embarrass individuals,
ruin reputations, harm political ambitions, or to get an
individual’s employment terminated.
The practice is increasingly used by members across the
political spectrum, from the far left
to the far right, and has become an everyday weapon in the
battle of political ideologies.
Some think of it as a tactic that leverages the critical power of
free speech, whereas others
see it as a vigilante approach to online justice given that its
practitioners are often
anonymous, or at least unaccountable for the harms of doxing
individuals. The doxing of
Mekelburg is important as it merges tactics of investigative
journalism and online activism,
and raises many ethical concerns.
The crowdsourced nature of social media has made it possible
for everyday individuals to
gain celebrity status or to become known as public figures

through their online personas.
The malleable nature of online identity means that individuals
are able to remain anonymous
or control which parts of their identity are viewable to others,
often making it easier to share
controversial opinions or ideas. As such individuals gain more
social and political influence,
some argue that the public has a right to know who they are.
This is why HuffPost started
investigations into influential anonymous social media
accounts, such as that of Mekelburg,
that were spreading what many judge as false information and
hate speech. HuffPost
reporter Nick Baumann explains that while the First Amendment
gives individuals the right
to spread hate speech and discredited ideas anonymously, “the
identities of influential
anonymous people are inherently newsworthy” and should be
made know to those who wish
Screencapture: Twitter.com
to know them. Baumann and O’Brien argued that the story was
not a case of doxing at all,
since it presented newsworthy information to the public and
answered concerns about the
possibilities of Mekelburg’s account being an artificial bot or
Russian troll. In this manner,
they maintain that the story followed journalistic codes of

ethics, including reaching out to
Mekelburg’s family and her husband’s employer, World
Wrestling Entertainment, who
subsequently terminated his employment after news of the story
broke. The journalists
maintained that this was not the coordinated harassment of
many doxing campaigns, but
was instead the common journalistic practice of seeking
comments and reactions from those
affected by the story before its publication. O’Brien argued that
giving sources and affected
parties “a chance to respond to information” is “exactly how
ethical journalism works” and
defended the information included in his report as necessary to
the story. Emma Grey Ellis
points out that while doxing campaigns tend to be undertaken by
anonymous individuals
that cannot be criticized in return, cases such as this involve
named reporters who “have
bylines, and can therefore be held accountable” for the stories
they write and the information
they include. Because of this, she argued that reporters like
O’Brien “include only personal
information that is relevant to a story--facts the public has a
compelling interest in knowing.”
Many believe that the information in the story was necessary to
create a profile of Amy
Mekelburg and provided context for her often-bigoted posts.
Others consider the story to be
a case of justified doxing and as serving the public good. Many,
like Marla Wilson, believe
that doxing is “an effective way to make people think twice
about being so bold with their
racism” and that releasing the names of those behind racist
online accounts creates a sense
of accountability and encourages reflexivity by those who feel

inclined to create them. Some
argue that doxing forces those uttering unpopular opinions and
beliefs to face the public and
defend their ideologies rather than just placing them online.
Some believe that the Mekelburg story included information
that was not necessary, or that
was counterproductive for improving political discourse.
Conservative reporter Kevin Boyd
points out that by including background information that
revealed the identities of
Mekelburg’s family members and their businesses, the story
gave “the impression that they
either knew about or [agreed] with her tweets” and indicted
them as supporters of her
account and her beliefs. Because of such implications, many
consider the story to be nothing
more than an attempt to shame Mekelburg for her views and
hurt her family’s businesses,
ones that Mekelburg “has never been linked to or involved
with” according to her sister-in-
law Alicia Guevara. Damon McCoy points out that one of the
main reasons doxing is used is
to “expose those with whom [people] disagree with,” a position
held by those who suggest
that the report done by O’Brien and HuffPost was motivated by
bringing shame to those with
divergent political viewpoints. Some may argue that the
revealing the identities of those
behind reprehensible or unpopular speech is actually
counterproductive to serving the
public interest. Tony McAleer, a former white supremacist who
now runs a rehabilitation
program for neo-Nazis, argues that doxing is not effective in
ending hate speech and
changing peoples’ viewpoints. “If isolation and shame is the

driver for people joining [hate]
groups, doxxing certainly isn’t the answer” argues McAleer. It
actually “slows things down”
in his efforts to rehabilitate those who subscribe to hateful
ideologies given its employment
of isolation and shame.
The ethics of doxing must be discussed more as its practice
grows to include journalists and
targets on all sides of the partisan spectrum. Emma Gray Ellis
worries that “once you strip
away the intentions… both sides are sharing the same swampy
low ground” when doxing is
used as an attempt to punish individuals for their political or
personal beliefs. What are we
to think about the uses of intentional or unintentional doxing by
journalists working on
contentious but important stories that might shed light on the
political and social
controversies of the day?
Discussion Questions:
1. Was the HuffPost story on Mekelburg a case of doxing? Why
or why not?
2. Was the story written and researched in the right way,
regardless of whether we

label it as a case of doxing?
3. Can journalists “dox” individuals behind online accounts?
When and why can they
participate in this practice? What limits should constrain their
revelation of online
identities?
4. How does the practice of doxing differ in the context of
online journalism from that
of activists seeking social justice? Does the role of journalist
make any difference to
the ethical limits of the act of doxing? How does investigative
journalism differ from
doxing, either by journalists or members of the public?
Further Information:
Baumann, N. (2018, June 05). “A HuffPost Reporter Was
Bombarded With Threats.
Twitter Suspended Him.” HuffPost. Available at:
https://www.huffingtonpost.com/entry/luke-obrien-doxed-
threats-
amymek_us_5b16bb9de4b0734a9937f2ca
Bowles, N. (2017, August 30). “How 'Doxxing' Became a
Mainstream Tool in the
Culture Wars.” New York Times. Available at:
https://www.nytimes.com/2017/08/30/technology/doxxing-
protests.html
Boyd, K. (2018, June 04). “The HuffPost Ruined An Entire
Family For One Person's

Tweets.” The Federalist. Available at:
https://thefederalist.com/2018/06/04/huffpost-ruined-entire-
family-one-persons-
tweets/
Ellis, E. G. (2017, August 17). “Don't Let the Alt-Right Fool
You: Journalism Isn't
Doxing.” Wired. Available at:
https://www.wired.com/story/journalism-isnt-
doxing-alt-right/
threats-amymek_us_5b16bb9de4b0734a9937f2ca
threats-amymek_us_5b16bb9de4b0734a9937f2ca
https://www.nytimes.com/2017/08/30/technology/doxxing-
protests.html
family-one-persons-tweets/
family-one-persons-tweets/
https://www.wired.com/story/journalism-isnt-doxing-alt-right/
https://www.wired.com/story/journalism-isnt-doxing-alt-right/
Ellis, E. G. (2017, August 18). Doxing Is a Perilous Form of
Justice-Even When It's
Outing Nazis. Wired. Available at:
https://www.wired.com/story/doxing-
charlottesville/

McCoy, D. (2018, May 01). When Studying Doxing Gets You
Doxed.” HuffPost.
Available at: https://www.huffingtonpost.com/entry/opinion-
mccoy-doxing-
study_us_5ae75ec7e4b02baed1bd06cc
O'Brien, L. (2018, May 31). “Trump's Loudest Anti-Muslim
Twitter Troll is a Shady
Vegan Wed to An Ex-WWE Exec.” HuffPost. Available at:
https://www.huffingtonpost.com/entry/anti-muslim-twitter-troll-
amy-mek-
mekelburg_us_5b0d9e40e4b0802d69cf0264
Wilson, M. (2018, June 06). “An Online Agitator, a Social
Media Exposé and the
Fallout in Brooklyn.” New York Times. Available at:
https://www.nytimes.com/2018/06/06/nyregion/amymek-
mekelburg-huffpost-
doxxing.html
Author:
Jason Head
Media Ethics Initiative
Center for Media Engagement
University of Texas at Austin
June 15, 2018
www.mediaethicsinitiative.org
https://www.wired.com/story/doxing-charlottesville/

https://www.wired.com/story/doxing-charlottesville/
https://www.huffingtonpost.com/entry/opinion-mccoy-doxing-
https://www.huffingtonpost.com/entry/opinion-mccoy-doxing-
amy-mek-mekelburg_us_5b0d9e40e4b0802d69cf0264
amy-mek-mekelburg_us_5b0d9e40e4b0802d69cf0264
mekelburg-huffpost-doxxing.html
mekelburg-huffpost-doxxing.html

1 www.mediaethicsinitiative.org How Deep Does the .docx

Recommended

Recommended

More Related Content

Similar to 1 www.mediaethicsinitiative.org How Deep Does the .docx

Similar to 1 www.mediaethicsinitiative.org How Deep Does the .docx (20)

More from teresehearn

More from teresehearn (20)

Recently uploaded

Recently uploaded (20)

1 www.mediaethicsinitiative.org How Deep Does the .docx