Individual ethical choices have strong impacts on organizational ethical behaviors. In fact, individual ethical choices are precisely what constitute organizational ethics, as organizations are only as ethical as their employees. In health care organizations, ethics become critical and may have strong bearings on patient outcomes or community health outcomes. Professional ethical standards and personal ethical codes combine to influence my ethical decisions. The ACHE Ethics Self-Assessment Tool highlights the multitude of ways an individual's behavior may impact the organization, its clients, and its stakeholders. The inventory includes items related to leadership behaviors, communications issues, honesty, personal integrity, compliance with ethical standards, and willingness to broach difficult subjects with supervisors or colleagues. Categories include leadership, relationships with community, patients, patient families, the board, colleagues, staff, clinicians, and buyers or purveyors. The thoroughness of the ACHE Ethics Self-Assessment allows for a reliable and accurate personal inventory worthy of in-depth reflection.

My scores did not reveal critical "red flag" issues. I have been working in the health care field long enough to have developed confidence in my ability to raise ethical questions and present concerns to others. I also understand how my behaviors impact the lives of others. I have become aware of and thoroughly familiar with the codes of ethics of my organization as well as professional codes that we comply with as health care workers. The only potential conflicts that have arisen in my experience have been with complex situations in which there are no clear-cut answer. The ACHE Ethics Self-Assessment does not include nuanced scenarios that arise in real-life situations, which is why it is not an ideal tool for ethical reflection. However, it has brought to light some of the behaviors that I could improve upon. For example, I have occasionally omitted information to colleagues or supervisors to avoid overly complicating things, even though I was supposed to bring something to their attention according to our regulations. Yet I make these decisions consciously; after all, there are situations in which the procedural codes and guidelines are arbitrary and time-consuming....

When there are life/death situations, I believe that I make the judicious ethical decisions on behalf of the patient. Patient outcomes to me are more important than whether paperwork was filled out properly.
While I admit to some violations of formal ethical codes, I do believe that my ethical decision-making promotes the core values of my organization and my profession as a whole. I have a strong sense of moral obligation to patients and community health. As a health care worker, I value ethical behaviors that promote patient well-being and public health. When working as a leader in my organization, I am aware that there are financial and other considerations that need to be taken into account. It has been difficult for me to work with colleagues and administrators who focus more on financial issues than on patient outcomes or on the needs of family members. Some of the decisions made by administrators conform to the most basic ethical standards but I feel do not go far enough to ensure patient satisfaction. There is a big difference between a patient who is simply satisfied and a patient who is deeply grateful for the service provided. I have therefore tried to convey to my administrators the need to create happy clients who will tell their friends and family members about the service they received at our institution.

Of course, I follow all ethical injunctions against breaches of confidentiality and other basic ethical tenets. Equal treatment of all patients is not something I have ever struggled with, but there have been situations that have arisen in which there were conflicts between how to allocate resources. I tend to weight the needs of more serious or acute patient needs vs. non-emergency situations. This has put me in conflict with both patients and colleagues. A patient-centered approach is one that, I believe, recognizes that ethical decisions must be made decisively and logically. Relying on a sort of triage system in which resources are allocated according to need is something that I believe works. It might create some discomfort and even animosity, but when it comes to preventing infections and other immediate needs, it is critical to attend first to core concerns.

One area that I am working on to improve my ethical decision making in the future is…