Ethics in Healthcare: ACHE Self-Assessment and Decision Making

Introduction

The role of ethics in healthcare is to mitigate risks and ensure oversight of each strategic process area, guaranteeing consistency and transparency in patient treatment quality. The American College of Healthcare Executives (ACHE) Code of Ethics and its self-assessment provide foundational insights into how ethical decisions can be made more effectively and how decision making can align with ACHE standards. Ethics are the foundation of patient trust and must serve as the catalyst for transparency throughout a healthcare provider organization, from the practice level upward, ultimately solidifying collaboration between patients and providers toward common goals (Higgins, Gross, & Hackett, 2000).

In the highest-performing healthcare organizations, there is a tight alignment between patient expectations and the need for transparency on one hand, and the ethics and willingness of healthcare providers to disclose the data and knowledge necessary to keep treatment plans progressing on the other (Frederick, Wasieleski, & Weber, 2000). In addition to the ethical requirements of healthcare providers to share information, intelligence, insights, and knowledge, there is a moral imperative to guide patients toward the best possible treatment programs and to redefine treatment workflows as needed (Weil, Kimball, & Lerner, 2010).

Ethical Decision Making: Lessons From Self-Assessments

The ACHE self-assessment provided insightful analysis of leadership and the many facets of relationships that healthcare professionals must manage effectively in order to deliver exceptional service (Higgins, Gross, & Hackett, 2000). These facets of relationships include community, patients and their families, boards, colleagues and staff, clinicians, and buyers, payors, and suppliers. After completing this self-assessment, the following observations were made.

First, sustaining ethical behavior and guidance as defined by the ACHE Self-Assessment over a long period of time is very difficult without a robust set of transformational leadership skills. This is corroborated by empirical studies demonstrating the value of Emotional Intelligence (EI) in maintaining ethical values and decision making as a core attribute of healthcare provider culture (Weil, Kimball, & Lerner, 2010). Also evident is that transformational leadership — which seeks to motivate entire healthcare staffs to remain committed to ethical behavior and decision making — depends heavily on the ability to persuade, combined with the attributes of charismatic leadership and EI as part of an integrated leadership strategy (Higgins, Gross, & Hackett, 2000).

Second, ethical practice across communities, both within and outside a healthcare provider organization, is an iterative process that must incorporate both qualitative and quantitative dimensions to succeed. This is supported by empirical studies showing the inherent value of attending to both quantitative and qualitative aspects of ethical compliance and best practices attainment (Frederick, Wasieleski, & Weber, 2000). The community-focused questions in the self-assessment — particularly those regarding patients and their families, colleagues and staff, and clinicians — highlight the need for continual attention to authenticity and transparency so that trust can be created and maintained over time.

The quantification of trust has been a focus of researchers examining how ethics could be incorporated into balanced scorecards and performance analytics; however, ease of measurement has remained elusive (Weil, Kimball, & Lerner, 2010). The focus has instead shifted toward defining policies and processes for ethical compliance, yet many of these approaches have lacked the agility to respond to changing healthcare requirements (Weil, Kimball, & Lerner, 2010). Completing the ACHE Self-Assessment makes clear that there is room for innovation and improvement in how healthcare providers interpret and act on the data it provides, even at the individual level. It is reasonable to conclude that the aggregation of responses to the ACHE Self-Assessment could serve as a benchmark across an entire healthcare organization. The continual pursuit of analytics, key performance indicators (KPIs), and performance metrics indicating relative levels of ethical compliance is critically important across the healthcare profession (Ehlen & Sprenger, 1998). Only by aggregating these responses will a healthcare provider gain meaningful insight into how it can improve ethically and serve patients with greater transparency, thereby earning and sustaining trust.