An Ethical Culture By Jack Gilbert

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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

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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


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DEFINING ETHICS AND
INTEGRITY


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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


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Strengthening Ethics: A Partnership of Goodwill

Employees
taking action to
The organization strengthen
taking action to ethical behavior
strengthen ethical
behavior


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THE RELATIONSHIP OF
ETHICS AND
PERFORMANCE


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Any Organization Transforms Intentions Into Performance

Intentions:
Vision, Mission, Values, Strategy, Goals

Performance:
Safety, Quality of Care, Financial Health,
Satisfaction, Retention, Reputation


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Robert Wood Johnson Fred Kilmer

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“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


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Peace will come
when people have
food

Eating wisely will
enhance beauty and
health

The creation of food
will serve society

Momofuku Ando

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How many
individual servings
of instant noodles
were eaten
worldwide in 2005?

86
Billion

Momofuku Ando

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There Are Ethical Pathways To Performance

Intentions:

Ethical Ethical Pathways
Erosion

Performance:


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ETHICAL EROSION


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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…”


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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


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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…”


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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


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Ethical Erosion and Patient Safety

127 Sentinel Events
3,097 Harmful Events

245,509 Non-Harmful
Events

Figure 1: MEDMARXsm Total Medication Errors, 2004


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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%


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Ethical Erosion and Patient Safety: Hidden Events

Sentinel Events
Harmful Events

Non-Harmful Events

Unreported and Unexposed Events


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Common Practice

≠
Ethical Practice


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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.


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Ethical Erosion and Ethical Wisdom Will Impact The
Health of Ethical Pathways
Intentions:

Ethical Ethical
Ethical Pathways
Erosion Wisdom

Performance:


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ETHICAL WISDOM


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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.


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THE FOUR ETHICAL
PATHWAYS TO
PERFORMANCE


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2007 American Hospital Association Summit

There Are Four Ethical Pathways
Intentions:

Culture Leadership

Ethical Ethical
Erosion Wisdom
Personal
Infrastructure
Integrity

Performance:

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THE ETHICAL PATHWAY
OF CULTURE


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An Ethical Culture Has Five Disciplines Culture Infrastructure

Personal
Intentions Leadership
Integrity

Mindfulness Voice
Ethical Ethical
Erosion Wisdom
Tenacity
Respect Legacy

Performance:


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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


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A HIGH LEVEL
ORGANIZATIONAL
DIAGNOSTIC


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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: ______________

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A Partnership of Goodwill

Employees
taking action to
The organization strengthen
taking action to ethical behavior
strengthen ethical
behavior


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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: ______________

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Closing Thought: The Lesson of Notre Dame
Cathedral


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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


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