Abstract
In today’s climate and environment, the conventional relationship between caring, economic, and leadership practices may no longer meet the needs of patients, clinicians, providers, or systems. It is asserted that in the current complicated and complex healthcare environment challenged by a multitude of issues, a shift toward human caring values and an ethic of authentic healing relationships is required, especially in light of the current COVID-19 pandemic. The costs of unethical behaviour can be even greater for followers. When we assume the benefits of leadership, we also assume ethical burdens. It is the assertion and experience of the authors that the triangle of ethics and ethical behaviour, followers, and patient outcomes is closely interrelated and affects each other in a very intimate and direct way. Unethical leadership may lead to follower disappointment and distrust, leading to lack of interest and commitment, consequently negatively impacting patient outcomes and organizational effectiveness.
Introduction
Glouberman and Zimmerman stated that “the Canadian healthcare system is both complex and complicated, a notion well familiar to those attempting to navigate it and access its services and those who work within it and make a daily effort to deliver the range of services it offers.” 1 The most recent COVID-19 pandemic had added an additional layer of hardship to the already overburdened and overchallenged system. Health leaders have become accustomed to shift priorities and function in a rapidly changing environment, often reacting or responding to the “crisis of the day.” This has had significant implications on how leaders manage and navigate their days, as many find that “putting out fires” has a major force in shaping their mandate.
If you were to ask multiple health leaders what is their priority, how do you think they would respond? Answers vary from: Ensuring we provide safe care during the pandemic, Our staff are safe, We have enough Personal Protective Equipment (PPE), We contain COVID-19 and do not spread it further, We receive financial support from the government.
Few would state: We learned and continue to learn from the pandemic, We do things smarter, safer, and better, We leverage virtual care, We strive to be more cautious and careful, We drive change forward, We pride ourselves on the provision of ethical and moral leadership at all times.
The premise of this article is to ask ourselves—What is authentic leadership? What is ethical leadership? How do these types of leadership styles affect the quality of care delivered in the healthcare sector? How does it influence one’s followers?
When we assume the benefits of leadership, we also assume ethical burdens, as well as authenticity conflicts. It is the assertion and experience of the authors that the triangle of authenticity and ethical behaviour, followers, and patient outcomes is interrelated and impacts each other in a direct manner. “Unethical leadership can cause followers to be disappointed, distrust management, become unmotivated, and decrease their loyalty and commitment to the organization, thus leading to negative patient outcomes and decreased organizational effectiveness.” 1,2 “Authenticity conflicts or incongruence, as experienced by the leader, may result in similar outcomes, such as decreased motivation, decreased self-confidence, and decreased trust, to name a few repercussions, in turn causing a perceived leadership failure with much greater environmental impact.” 1,2
The healthcare environment has been described as turbulent, complex, complicated, uncertain, and ambiguous. 3 –5 Thriving and surviving requires a rethinking of the most effective leadership style required; one where health leaders balance the delivery of quality person-centred care with being responsible and accountable within fiscal boundaries, balancing ethical behaviour and quality patient outcomes. 6 –13 To do so requires health leaders to be seen as ethical, moral, transformational, emotionally intelligent, and authentic. 4,7,14 –18 To date, limited evidence exists to support the value and impact that ethical and authentic leadership have on one’s followers, organizational performance, or patient outcomes within the healthcare sector. 6,7,19 –23 Building on Glouberman and Zimmerman’s 1 statement that the healthcare system is both complicated and complex, we assert that today’s organizations are morally complex environments, constantly facing ethical demands and challenges. Ethical and authentic leaders are able to impact their followers to be moral, ethical, and committed to their organizations. 21
In 2003, May et al. 24 introduced the importance of the moral component of authentic leadership following losses due to ethical corporate meltdowns during the latter part of the 20th century. Corporate scandals created financial losses and demonstrated the impact of inauthentic and unethical leadership. May et al. 24 stated that authentic leadership involved authentic decision making, which impacts ethical situations organizations faced. Authentic leaders, for the most part, demonstrate a higher moral capacity to view dilemmas from different angles.
What is ethical leadership?
Ethical leadership is the activity of leaders to foster an environment and culture that supports ethical practice throughout the organization. All leaders play a vital role in creating, sustaining, and changing their organization’s culture through their own behaviour and through programs and activities they support, praise, criticize, and neglect. Ethical leaders serve as role models for their followers and demonstrate how behavioural boundaries are set within their organizations. 5,9
What is authentic leadership?
Authentic leadership is a construct that emerged within the leadership literature since 2004. 1,4,6,19,25,26,27 Authentic leadership has been defined as owning one’s own personal experiences, values, feelings, and emotions; it is very subjective. “Authentic leaders are genuine and values driven.” 11 The research suggested that chief executive officers and senior health leaders need to be in alignment with their organization’s vision, mission, strategy, structure, and culture 16,28 –30 in order to be sustainable and outcome focused.
“Authentic leaders could make a difference in organizations by helping individuals to find meaning in their work, building optimism and commitment amongst their followers, encouraging transparency, trust, and promoting positive ethical climates.” 6
What are the characteristics of ethical leaders?
Ethical leaders are perceived to be honest, truthful, trustworthy, courageous, fair, just, reliable, responsible, and most of all authentic. 21 It is important to integrate ethics into the overall organizational culture whenever possible and feasible. While additional exploration and research is required to determine the value and impact of ethical leadership on followers and organizational performance, it is nevertheless understood to be multifaceted and subjective at times. Ethical leadership may be viewed to be preventing people from carrying out inappropriate acts, while others suggest it is enabling people to do the right thing. An ethical leader is a person living up to the principles of conduct that are crucial for him/her to perform. 21
Ethical leaders need to respect others and listen to diverse perspectives and support their followers to feel proficient about their work. They are there to serve others—they are altruistic and place their follower’s welfare in their plans through mentoring, coaching, team building, while empowering their followers to carry on in their roles.
Ethical leaders are just. They are concerned about justice, equality, diversity, and fairness. They treat their followers as equals. In addition, ethical leaders are honest. This is an integral trait that all ethical leaders must have to be successful. Their followers place their trust in the leader and expect nothing less than transparency and honesty. It is vital that ethical leaders build communities. The leader and his or her followers work collaboratively with each other towards attaining their organizational goals to enhance patient, family, and organizational outcomes.
Authentic and ethical leaders are seen to be considerate and thoughtful—they are concerned about the well-being of others rather than their own progression. They are humble, concerned for others, honest, straightforward in dealing with others, fulfill their organizational commitment, strive for equity and fairness, treat all individuals equally, and do not discriminate against anybody. Ethical and authentic leaders are considerate and motivate their employees to achieve their goals. They are known as leaders who are kind-hearted, respectful, and courageous and lead with integrity at all times.
The American College of Healthcare Executives stated that is important to address ethical decisions systematically and that all healthcare executives have the responsibility to address the growing number of complex ethical dilemmas they are facing using sound ethical decision making process. Ethical leaders use sound frameworks to look at realms of decision making and engage others for input into decisions.
According to the State Expert Panel on the Ethics of Disaster Preparedness in collaboration with the Wisconsin Hospital Association and Wisconsin Public health, 13 there are multiple ethical responsibilities health leaders need to be cognizant of and demonstrate in their day-to-day behaviours. Ethical leaders are expected to provide consistent and rational leadership, especially when leading through crises, such as COVID-19; requiring specific processes and strategies to think through and discuss. Their “duty to provide safe quality care” and strategies that are anchored in collaboration, innovation, creativity, ethical, and authentic behaviour and decision making. Confirming required supply of PPE, ensuring consistent and reliable plans to sustain and meet the changing needs for PPEs, relevant education and training, and availability of required human resources, updated emergency preparedness, and pandemic plans to name a few.
It is integral that health leaders remain calm, courageous, engage in consistent open and honest communication, and remain aware and informed of any changes affecting the working environment and providers.
What is an ethical organization?
Organizations are considered to be systems made up of individuals who work and collaborate with each other for the purpose of meeting the organization’s vision, mission, and goals. Organizations that are ethical are comprised of monetary resources (finances) and human resources (employees). Ethical organizations are comprehensive in relation to their vision, mission, goals, culture, values, procedures, policies, rules, and outcomes. 9,23 A reference to an ethical organization often refers to the organizational ability to define the mission, vision, and values. An ethical organization may also be acknowledged and identified through the ability and effort of its leaders to recognize and identify whether and how the vision, mission, and values generate stressful situations and problems while framing solutions and processes to resolve such tensions and conflicts. Ensuring that the organization is guided by an ethical framework that supports its vision, mission, values, and culture is essential in preventing ethical dilemmas, conflicts, and tensions. Being recognized as an ethical organization is vital in garnering the public’s trust in the services and care delivered within its walls. Leaders are responsible for creating a workplace culture based on integrity, accountability, fairness, and respect. 11,13,16,27
Even though everyday ethical issues arise, if remain unresolved or not addressed, they may lead to unnecessary and costly decisions and may result in unhappy employees/followers who end up becoming less engaged, less committed, struggling with moral distress, burnout, increased turnover, decreased productivity, and decreased efficiency, all impacting the health of the organization and its functional ability to provide safe quality care. The overall goal of ethical leadership is fostering an ethical environment and culture, promoting ethical decision making, and supporting the organization and its employees through the complexity and complications of daily challenges and unpredictable crises.
Conclusion
Ethical leadership is primarily dedicated to the implementation of the responsibilities in an appropriate manner regarding the tasks and functions of the organization. Ethics is primarily concerned with the principles, standards, morals, values, norms, and behaviours that are acceptable by the leaders and other members of the organizations. Ethical leaders are fair in their dealings with others and should not discriminate against anybody on any grounds. Ethical leaders are those leaders who are moral and authentic that walk the talk in all of their actions.
