Authentic, attentive, and empathic leaders are more likely to emphasize the importance of ethical decision-making (Kovach, 2018). Leaders that are ethical are able to build trust and foster healthy relationships; this results in higher levels of engagement and improved individual as well as team performance (West et al., 2015). Brown and Trevino, (2006) define ethical leadership as:
"The demonstration of normatively appropriate conduct through personal actions and interpersonal relationships, and the promotion of such conduct to followers through two-way communication, reinforcement, and decision-making."
Orientations of Ethical Leadership (Eisenbeiss, 2012):
1) Humane: People should be treated with dignity and respect.
2) Responsibility and Sustainability: The welfare of society and the environment matter.
4) Justice: Decisions should be fair and without discrimination.
4) Moderation: Temperance and humility are needed.
Ethical leadership is needed across disciplines; in healthcare, prioritizing ethics is necessary to provide optimal patient care (Schick-Makaroff & Stoch, 2019). Studies have shown when managers are perceived as authentic by their nursing staff, these nurses are more likely to report managerial trust, have greater work engagement, and provide better quality of patient care (Wong et al., 2010; Wong & Giallonardo, 2013).
The top 3 ethical problems in healthcare are caused by (Aitamaa et al., 2016):
1) Scarce resources 2) Limited power 3) Protection of incompetent staff
The best way to solve ethical problems is to (Laukkanen et al., 2016):
1) Discuss with the team or leader 2) Use an ethical decision-making model 3) Have an intervention 4) Think about personal values and life experience 5) Rely on statistics and feedback 6) Refer to a professional code of ethics
Codes of ethics can help steer a conversation in a positive direction. National and international nursing codes of ethics consistently ask that ethical concerns be brought to the attention of a supervisor or the employer (Schick-Makaroff & Storch, 2019).
"The quality of a leader determines the quality of the organization" (Ming-Dao, 1996).
I believe that an organization can still be high quality despite having poor leadership from those in authoritative positions; however, this is a significantly more stressful experience for teams and requires new leaders to emerge to make up for the incompetence of those in a higher ranking position within the formal hierarchy. I don’t believe this is sustainable and most people working in this type of environment would eventually burnout or quit. For long-term success, high quality leaders (especially those towards the top of the organization's hierarchy) are necessary for consistent success within the organization. To me, a high quality leader must be highly ethical, transparent, and honest. In healthcare, excellent leadership translates to excellent patient care when leaders focus on employees’ well-being, continuous education/training, and on-going improvements to policy and procedures (West et al., 2015).
Strong yet ethical leadership takes away the ambiguity about direction and ensures everyone in the organization is behaving in a way that is consistent with the team’s vision and values (West et al., 2015). Having organized, coordinated integration of the work is known as alignment (West et al., 2015). Without clear communication, the already chaotic healthcare setting would be unsafe. Video 1 highlights the relationship between communication and ethical leadership (Lyon, 2018). Lyon (2018) identifies the core aspects of ethical leadership as being openness, info sharing, and candour.
Video 1. Organizational Transparency Model (Lyon, 2018)
The organization can flourish more easily when the leaders provide compassionate guidance and create a healthy work climate. Climate is the “shared meaning employees attach to the policies, practices and procedures they experience and the behaviours they observe getting rewarded, supported and expected” (Schneider & Barbera, 2014).
“Leadership is the most influential factor in shaping organizational culture" (West et al., 2015)
If employees’ enjoy working with their teams, they are more likely to be committed to making sure the team succeeds (West et al., 2015). Leaders that encourage participation and feedback (from patients and staff) are more likely to prevent serious conflicts or errors due to clear communication and transparency (West et al., 2015). In addition, ethical leaders can help decrease staff injuries, harassment, bullying, and staff absenteeism (West et al., 2015).
Many ethical healthcare leaders use the transformational leadership style. Transformational leadership is effective under various circumstances (Kovach, 2018). In the context of business, transformational leadership was found to increase ethical decisions made within the organization, enhance a shared value system, improve commitment, create responsibility for outcomes, and encourage corporate social responsibility (Kovach, 2018). Athletes also benefit from coaches that use transformational leadership. In the realm of competitive sports, transformational leadership has been shown to generate exceptional performance, better team dynamics, positive cultures, stronger vision, positive attitudes, and enjoyment of the experience (Kovach, 2018).
Kovach (2018) demonstrated the utility of transformational leadership across disciplines as it enhances not only productivity of followers’ but also their psychosocial feelings and motivation. Moreover, groups profited from the transformational style since it created higher levels of cohesion (Kovach, 2018). Overall, transformational leadership positively impacts achievement, with followers’ reaching or exceeding performance goals (Kovach, 2018).
Aitamaa, E., Leino-Kilpi, H., Iltanen, S. & Suhonen, R. (2016). Ethical problems in nursing management: The view of nurse managers.” Nursing Ethics 23(6): 646-658. Brown, M.E. & Trevino, L.K. (2006). Socialized charismatic leadership, value congruence, and deviance in work groups. Journal of Applied Psychology, 91: 954-962. Eisenbeiss, S.A. (2012). Rethinking ethical leadership: An interdisciplinary integrative approach. Leadership Quarterly, 21: 791-808. Kovach, M. (2018). An examination of leadership theories in business and sport achievement contexts. The Journal of Values-Based Leadership, 11(2). Laukkanen, L., Leino-Kilpi, H., Suhonen, R. (2016). Solving work-related ethical problems: The activities of nurse managers. Nursing Ethics, 23(8): 838-850. Lyon, A. [Communication Coach Alex Lyon]. (2018, January 22). Ethical leadership and communication [Video]. YouTube. https://www.youtube.com/watch?v=CHzL4PJIKLw Schick-Makaroff, K. & Storch, J.L. (2019). Guidance for ethical leadership in nursing codes of ethics: An integrative review. Nursing Leadership, 32(1), 60-73. Schneider, B. & Barbera, K.M. (eds.) (2014). The Oxford handbook of organizational climate and culture. Oxford: Oxford University Press. West, M.A., Armit, K., Loewenthal, L., Eckert, R., West, T. & Lee, A. (2015). Leadership and leadership development in healthcare: The evidence base. London, Faculty of Medical Leadership and Management. Wong, C.A. & Giallonardo, L.M. (2013). Authentic leadership and nurse-assessed adverse patient outcomes. Journal of Nursing Management, 21(5), 740-752. Wong, C.A., Laschinger, H.K. & Cummings, G.G. (2010). Authentic leadership and nurses’ voice behaviour and perceptions of care quality. Journal of Nursing Management, 18(8), 889-900.
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