Going Beyond the Code of Conduct

A c-suite executive recently expressed the following frustration to me. Following an issue involving an employee’s unethical behaviour two years ago, the company put more resources into its compliance program. They hired additional staff and increased the training all employees receive. Then, about a month ago, there was another ethics breach. The executive described her frustration as follows: “This employee’s behaviour was clearly wrong. Our code of conduct is now twice as long as it was before, but the employee’s behaviour isn’t clearly captured in the code. Now we don’t know what recourse we have.”

In North America, organizational ethics has usually been covered by an ethics and compliance department, and the people who work in these programs often have legal training. Historically, the way these programs promote ethics and compliance is through the drafting of codes of conduct, which employees are trained on. When an employee encounters a situation where it’s unclear how they should act, they can contact E&C and ask “Do we have a rule regarding this situation?” When the answer is no, some employees will then reason “since I’m not breaking a rule, what I’m doing must be permissible.”

Compliance programs are an essential part of healthcare organizations. There are many predictable situations that employees might find themselves in where clear rules will clarify good conduct. And, of course, there are laws that must be complied with. However, while following the law can be an important ethical matter, using compliance as a proxy for ethics can impede developing a more ethical organizational culture.

The best organizational structure makes a clear distinction between compliance, law, and ethics. Some issues will involve all three, but each has distinct roles. Ethical issues are often difficult because there’s no clear legal guidance, and, while the compliance approach of making rules is effective for clear-cut cases, many answers can’t be codified effectively. Here are three recommendations for building a more ethically robust organization.

Return to the values

At their best, an organization’s values are central to both big-picture planning and day-to-day operations. Too often, organizations choose values that are already expected (e.g., high quality service) or too vague to guide action (e.g., integrity). Instead, ensure that your organization’s values are remarkable and prescriptive (i.e., one can infer appropriate action from them). If the values could apply to every other company in your industry, they aren’t sufficiently specific. A sign of a good value is that leaders appeal to it on a regular basis. If no one in your organization is using its values, they need to change (or your organization needs to).

Develop heuristics

It can be difficult to start from the values and work down to specific cases. Since the purpose of organizational values is to guide action, consider some representative actions for employees to know, then connect them to appropriate values. For example, a common value in hospitals is patient-centred care, but physicians and staff often don’t know what that means. In a previous post, we explored ways to operationalize that term. To communicate that message, find a story that demonstrates the best meaning that’s relevant to your organization. Through memorable examples, staff develop a heuristic they can use in other circumstances. 

Build in processes for ethical consideration

Just as organizations require compliance and legal support, an ethical organization has processes for identifying and addressing ethics issues. Multiple processes are necessary. All staff should feel comfortable asking questions about the ethics of any decision, and they should have a way to raise concerns outside their normal chain of command. Staff and middle managers should know the organization’s values and see how they connect to day-to-day operations. Leaders should also be appealing to values when making decisions. Just as organizations verify legal compliance in their operations, there should be processes for verifying ethical conduct.