Purpose of the Ethics Self-Assessment
Members of the American College of Healthcare Executives agree, as a condition of membership, to abide by ACHE’s Code of Ethics. The Code provides an overall standard of conduct and includes specific standards of ethical behavior to guide healthcare executives in their professional relationships.
Based on the Code of Ethics, the Ethics Self-Assessment is intended for your personal use to assist you in thinking about your ethics-related leadership and actions. It should not be returned to ACHE nor should it be used as a tool for evaluating the ethical behavior of others.
The Ethics Self-Assessment can help you identify those areas in which you are on strong ethical ground, areas in which you may wish to examine the basis for your responses and opportunities for further reflection. The Ethics Self-Assessment does not have a scoring mechanism, as we do not believe that ethical behavior can or should be quantified.
How to Use This Self-Assessment
We hope you find this self-assessment thought-provoking and useful as a part of your reflection on applying the ACHE Code of Ethics to your everyday activities. You are to be commended for taking time out of your busy schedule to complete it.
Once you have finished the self-assessment, it is suggested that you review your responses, noting which questions you answered “usually,” “occasionally” and “almost never.” You may find that in some cases an answer of “usually” is satisfactory, but in other cases, such as when answering a question about protecting staff’s well-being, an answer of “usually” may raise an ethical red flag.
We are confident that you will uncover few red flags where your responses are not compatible with the ACHE Code of Ethics. For those you may discover, you should use this as an opportunity to enhance your ethical practice and leadership by developing a specific action plan. For example, you may have noted in the self-assessment that you have not used your organization’s ethics mechanism to assist you in addressing challenging ethical conflicts. As a result of this insight, you might meet with the chair of the ethics committee to better understand the committee’s functions, including case consultation activities and how you might access this resource when future ethical conflicts arise.
We also want you to consider ACHE as a resource when you and your management team are confronted with difficult ethical dilemmas. Access the Ethics Toolkit, a group of practical resources that will help you understand how to integrate ethics into your organization, at ache.org/EthicsToolkit. In addition, you can refer to our regular “Healthcare Management Ethics” column in Healthcare Executive magazine.
Please check one answer for each of the following questions.
Almost Never/Occasionally/Usually/Always/Not Applicable
I take courageous, consistent and appropriate management actions to overcome barriers to achieving my organization’s mission.
I place community/patient benefit over my personal gain.
I strive to be a role model for ethical behavior.
I work to ensure that decisions about access to care are based primarily on medical necessity, not only on the ability to pay.
My statements and actions are consistent with professional ethical standards, including the ACHE Code of Ethics.
My statements and actions are honest even when circumstances would allow me to confuse the issues.
I advocate ethical decision making by the board, management team and medical staff.
I use an ethical approach to conflict resolution.
I initiate and encourage discussion of the ethical aspects of management/financial issues.
I initiate and promote discussion of controversial issues affecting community/patient health (e.g., domestic and community violence and decisions near the end of life).
I promptly and candidly explain to internal and external stakeholders negative economic trends and encourage appropriate action.
I use my authority solely to fulfill my responsibilities and not for self-interest or to further the interests of family, friends or associates.
When an ethical conflict confronts my organization or me, I am successful in finding an effective resolution process and ensure it is followed.
I demonstrate respect for my colleagues, superiors and staff.
I demonstrate my organization’s vision, mission and value statements in my actions.
I make timely decisions rather than delaying them to avoid difficult or politically risky choices.
I seek the advice of the ethics committee when making ethically challenging decisions.
My personal expense reports are accurate and are only billed to a single organization.
I openly support establishing and monitoring internal mechanisms (e.g., an ethics committee or program) to support ethical decision making.
I thoughtfully consider decisions when making a promise on behalf of the organization to a person or a group of people.
I take responsibility for understanding workplace violence and take steps to eliminate it.
I promote community health status improvement as a guiding goal of my organization and as a cornerstone of my efforts on behalf of my organization.
I personally devote time to developing solutions to community health problems.
I participate in and encourage my management team to devote personal time to community service.
I engage in collaborative efforts with healthcare organizations, businesses, elected officials and others to improve the community's well-being.
I seek to identify, understand and eliminate health disparities in my community.
I seek to understand and identify the social determinants of health in my community.
Patients and Their Families
I use a patient- and family-centered approach to patient care.
I am a patient advocate on both clinical and financial matters.
I ensure equitable treatment of patients regardless of socio-economic group or payor category.
I respect the practices and customs of a diverse patient population while maintaining the organization’s mission.
I demonstrate through organizational policies and personal actions that overtreatment and undertreatment of patients are unacceptable.
I protect patients’ rights to autonomy, clinical efficacy, and full information about their illnesses, treatment options, and related costs.
I promote a patient’s right to privacy, including medical record confidentiality, and do not tolerate breaches of this confidentiality.
I am committed to eliminating harm in the workplace.
I am committed to helping address affordability challenges in healthcare.
I have a routine system in place for board members to make full disclosure and reveal potential conflicts of interest.
I ensure that reports to the board, my own or others’, appropriately convey risks of decisions or proposed projects.
I work to keep the board focused on ethical issues of importance to the organization, community and other stakeholders.
I keep the board appropriately informed of patient safety and quality indicators.
I promote board discussion of resource allocation issues, particularly those where organizational and community interests may appear to be incompatible.
I keep the board appropriately informed about issues of alleged financial malfeasance, clinical malpractice and potential litigious situations involving employees.
Colleagues and Staff
I foster discussions about ethical concerns when they arise.
I maintain confidences entrusted to me.
I demonstrate through personal actions and organizational policies zero tolerance for any form of staff harassment.
I encourage discussions about and advocate for the implementation of the organization’s code of ethics and value statements.
I fulfill the promises I make.
I am respectful of views different from mine.
I am respectful of individuals who differ from me in ethnicity, gender, education or job position.
I convey negative news promptly and openly, not allowing employees or others to be misled.
I expect and hold staff accountable for adherence to our organization’s ethical standards (e.g., performance reviews).
I demonstrate that incompetent supervision is not tolerated and make timely decisions regarding marginally performing managers.
I ensure adherence to ethics-related policies and practices affecting patients and staff.
I am sensitive to employees who have ethical concerns and facilitate resolution of these concerns.
I encourage the use of organizational mechanisms (e.g., an ethics committee or program) and other ethics resources to address ethical issues.
I act quickly and decisively when employees are not treated fairly in their relationships with other employees.
I assign staff only to official duties and do not ask them to assist me with work on behalf of my family, friends or associates.
I hold all staff and clinical/business partners accountable for compliance with professional standards, including ethical behavior.
I am sensitive to the stress of the healthcare workforce (including physicians and other clinicians), and take steps to address personal wellness and professional fulfillment, such as incorporating these issues in employee and physician satisfaction/engagement surveys.
I take steps to understand my workforce as it relates to safety, stress and burnout, and consider the impact of those who are in positions of authority (including executives and physicians).
When problems arise with clinical care, I ensure that the problems receive prompt attention and resolution by the responsible parties.
I insist that my organization’s clinical practice guidelines are consistent with our vision, mission, value statements and ethical standards of practice.
When practice variations in care suggest quality of care is at stake, I encourage timely actions that serve patients’ interests.
I insist that participating clinicians and staff live up to the terms of managed care contracts.
I encourage clinicians to access ethics resources when ethical conflicts occur.
I encourage resource allocation that is equitable, is based on clinical needs and appropriately balances patient needs and organizational/clinical resources.
I expeditiously and forthrightly deal with impaired clinicians and take necessary action when I believe a clinician is not competent to perform his/her clinical duties.
I expect and hold clinicians accountable for adhering to their professional and the organization’s ethical practices.
Buyers, Payors and Suppliers
I negotiate and expect my management team to negotiate in good faith.
I am mindful of the importance of avoiding even the appearance of wrongdoing, conflict of interest, or interference with free competition.
I personally disclose and expect board members, staff members and clinicians to disclose any possible conflicts of interests before pursuing or entering into relationships with potential business partners.
I promote familiarity and compliance with organizational policies governing relationships with buyers, payors and suppliers.
I set an example for others in my organization by not accepting personal gifts from suppliers.
After you’ve completed the self-assessment:
Now that you have finished the self-assessment, you will want to review your responses, noting which questions you answered “usually,” “occasionally,” and “almost never.” You may find that in some cases, an answer of “usually” is satisfactory , but in other cases, such as when answering a question about protecting staff's well-being, an answer of “usually” may raise an “ethical red flag.” You will note that the instrument does not have a scoring mechanism; this is intentional. We do not believe that ethical behavior can or should be quantified.
We are confident that you will uncover few red flags and that if you do, you will willingly and appropriately address them. We also want you to consider your professional society as an additional resource when you and your management teams are confronted with difficult ethical dilemmas. You should find our regular “Healthcare Management Ethics” column in Healthcare Executive magazine a useful resource as well as ACHE’s Ethical Policy Statements. In addition, you may wish to refer to the Ethics Bibliography, which we have compiled for your use. Finally, you may want to consider attending our annual ethics seminar.