‘You can give them wings to fly’: a qualitative study on values-based leadership in health care

Abstract

Background Within contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health care managers experience their job as being intrinsically ethical in itself. In the present article, we investigate the way in which ethical values are present in the lived experiences and daily practice of health care management. What does it imply to take up a managing position within a health care institution and to try to do this in an ethically inspired way? Method We carried out a qualitative study (Grounded Theory Approach) to explore the essence of values-based leadership in health care. We interviewed 15 people with extensive experience in health care management in the fields of elderly care, hospital care and mental health care in the various regions of Flanders, Belgium. Results Six predominant themes, presented as metaphors, illustrate the essence of values-based leadership in health care management. These are: (1) values-based health care management as managing a large garden , (2) as learning and using a foreign language , (3) going on a trekking with an ethical compass, (4) embodying integrity and authenticity in a credible encounter with everyone, (5) being a present and trustworthy leader during sun and storm , and (6) contributing to human flourishing by giving people wings to fly . Conclusions Notwithstanding the importance of organizing a good ethics infrastructure, values-based leadership in health care entails much more than that. It is about the co-creation of an integrated and comprehensive ethical climate of which community-model thinking and authentic leadership are essential components. As a never-ending process, the six metaphors can help leaders to take substantive proactive steps to shape a fruitful ethical climate within their organization.

Moral distress in medicine: An ethical analysis

“…Secondly, on a structural level, healthcare organisations might be able to contribute to lowering moral distress in medicine by creating a favourable institutional ethical climate, one with serious ethics education, tools, and guidelines for ethical discussion and reflection, and that promotes continuous ethical reflection and dialogue within teams. A caring attitude and a healthy ethical climate where collaboration and an open discussion are promoted systematically is a necessary contextual factor (Atabay et al, 2015; Denier et al, 2019; Hamric et al, 2012; Sauerland et al, 2014). Ethical frameworks for healthcare institutions and teams have been shown to be critical in responding to moral dilemmas and ethically challenging circumstances (Berlinger et al, 2020; Dawson, 2020; Dawson et al, 2020; Dunham et al, 2020).…”

“…Thus, the evidence shows that it is important for physicians to be able to work in an organisation that has a healthy care ethics approach and welcomes the ethical challenges of contemporary healthcare. Specifically, they create a culture of ethical reflection and discussion among colleagues, patients, and institutional representatives within an open and tolerant atmosphere (Atabay et al, 2015; Denier et al, 2019; Hamric and Wocial, 2016; Howe, 2017a; Sauerland et al, 2014; Whitehead et al, 2015). In short, a care ethics approach is promoted in which interpersonal relationships are emphasised.…”

“…Importantly, an organisation that aims to have an ethical climate also clearly defines how ethical issues should be handled. Such a climate does not regard moral distress as a threat, but instead welcomes its challenges by creating a culture of ethical reflection and discussion within an open and tolerant atmosphere (Atabay et al, 2015; Denier et al, 2019; Hamric and Wocial, 2016; Howe, 2017a; Rosenwohl-Mack et al, 2020; Sauerland et al, 2014; Whitehead et al, 2015).…”

Nursing and values‐based leadership: A literature review

“…Understanding the characteristics and evidence for such practices is, therefore, important. Denier et al (2019) and Faith (2013) note that core values in health care, such as care and compassion, are being undermined by the negative impacts of cost containment, political wrangling and other influences and that if a 'culture of care is to survive', there needs to be a commitment to values-based leadership (Faith, 2013, p6).…”

Management by Values: A Case Study of a Recruitment Company

“…Management by values has in practice been present, in its pure version, for a long time in non-profit organizations, because -by definition -their sense of operation is a mission which can only be carried out by values. The subject literature addresses the problem of values in sport organizations (Bell-Laroche et al, 2014) and health care (Denier et al, 2019). Research results indicate management by values fully mediates the influence of ethical and social organizational values on organizational performance (Kerwin et al, 2014).…”