Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, Faculty of Medicine, University of Leuven, Leuven, Belgium.
Zorgnet-Icuro Care Network Flanders, Brussels, Belgium.
BMC Med Ethics. 2019 May 27;20(1):35. doi: 10.1186/s12910-019-0374-x.
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?
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.
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.
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.
在当代医疗保健领域，许多影响患者健康和福祉的决策不是由临床医生或医疗保健专业人员做出的，而是由参与医疗保健管理的人员做出的。现有的组织伦理文献提供了对各种结构、流程和策略的洞察，例如使命声明、伦理委员会、伦理轮次等，这些都是为了营造一种促进道德实践和决策的组织氛围。然而，它并没有展示医疗保健管理者如何将自己的工作本身视为具有内在道德性。在本文中，我们探讨了伦理价值观在医疗保健管理的生活经历和日常实践中是如何存在的。在医疗保健机构中担任管理职位并试图以道德为灵感来管理意味着什么？
我们进行了一项定性研究（扎根理论方法），以探索基于价值观的领导力在医疗保健中的本质。我们采访了 15 名在比利时佛兰德斯各地的老年护理、医院护理和精神卫生保健领域拥有丰富管理经验的人。
六个主要主题，以隐喻的形式呈现，说明了医疗保健管理中基于价值观的领导力的本质。这些主题是：（1）以价值观为基础的医疗保健管理就像管理一个大花园，（2）学习和使用外语，（3）在道德指南针的指引下徒步旅行，（4）在与每个人的可信相遇中体现正直和真实性，（5）在阳光和风暴中成为一个当下和值得信赖的领导者，（6）通过给人们飞翔的翅膀为人类的繁荣做出贡献。
尽管组织良好的伦理基础设施很重要，但医疗保健中的基于价值观的领导力远不止于此。它涉及到共同创造一种综合和全面的伦理氛围，其中社区模型思维和真实的领导力是必不可少的组成部分。作为一个永无止境的过程，这六个隐喻可以帮助领导者采取实质性的主动措施，在组织内塑造一个富有成效的伦理氛围。
