Foglia Mary Beth, Cohen Jennifer Hadary
a National Center for Ethics in Health Care, Department of Veterans Affairs, Department of Bioethics and Humanities, University of Washington School of Medicine , Seattle , Washington , USA.
b National Center for Ethics in Health Care, Department of Veterans Affairs, Department of Epidemiology, University of Washington School of Public Health , Seattle , Washington , USA.
AJOB Empir Bioeth. 2019 Jul-Sep;10(3):155-163. doi: 10.1080/23294515.2019.1634654. Epub 2019 Jul 17.
The willingness of employees to proactively give voice to their concerns, including ethical concerns (ethics voice), is critical to improving organizational performance and integrity. In health care, speaking up is vital to ensuring a delivery system centered on patient safety and quality, including ethics quality. In this study, we explored whether ethical leadership practices contribute to employees' willingness to raise ethical concerns to those in the organization who have the authority to take corrective action. We conducted a secondary analysis of 2014 IntegratedEthics Staff Survey data administered to a random sample of 50% of VA health system staff. The data we used reflected responses from 42,412 employees who were associated with 141 administratively defined medical centers that encompass more than 1,400 sites of care delivery and VHA administrative program offices. The response rate to the survey was 29.4%. Employees positioned higher in the organizational hierarchy were more comfortable raising ethical concerns than lower ranked employees. Ethical leadership practices, and especially those that created an expectation of trust, follow-through, and fair treatment, made it more likely that employees would raise ethical concerns with managers. Speaking up about ethical concerns is essential to the delivery of high-quality patient care and is enabled by managers who embody ethical leadership practices. Ethics programs can help create favorable conditions for raising ethical concerns by providing managers and supervisors with ethical leadership coaching, recognizing power differentials, and modeling more egalitarian communication practices. More research is needed to understand how employees conceptualize ethics voice and to assess the comparative effectiveness of different methods of encouraging speaking up about ethical concerns in health care organizations.
员工主动表达自身关切（包括道德关切，即道德发声）的意愿，对于提升组织绩效和诚信至关重要。在医疗保健领域，直言不讳对于确保以患者安全和质量（包括道德质量）为核心的服务体系至关重要。在本研究中，我们探讨了道德领导行为是否有助于员工向组织中有权力采取纠正措施的人员提出道德关切。我们对2014年综合道德员工调查数据进行了二次分析，该调查数据来自退伍军人事务部（VA）医疗系统工作人员随机抽取的50%样本。我们使用的数据反映了42412名员工的回答，这些员工隶属于141个行政定义的医疗中心，这些医疗中心涵盖了1400多个护理地点以及退伍军人健康管理局（VHA）行政项目办公室。调查的回复率为29.4%。组织层级较高的员工比层级较低的员工更愿意提出道德关切。道德领导行为，尤其是那些营造了信任、贯彻到底和公平对待期望的行为，使员工更有可能向经理提出道德关切。直言不讳地表达道德关切对于提供高质量的患者护理至关重要，而体现道德领导行为的经理能够促成这一点。道德计划可以通过为经理和主管提供道德领导培训、认识到权力差异以及树立更平等的沟通方式，来帮助创造提出道德关切的有利条件。需要更多研究来了解员工如何理解道德发声，并评估在医疗保健组织中鼓励直言不讳地表达道德关切的不同方法的相对有效性。
