Reprinted from Nelson WA, Taylor E, Walsh T. Building an ethical organizational culture. Health Care Manag. 2014;33(2):158-164. doi:10.1097/HCM.0000000000000008. Author Affiliations: Dartmouth Institute for Health Policy and Clinical Practice (Drs Nelson, Taylor, and Walsh), Dartmouth Center for Health Care Delivery Science (Drs Nelson and Walsh), Community and Family Medicine (Dr Nelson), and Master of Health Care Delivery Science Program (Dr Walsh), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Health Care Manag (Frederick). 2020 Oct/Dec;39(4):168-174. doi: 10.1097/HCM.0000000000000304.
The success of a health care institution-as defined by delivering high-quality, high-value care, positive patient outcomes, and financial solvency-is inextricably tied to the culture within that organization. The ability to achieve and sustain alignment between its mission, values, and everyday practices defines a positive organizational culture. An institution that has a diminished organizational culture, reflected in the failure to consistently align management and clinical decisions and practices with its mission and values, will struggle. The presence of misalignment or of ethics gaps affects the quality of care being delivered, the morale of the staff, and the organization's image in the community. Transforming an organizational culture will provide a foundation for success and a framework for daily ethics-grounded operations in any organization. However, building an ethics-grounded organization is a challenging process requiring strong organization leadership and planning. Using a case study, the authors provide a multiyear, continuous step-by-step strategy consisting of identifying ethics culture gaps, establishing an ethics taskforce, clarifying and prioritizing the problems, developing strategy for change, implementing the strategy, and evaluating outcomes. This process will assist organizations in aligning its actions with its mission and values, to find success on all fronts.
医疗机构的成功——定义为提供高质量、高价值的医疗服务、积极的患者结果和财务稳健——与该组织内部的文化密不可分。实现和维持使命、价值观和日常实践之间的一致性的能力定义了积极的组织文化。一个组织的文化减弱,表现在管理层和临床决策和实践未能始终与使命和价值观保持一致,将面临困境。存在不匹配或道德差距会影响提供的护理质量、员工士气以及组织在社区中的形象。转变组织文化将为任何组织的成功提供基础,并为日常基于道德的运营提供框架。然而,建立一个基于道德的组织是一个具有挑战性的过程,需要强大的组织领导力和规划。作者通过案例研究提供了一个多年的、持续的分步策略,包括识别道德文化差距、建立道德工作组、澄清和优先处理问题、制定变革策略、实施策略和评估结果。这个过程将帮助组织将其行动与其使命和价值观保持一致,从而在所有方面取得成功。