Healthcare Management Ethics - An Ethical Analysis of Human Resource Issues

May 1994

As the political and economic forces that drive healthcare reform continue to gain momentum, issues related to employment practices have recently assumed greater significance for employers and employees alike. Considerations regarding compensation and benefits, though important, are currently superseded by their concerns about the quality of the workplace and downsizing. Although these are distinct issues, they raise similar questions about respect for employees as persons and respect for the meaning of human work — fundamental values innate to every person. This column explores the meaning of both values and how they can be applied to resolve a difficult work situation or positively alter the work environment.

The Values of Dignity and Work
Both these values — respect for the dignity of persons and respect for the meaning of human work — are held in esteem within the Catholic social tradition. In his September 14, 1981, encyclical, On Human Work, Pope John Paul II reiterates how the meaning of work and its place in persons' lives has been a central theme in the Church's social teachings. The pope describes how persons relate to their environment and become involved with their world through work.

The pope emphasizes that it is through work that resources are discovered, transformed, and placed at the service of the human community. Every human endeavor requires work. Whatever a person's role within an organization, that role requires both human energy and creativity to make something happen or to make something new. Human energy and creativity are evidenced in both simple and profound tasks. For example, they can be seen in tasty, attractive meals; in clean, inviting corridors; or in the latest laser technology.

Work is one of the most significant ways in which persons express themselves, realize their human potential, and grow as persons. Because work is so preeminently human, the pope strongly asserts that the person as producer and creator warrants more respect and attention than his or her product. Thus the meaning and value of work must be kept in proper perspective; to do otherwise is to risk demeaning employees by treating them merely as the means to fulfill a production quota.

Ideally, work also helps preserve and promote human dignity by enabling persons to fulfill their material needs, foster stable family life, and contribute to the well-being of society by contributing to the common good. The Church teaches that employment ensures access to food, clothing, shelter, medical care, and education. A basic level of security free of undue anxiety — provided through employment — may enable persons to attain spiritual well-being. Through work, persons may be able to fulfill their life's goals in accord with their God-given talents.

Managers who misunderstand or ignore the implications of this view of human nature in the workplace run the risk of depersonalizing employees, engendering passivity or uninterest at work, or laying the groundwork for dissatisfaction and, at times, conflict. Embracing the Church's view about the meaning of personhood will enable healthcare leaders and managers to redesign jobs in such a way that employees will be able to invest themselves in what they do and increase productivity.

Quality of the Workplace
How might respect for the dignity of persons and the meaning of work come together and positively affect the quality of the workplace? The essential component that characterizes the new paradigm in employment practices is employee empowerment.

Empowerment demonstrates respect for the dignity of each employee through the development of opportunities for job enrichment and participation. Empowering employees to develop new skills and to make autonomous decisions about their work while eliminating meaningless tasks presumes that responsible persons want to be challenged, to grow through their work experience, and to produce good work. David M. Noer of the Center for Creative Leadership makes the case for empowerment quite simply: "Good work is accomplished through employee voice and choice" (Healing the Wounds: Overcoming the Trauma of Layoffs and Revitalizing Downsized Organizations, Jossey-Bass, San Francisco, 1993, p. 164).

The goal of empowerment is to develop a healthy, autonomous, self-reliant, responsible work force. This goal presents management with uncommon challenges. With their emphasis on control, older hierarchical and paternalistic patterns of managing do not fit the new leadership paradigm, which is grounded in a shared vision of tasks and participation. The new style of leadership requires managers to develop self-directed work teams, with managers helping, facilitating, and coaching.

Setting aside former controls will not necessarily lead to lack of discipline. On the contrary, empowerment requires employees to be more accountable for their jobs. To this end, managers' tools, such as performance reviews, are refocused to facilitate employees' development, especially their capacity for a responsible and self-reliant investment in their work tasks.

As attempts to realize new efficiencies and economies of scale precipitate the formation of new institutional relationships among healthcare providers, work force reductions will inevitably occur. Can profound respect for the dignity of persons, as promoted by the Church's social tradition, humanize the process of downsizing? More specifically, can respect for employees as persons help reduce the sense of violation and betrayal that often accompanies a job loss? Can feelings of anxiety and stress be mitigated for both managers and employees?

A manager's role in downsizing is multi-dimensional. Two important dimensions are communication and planning. Honest communication seems to support all other aspects of work force reduction and makes the difficult task of laying off staff more palatable.

Honest communication presumes that managers have first come to grips with their own feelings about the task before them. When managers deny or ignore their own feelings about an impending layoff, common traps may emerge:

  • Managers may communicate insufficient information regarding the layoff because it is simply too difficult to talk about.
  • Managers may gloss over their responses to sensitive questions or carefully craft responses that appear memorized and thus insensitive.

What managers unintentionally communicate under such conditions is a lack of genuine concern, which usually generates anger among departing employees and anxiety among those workers who remain.

Open and truthful communication acknowledges the insightfulness and intelligence of the employees, who already sense the inevitability of work force reduction and who need to plan the transition to a new job. Open communication about the planning and implementing of the downsizing offers an antidote to troubling rumors, employee depression, and work paralysis.

Open communication is contrary to an older practice that issued employees an hour's notice of immediate dismissal. Recent journal articles demonstrate that terminated workers feel betrayed and angry that they have been laid off in favor of short-term profits; the survivors of a layoff fear the same fate will befall them. The ensuing work environment is one of demoralization, distrust, and insecurity. (See Richard L. Bunning, "The Dynamics of Downsizing," Personnel Journal, September 1990, pp. 68-75; Jeffery E. Myers, "Downsizing Blues: How to Keep Morale Up," Management Review, April 1993, pp. 28-31; and David A. Kelly, "Advice for the '90's: How to Lay Off Workers," Computerworld, March 30, 1992, p. 99.)

Newer employment practices recommend that managers give advance notice of termination. Those terminated may feel valued and trusted when they are given the opportunity to complete their work tasks and to say good-bye to their co-workers. The humane treatment of those who are terminated can be reassuring to those who remain on the job. In such instances morale may remain higher, with minimal complaining and distrust.

The planning function related to downsizing is as important as good communications. As a first step, managers should review the organization's mission statement and begin to implement the work force reduction in accord with the values espoused there. Respect for employees and managers alike can be evidenced if the plan for downsizing demonstrates a strategic direction. When decisions are directed toward goals that are well thought out and clearly communicated, managers present themselves as responsible. A well-thought-out plan is important to employees as well, for it could help avoid the trauma of a second wave of layoffs or the need to try to rehire those employees recently laid off.

Fairness is essential to carrying out the process of downsizing. Managers should try to reduce the depth of cuts by looking at normal attrition rates and providing opportunities for early retirement. They should show sensitivity and respect by offering outplacement services and just severance arrangements. Although downsizing is happening with more frequency, it is not routine, and training for managers can be beneficial.

Good Business Sense
Ethical reflection involves being aware of issues and their ramifications, including their impact on the institution and the legitimate stakeholders involved. Corporate ethics and management ethics begin with the recognition that decisions ought to be value driven. Leaders and managers must ensure that the decisions made within Catholic healthcare organizations reflect an ethical integrity.

Safeguarding the legitimate concerns of the employees as stakeholders in the healthcare organization's decisions is another way of serving the common good. Moral integrity and fairness make good business sense. They enhance the organization's reputation with employees and patients. In the long run, organizations that do good will also do well.

Sr. Lappetito is senior associate for corporate and social ethics, Catholic Health Association, St. Louis. She is also chairperson of CHA's Task Force on Healthcare Management Ethics.


Copyright © 1994 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Healthcare Management Ethics - An Ethical Analysis Of Human Resource Issues

Copyright © 1994 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.