Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine
Urgent message: As consumers pay closer attention to the ethical behaviors of the companies they do business with, the topic of workplace ethics has garnered renewed interest. Hence, the urgent care operator who makes a concerted effort to build an ethical workplace culture lays the groundwork for patient loyalty, motivated and productive employees, and financial success.
Thanks to what seems like a steady stream of headline-grabbing corporate scandals, misconduct accusations, and fraud investigations, the business ethics of organizations big and small remain under intense scrutiny. With each new tale of misdeed or impropriety, the media pounces, consumer confidence in once-trusted brands erodes, and embattled CEOs caught in the spotlight’s glare commence frantic damage control.
For sure, companies’ ethical cultures, including urgent care organizations, permeate every level of the business, and can be a critical factor in whether those businesses flourish or flounder. Author and global leadership expert Jeremy Tozer, in his 2012 book Leading Through Leaders: Driving Strategy; Execution and Change, sums up the essence of ethics in business this way:1 “A business perceived to lack integrity or to operate in an unethical, immoral, or irresponsible manner soon loses the support of customers, suppliers and the community at large.”
More than ever, consumers—simultaneously numb and fed up with what they deem betrayals of their trust—are voting with their wallets and forgoing businesses that fail to maintain the high ethical standards they expect. Not to mention a growing workforce of employees and top talent who increasingly place a premium on their companies’ ethical cultures, to the point where they’re prioritizing ethics ahead of benefits, perks, and even salary.
Why an Ethical Culture is Important
As it turns out, good ethics is more than simply doing the right thing for honesty’s sake; It makes good business sense. This is evidenced further by the fact that most of Fortune magazine’s “The 100 Best Companies to Work For” also find themselves on the “Most Popular Consumer Brands” list. In fact, it perfectly underscores the notion that companies that treat their employees well and maintain a strong workplace culture will naturally realize that trickle-down effect through their employees treating customers with same high regard.
So, when considering an urgent care environment, what are some common ethical dilemmas care teams, physicians, and managers might be forced to confront? Here are a few examples, gathered through anonymous surveys of healthcare workers courtesy of Medscape:
- Prescribing antibiotics to patients who don’t need them, yet are arguing for them
- Choosing to not reveal a minor mistake in treatment or diagnosis of a patient simply because it will not cause harm
- Covering for a colleague who is impaired due to drug or alcohol use, or illness
- Discussing a patient’s information with a colleague in a way that violates the patient’s privacy
- Accepting inappropriate gifts and perks from suppliers and/or vendors
- Witnessing a coworker behave rudely towards a patient and wrestling with whether to report the incident to supervisors
- Witnessing a team member stealing medical and/or office supplies
- Overstating a patient’s condition in order to submit a false claim or prior authorization
- Showing favoritism towards certain team members or colleagues (e.g. vacation, scheduling, breaks, duties, shift preferences, leniency)
- Hiring or promoting individuals with lesser qualifications than more qualified candidates based on race, gender, age, nepotism, etc.
- Failing to consistently exercise proper hygiene and sanitization standards and protocols
- Misuse of the prescription pad
Not an exhaustive list certainly, but it does a good job of spotlighting where typical ethical lapses can occur in urgent care. And such lapses probably occur more often than you’d think: According to the Ethic’s Resource Center’s 2013 National Business Ethics Survey, more than 40% of employees in the U.S. witnessed illegal or unethical activity at work.2 Worse, troubling encounters such as are not without secondary consequences: When employees’ witness colleagues violating ethical rules and norms without reprimand or punishment, they may decide that ethics aren’t important and join in themselves or become disillusioned and depart the company altogether. Not the hallmarks of a strong workplace culture, nor a formula for success.
Combined with the additional pressure that the rise of social media has placed upon companies to be ethical and transparent—or risk online exposure to an audience of millions—it’s clearer than ever that an all-out emphasis on ensuring an ethical workplace culture is critical. Additionally, studies show that unethical cultures invariably lead to lowered morale, loss of customer, community, and vendor support, and are a breeding ground for lawsuits. In short, workplaces that tolerate or turn a blind eye to misconduct will suffer higher turnover, diminished employee engagement, and a lowered reputation, whereas organizations that build and nurture ethical workplace cultures see increased profits, a workforce that is engaged and productive, and happier customers.
What an Ethical Culture Looks Like
How do you define an ethical culture? There are few hard and fast rules as to what constitutes an “ethical” culture, given that each workplace environment has its own unique objectives and dynamics. However, most ethical cultures share an overarching theme: A workplace where the entire staff, starting with ownership down to the managers and team members, believe in, support, and practice legal and moral business practices. Further, ethical workplace cultures encourage, spotlight, and reward ethical behavior, while discouraging and punishing ethical lapses.
Observe enough workplace cultures, though, and you’ll discover a wide variety of ethical standards that aren’t necessarily laid out clearly in manuals or contracts. Rather, the attitudes and behaviors that comprise a company’s culture are mostly inferred – even unspoken in some cases – depending on nature of the business or the organization in general. Regardless, companies that boasts stellar ethical cultures rarely develop them by accident; ethical cultures flourish only when there is a clear commitment to building and maintaining them, by leaders who understand how important ethics are to the livelihood of the organization. With that in mind, the following sections will examine such factors as behavioral “nudges” to influence ethical workplace behavior, how an ethical culture can help guide decision making in the absence of specific training, and the consensus best practices for building an ethical workplace culture.
How ‘Nudges’ Support and Reinforce Ethical Behavior
Behavioral nudges can be loosely defined as suggestions, reminders, and gentle proddings toward doing what’s healthy, moral, responsible, and ethical. The concept of workplace nudges originated in the government public policy sector, where it was developed by American behavioral economist Richard Thaler, who in 2008 authored a seminal work on nudges. This led to Thaler being awarded the 2017 Nobel Prize for economics based largely on his work in nudge theory dynamics.
The concept behind nudges is a straightforward one: People are not as rational or reasonable as they like to believe; thus, strategic nudges can help direct them toward desired behaviors. Thaler, when asked to summarize his theory, was able to do so in just three words: “Make it easy.”3 Indeed, nudge theory presumes that people resist change when it requires expenditure of mental energy, so by “making it easy” to perform the desired change, compliance rates, ethical decisions, and healthy, responsible choices skyrocket.
Nudges are also based on what Thaler calls “choice architecture.”4 Meaning, the way a nudge is presented and communicated plays a huge role in how effective it is. With nudges, the theory goes, the practice is most successful when the nudge strikes a perfect balancing between articulating benefits, and making people feel like performing the desired behavior was really their choice. Explicit demands or veiled threats, on the other hand, have shown to be much less effective than strategic prodding, and are if fact likely to backfire. Basically, the employee must feel like they made the right decision on their own, even if the nudge helped steered their choice.
One example of a successful nudge Thaler documented that has practical implications for urgent care was a nudge within a food processing plant. In the case study, a researcher and his team were able to increase compliance rates for hand washing by 63% with a deceptively simple nudge: an ink handstamp reminding team members to…wash their hands. Make it easy. When considering the many times throughout an urgent care shift that routine activities such as hand washing, applying latex gloves, and sanitizing surfaces and instruments should occur but might not, a similar nudge could help boost compliance rates towards maintaining a clean and sanitized workplace environment, which is indeed an ethical consideration in a medical practice.5,6
How an Ethical Culture Helps ‘Fill in the Gaps’
Another benefit of building and maintaining an ethical culture is that its foundational principles can serve as guideposts for handling situations that employees and team members haven’t been specifically trained for. Given that a typical urgent care is a fast-paced clinical environment with walk-in patient flow and varied patient presentations, unpredictable situations can unfold in a moment’s notice. Thus, when a strong ethical culture is ingrained in the center’s staff, team members are empowered to do the right thing for patients and staff members.
If an urgent care center holds values of “compassionate care,” “treating patients like honored guests,” and “going above and beyond,” for instance, then those ethical principles will “fill in the gaps” between what team members were specifically trained for and the unusual situations that may arise. In one real-life anecdotal example, a passerby wandered into an urgent care confused about his explanation of insurance benefits he received from a different medical provider. Rather than dismiss the non-patient and direct him back to his PCP, the urgent care office manager, falling back on the center’s values, instead invited the passerby back to her office where she called the insurance company herself and got the man the clarification he needed.
Was the office manager, obviously a busy professional, obligated to do that? Of course not. But “going above and beyond” is one of the center’s values, so it not only served as a guidepost as for what to do, but it freed her to be the compassionate, caring individual she is at her core. The passerby was naturally elated and promised to reward the center with his patronage when the need arose, as well as sharing the story of his wonderful encounter with family and friends. It’s stories like this one, repeated often, that work in tandem with managerial edicts to really help form the kind of ethical culture that every urgent care should strive for.7
Best Practices for Building an Ethical Workplace Culture
When it comes to building an ethical workplace culture, at least one fact is in near consensus among experts: it starts at the top. This assertion is widely supported by research studies, including one conducted by highly-regarded Stanford psychologist Al Bandura, which showed that people are predisposed to follow the behavior of others they admire or view as leaders. So for urgent care operators, the task is remaining ever cognizant that their behavior sets the tone, their words and actions are being closely observed, and that they must lead by example at all times.
To that end, here are several foundational principles espoused by Tozer, Thaler, and other HR experts that any urgent care organization can embrace towards building, maintaining, and nurturing an ethical culture:8,9
- Communicate ethical expectations. An employee handbook that clearly outlines the center’s ethical values should be read and signed by each team member. In addition, the walls and bulletin boards should be adorned with placards, posters, and framed pictures declaring the center’s guiding principles as both a nudge to desired behaviors and an ever-present reminder to patients and employees.
- Model the ethical behavior you expect. When ethical dilemmas inevitably arise, forgo expediency and convenience, and let others witness you take ethical action – even if it’s costly or inconvenient. For example, always demonstrate impartiality, flexibility, and compassion to your team members and patients. This lets everyone know that the center’s values are not simply lip service, but guiding principles that you believe in, and expect everyone to follow.
- Talk about ethics often. Repeat stories and anecdotes often that involved ethical decision making. Provide corrective feedback when an inadvertent ethical lapse occurs. Bring up ethical dilemmas in meetings and huddles and solicit feedback and input from your team. Above all, keep the topic of ethics top-of-mind so team members remain vigilant against ethical lapses.
- Provide ethics training. Go beyond manuals and contracts, and augment your ethics training with workshops, seminars, and online programs. The training should help develop effective ethical decision making and teach the proper way to navigate ethical dilemmas. Moreover, research shows that when ethics training is dynamic and interactive as opposed to rote and dull, the ethical principles and values are assimilated better, further ingrained, and acted upon more frequently.
- Make reporting ethical violations safe. Ensure that mechanisms are in place that allow team members to report ethics violations safely and in confidence without fear of retribution. Leave no doubt to employees that their ethical concerns are important and will be taken seriously no matter their role or seniority.
- Manage performance expectations. If the KPI’s and metrics you task your team members with exceeding are unreasonable, they may be tempted cut corners and take shortcuts, undermining the center’s ethical values and compromising the patient experience. Thus, ensure that performance objectives and goals are attainable, processes are in place to support them, and team members are empowered to speak up when they’re not.
- Praise and reward ethical behavior. By placing a spotlight on your team members’ exemplary ethical choices, decisions, and behaviors, you’re communicating to everyone how important and valued their adherence to those principles are. By the same token, ethical lapses and violations must be addressed immediately and decisively to discourage future incidents. Remember, ethical lapses tend to snowball when they go unchecked, others are watching and taking cues based on how leaders respond, and the livelihood of the center, in a very real way, is at stake.
As organizations realize that both consumers and employees are placing heightened importance on ethical cultures, the onus is on leaders to ensure that their workplace meets or exceeds ethical expectations. It’s clear that strong ethical cultures help reduce misbehavior and doing the right thing – even when it’s inconvenient to do so – signals to everyone that the organization is truly committed.
Hence, it’s up to urgent care leaders to promote ethics in their workplaces by talking about ethics often, making accountability simple, nudging where appropriate, and giving team members tools and safeguards that make the ethical choice the easy one. The rewards to patients, employees, and the health of the organization are certainly worth it.
- Nguyen S. Creating an ethical organizational culture. Workplace Psychology. February 14, 2011. Available at: https://workplacepsychology.net/2011/02/14/creating-an-ethical-organizational-culture/. Accessed July 2, 2018.
- Ethics & Compliance Initiative. National Business Ethics Survey 2013. Available at: http://www.ethics.org/ecihome/research/nbes/nbes-reports/nbes-2013). Accessed July 2, 2018.
3. Lovallo D, Webb A. Nudging the world toward smarter public policy: an interview with Richard Thaler. McKinsey Quarterly. June 2011. Available at: https://www.mckinsey.com/industries/public-sector/our-insights/nudging-the-world-toward-smarter-public-policy-an-interview-with-richard-thaler. Accessed July 2, 2018.
- Thaler R, Sunstein C. Nudge: Improving Decisions about Health, Wealth, and Happiness. New York, NY: Penguin Books; 2008.
- Gray To nudge or not to nudge? HR. Available at: http://www.hrmagazine.co.uk/article-details/to-nudge-or-not-to-nudge. Accessed July 2, 2018.
- Palmquist M. Want more ethical employees? Given ’em a nudge. Strategy-Business. Available at: https://www.strategy-business.com/blog/Want-More-Ethical-Employees-Give-Em-a-Nudge?gko=9db79. Accessed July 2, 2018.
- Ayers A. Culture fills in the gaps. Available at: http://www.alanayersurgentcare.com/Linked_Files/2014_Articles/Ayers_UCAOA_Blog_Culture_June_2014.pdf. Accessed July 2, 2018.
- Tucker K. What is cultivating ethical culture at a workplace? Career Trend. Available at: https://careertrend.com/cultivating-ethical-culture-workplace-29009.html. Accessed July 2, 2018.
- Miller CB. Science-tested tips to be a better person. Wall Street Journal. January 5, 2018. Available at: https://www.wsj.com/articles/science-tested-tips-to-be-a-better-person-1515169638?mod=searchresults&page=1&pos=5. Accessed July 2, 2018.