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Time to set a higher standard

Remember that most people learn not from experience, but rather from observing the actions of others.

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Modeling professional and ethical behaviors is an important role for physician leaders to play. Credibility depends on how others perceive leaders in both their career roles and private lives. Any institution’s supervisors and medical staff will always look to their leaders for behavioral guidance.

In my experience, I’ve come to realize that there are three valuable concepts to keep in mind: role modeling, professionalism and, most importantly, ethical behavior. Each concept has important implications for all physician leaders and are essentially interlinked.

Consider role modeling. It’s based on a set of standards that a person lives and acts by. It includes passing on standards of behavior, values and attitudes to others. These standards, however, may be considered to be negative or positive. An example of negative standards of behavior would be rumor spreading, sexual harassment and verbal abuse. On the other hand, positive workplace behaviors that others may desire to emulate include innovation, optimism and empathy.

As a leader, you need to ask yourself, “What behaviors and attitudes am I demonstrating to others, and will these have a positive or negative impact on my constituency?” Remember that most people learn not from experience, but rather from observing the actions of others. People form ideas about how role models should act in certain situations and imitate those behaviors when they are placed in similar situations. That’s why it’s so important for today’s leaders to recognize how they are perceived by others.

Effective role models can come in several iterations but you’ll find them in those with a positive outlook, a desire for excellence and commitment to growth, integrity and leadership. Someone who inspires others to excel, build and support team functioning, have excellent communication skills, and one who is nonjudgmental in his relationship with other members of the care and administrative team.

The second important concept for leaders to demonstrate is that of professionalism. Professionalism is a set of attitudes and behaviors specific to a given profession. In medicine, this is rooted in the social contract that all physicians have with society, allowing us to intimately engage with patients like no other profession. There are a number of important responsibilities that form the foundation of professionalism in medicine. These include competency, honesty, confidentiality of patient information and managing conflicts of interest.

Many organizations embed core values within their mission statement. These include behavioral attributes that the organization’s leaders expect everyone to follow. However, the tone is set from the top and it’s the organizational leaders that should demonstrate these core values the most. Some of the values you might find in the statement of an organizations core values include: altruism, accountability, a commitment to service, honor and integrity, respect for others and teamwork.

Professional behavior might even provide fiscal benefits. Patients are more likely to stay with physicians they perceive as behaving professionally. Conversely, and from what I’ve observed, complaints about physicians most often involve physicians’ unprofessional behaviors.

It’s always helpful to see things from the patient’s perspective. How would a patient perceive or judge you as being professional? One of the most important personal characteristics that you might consider is humility, a mark of maturity and experience that keeps us from becoming arrogant and egotistical. It also provides one with a sense of his limitations, especially important in higher levels of leadership.

Finally, it is crucial to recognize that the acts of medical professionalism are based on the promises made by physicians to patients and their communities that physicians will use their authority wisely and will not abuse that authority for the sake of money and/or power.

What about ethics? Intertwined into the concept of professionalism, ethical leadership specifically identifies behaviors of integrity, honesty and trustworthiness as core behaviors of moral people.
More specifically for physicians, the relationship we have with our patients are bound by the principles of biomedical ethics. Beneficence, non-maleficence, respect for autonomy, and justice are only but a few of these important principles. In addition, there are other ethical considerations that physician leaders need to be concerned about, including, but not limited to, informed consent, confidentiality, conflicts of interest, sexual relationships and medical research.

It is imperative that leaders be ethical at all times, but they must also ensure their organizations have systems that teach, maintain and monitor ethical conduct by all employees, including themselves. Unethical behavior can destroy an organization. Not only can it lead to undesirable outcomes, it also damages the reputation of the organization and can even lead to costly litigation.

It’s hard to argue against the benefit of having systems of ethical training and oversight in an organization as this provides higher quality care and greater consumer protection. However, to be effective, efforts of its implementation must be genuine and not merely be for show, or worse, a sham. Finally, any ethical leader should always remember that in difficult times when failure has occurred, they should admit to the failure when their decisions were the cause.

It’s important to keep top executives of organizations accountable. This is one of the most important actions any organization must have in order to engage and foster ethical business practices. Employees are actually most influenced by the ones they work with the most.

So it’s imperative that we ensure the creation of a systematic and systemwide effort to teach and monitor an individual’s ethical behaviors in an organization. In addition, one should remember that microcultures (at the individual work units in the organization) play significant roles in shaping the ethical behavior of employees.

Remember, teams look to their leaders for a better understanding of professional expectations and ethical behaviors. Supervisors must always be aware that all eyes are on them to set — and live — the standards.

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