Infection Control Today - 05/2003: Trust and Ethics

Trust and Ethics: Essential Ingredients

By Bryant Broder, ACSP

Trust isone of those words that is commonly used but rarely defined. One definition,penned by an unknown author, stated simply, "Trust is the residue ofpromises fulfilled." This is a simple statement, but right on the nosebecause it captures that trust is a consequence -- a result of certain specificactions. Then, it ties trust to the predictability of one's actions or behavior.That's a pretty accurate definition, don't you think?

Ethics involves learning what is right or wrong, and thenchoosing and doing the right thing. But "the right thing" is notnearly as straightforward as conveyed in the aforementioned quote or in themountain of literature on business ethics. Most ethical dilemmas in theworkplace are not simply a matter of "Should Bob steal from Jack?" or"Should Jack lie to his boss?" What are ethics in healthcare and howdo healthcare professionals demonstrate they are trustworthy?

In writing this article, I spoke to many smart people, researched articlesand the World Wide Web and reviewed a couple of hospitals' policies. Manyethicists and several of the smarter people I spoke with assert that there'salways a right thing to do based on moral principle, while others believe theright thing to do depends on the situation -- ultimately it's up to theindividual.

Many people I spoke with agreed that trust is earned over time. You trustsomeone because his or her actions are consistent over time and because theperson practices what he or she preaches. You don't have to like someone youtrust, but you know that they have integrity.

So, what does it mean to be trustworthy? It means to be deserving of trust,which ideally is a predecessor to being trusted. Trustworthiness is an internalphenomenon. The minimum standard of trustworthiness should be absolutecompliance with legal standards of conduct. It should also include evidence of agood faith effort to ensure that the actions of an organization or individualsconforms to society's expectations for ethical conduct, even if not compelled toso act by law or regulation.

Preston Townley, in his speech "Business Ethics: Commitment to ToughDecisions" (Vital Speeches, January 1992, pp. 208-211), states "... itought to be fairly easy to choose between right and wrong by relying onprinciples, but business activity often demands that we select from alternativesthat are neither wholly right or wholly wrong." While I'm sure Townley'sremarks were pertinent in 1992, he could not have described the vast majority oftoday's transactions -- in our world of countless shades of grey -- moreaccurately if he'd tried.

Do we try to perform our responsibilities based purely on integrity? What dowe use for guidance? Is there a "line in the sand" we should watch outfor? Can we get done what needs to be done without veering into those shades ofgrey? Are business meetings during lunch ethical? Are they necessary given thatthere is fewer staff responsible for greater workloads, preventing you fromfinding time to research a new vendor or product other than during lunchtime?Are site visits ethical? I don't know of many, if any, individuals who planpersonal vacations to include meeting time with vendors and listening topresentations on the next greatest and latest service or invention, but what ifthe vendor is located outside of Orlando?

A good friend of mine battling cancer provided me with examples of ethicaldilemmas of even greater scope to think about, including "Are things alwaysethical even when they are against the law? What about euthanasia, use ofexperimental drugs, or the use of life extending procedures that aren't FDAapproved? How do we justify the death penalty as morally ethical, whenindividuals at the end of their lives cannot freely elect to limit or end theirown misery?" These are difficult questions about huge issues and almostimpossible to provide "rubber stamp" answers in that every situationis unique. However, some of the business-related issues could be addressed byusing common sense and acting in a trustworthy manner.

The following list, attributable to Frank J. Navran, director of training atthe Ethics Resource Center, gives us a good overview of how to conduct ourselvesin order to gain trust from our coworkers, managers and others.

• Be proactive in reporting problems or errors -- be the first to report your own mistakes

• Accept responsibility to fix what is wrong even if you were not responsible for making it wrong

• Apologize

• Show that the event was an exception

• Tell how you will prevent its recurrence -- focuse on fixing the problem, not the blame

• Invite public scrutiny of the issue and your proposed responses

• Don't do it again

Set an example among your co-workers and for your staff by using good commonsense. Let's look at the ethical nature of business meetings held duringbreakfast or lunch. Meals occurring in connection with business discussions orthe development of business relationships are generally deemed appropriate inthe conduct of ethical business. As a general guideline, business entertainmentin the form of meals and non-alcoholic beverages is acceptable, as long as themeals are modest, infrequent and, as much as possible, conducted on a reciprocalbasis. When was the last time you bought a vendor lunch? Entertainment in anyform that would likely result in a feeling or expectation of personal obligationshould not be extended or accepted.

If you have any doubt about the appropriateness of a situation, seek inputfrom your immediate supervisor as to whether a gift or entertainment might becompromising or could be considered unreasonable under the circumstances.Remember, the significance of the gift often lies not in the dollar value, butin the circumstances surrounding the gift and its acceptance. When in doubt,check with your manager or consider talking to your organization's humanresources staff.

Don't gossip about co-workers, vendors or other organizations. What yourepeat could be harmful to someone, or even slanderous, and you just don't needthat hassle when you're trying to get work done. Here's a good saying toremember when you're tempted to dish dirt about someone or something:"Small minds talk about people; mediocre minds discuss events; great mindscommunicate about ideas."

I'm sure that all of my fellow healthcare professionals possess great minds.

I'll leave you with one last thought to ponder. Bob Dunn, president and CEOof San Francisco-based Business for Social Responsibility, said, "Ethicaldecisions aren't as easy as they used to be. Now, they're the difference betweenright -- and right."

Bryant Broder, ACSP, is the immediate past president of the AmericanSociety for Health Central Service Professionals, and is the manager of surgicalprocessing at Saint Mary's Health Services in Grand Rapids, Mich.