Org Ethics Master Booket 2013.pdf

Group Six Session Ten

Organizational Ethics November 2013

The Identity of Leaders in Catholic Health Care

“As leaders in Catholic Health Care, we understand ourselves as (1) called to this work (2) in the context of a ministerial tradition that ultimately takes its inspiration and direction from the healing mission of Jesus. As part of this tradition, (3) we are committed personally and professionally to the spiritually grounded values (4) that guide our efforts to respond to human suffering.”

The Work of Leaders in Catholic Health Care

“As leaders in Catholic Health Care, we work (5) to integrate core values into organizational structures, policies, and behaviors; (6) to link discernment to strategic decision making, innovation, and team composition; (7) to incorporate the Catholic Social Tradition into organizational life and mission; (8) to develop and insure accountability for ethical policies, practices, and behaviors in our clinical settings; (9) to develop and insure accountability for ethical policies, practices, and behaviors in our organizational relationships; (10) to bring the benefits of healthcare to the poorest and most vulnerable members of our society; (11) to respect and attend to the whole person of patients, physicians, associates, and volunteers; (12) and to work collaboratively with Church authorities and agencies.”

Table&of&Contents&Organizational&Ethics&November&2013&–&Group&6&

&&

Ethical&Leadership&&&&&&&Making&and&Communicating&Strategic&Decisions&&&

1&

Aspects&of&Organizational&Ethics:&&&&&&Leadership&Considerations&&&

5&

Zumanda&Refrigerator&Case&&&

20&

The&Kidney&Case&&&

26&

The&Brakenridge&Hospital&Case&&&

30&

March&of&Dimes&Issues&&&

32&

Ethical&and&Religious&Directives&&&

33&

Six&System’s&Framework&for&Ethical&Decision&Making&&&&&&&Dignity&Health&&&&&&Daughters&of&Charity&Health&System&&&&&&&PeaceHealth&System&&&&&&Providence&Health&&&Services&&&&&&St.&Joseph&Health&&&&&&Sisters&of&Charity&&&

&&35&43&55&58&60&62&

Action|Feedback& 75&&

Organizational Ethics November 2013 – Group 6

Christopher W. Bauman © UCIrvine, The Paul Merage School of Business

PE

RS

UA

SIV

E C

OE

RC

IVE

“Leadership is the art of getting someone else to do something you want done because he wants to do it. ”

n Constructing formal incentive structures n e.g., armies, police, institutions, contracts

n Creating norms, setting expectations and being exemplars of desired behavior n e.g., acts of heroism, generosity

n Inspiring, making arguments, telling stories, showing images

What is Leadership?

Rational persuasion, inspirational appeal, and consultation are more effective than pressure, coalition, and legitimation. Yukl & Tracey (1992)

Dwight D. Eisenhower

Ethical Leadership: Making and Communicating Strategic Decisions

Chris Bauman University of California, Irvine Merage School of Business


1



If you want people to surrender or to yield to you, you can use fear

If you want people to work or to serve you, you can use duty

If you want people to go somewhere or to do something, you can show them the interest

Harry Emerson Fosdick

“Men will work hard for money. They will work harder for other men.

But men will work hardest of all when they are dedicated to a cause.”

What Really Matters? n Does life satisfaction go up

or down after people have children? ■ Why?

n Less sleep, less money, less sex,

less time for personal entertainment n Sense of purpose!


2


CAUSES


n Threat to harmony n Resort to public statements of general Policy n Prevent cycles finger-pointing

n Threat to efficiency n Ideological engagement can lead to stalemates n May constrain decision-making flexibility

n Threat to image of power and effectiveness

n May not be able to implement lofty goals n Unclear whether they carry real weight vis-à-vis other concerns n Little experience making moral arguments

Moral Muteness of Managers

Leadership Challenge n Leaders must have a vision and be able to

articulate it to those who will implement it n Must see a better world and help others see it too n Build off cultural values and symbols that resonate

n Unfortunately, there is a tendency for leaders to be more self-focused n They’re in charge - used to making decisions n Busy - not enough time in the day


3


Value Propositions n A value proposition is a principle for generating clearly

ordered preferences among a set of choices n Economics n Duty/obligation n Net social benefits n Fairness n Emotions

n Value propositions guide an individuals decisions about what they ought to do in a specific situation

n Situations can be approached from multiple perspectives and leaders much recognize that different viewpoints exist, both across and within individuals

n An effective leader develops and communicates value propositions that generalize across a range of situations n As leaders, you play a key role in translating abstract values

to specific situations Christopher W. Bauman © UCIrvine, The Paul Merage School of Business


n You are the director of the corporate strategy team advising Zumanda Corporation’s top management team on whether the company should move ahead with production of a new technology refrigerator

n You should have already clarified your individual opinions by filling out the attached worksheet n Submit the worksheet before joining your group n Assemble your group n Groups must make a recommendation and prepare a

statement that describes and justifies the decision n When we reconvene, groups will present their

recommendation and accompanying rationale

Zumanda Exercise

4


© Copyright 2013 Ministry Leadership Center

Sacramento, CA

Aspects of Organizational Ethics:

Leadership Considerations

MINISTRY LEADERSHIP CENTER

Overview

!  Desire To Be Ethical !  Causes, Consequences, and Remedies of

Moral Muteness !  The Ethical Nose !  Cooperation, Partnerships, Affiliations,

and Joint Ventures !  Tendencies in Thinking that Affect Ethical

Decision-Making


Desire To Be Ethical

!  “As I see it, there are two major ingredients to an ethical decision. The desire to act ethically [why do it] and the knowledge of what it takes in this particular situation to act ethically [how to do it]. In my experience, the lack of desire is more common than the lack of knowledge.”

– Rev. Ray Baumhart, Past President of Loyola University Chicago

5



Sacramento, CA


Desire To Be Ethical

!  Moral Dilemma – When one is unsure which principles apply or

when the values and principles conflict and one is unsure how to resolve the conflict

!  Moral Distress – When one knows the right thing to do but internal

and external constraints make it difficult to do

!  The relationship of ethical desire to ethical action


Tradition: Desire to Be Ethical:

!  “Deep within his conscience, man discovers a law

which he has not laid upon himself but which he must obey. Its voice, ever calling him to love and to do what is good and to avoid evil, tells him inwardly at the right moment: do this, shun that. For man has in his heart a law inscribed by God. His dignity lies in observing this law and by it he will be judged. His conscience is man's most secret core, and his sanctuary. There he is alone with God whose voice echoes in his depths. By conscience in a wonderful way, that law is made known which is fulfilled in the love of God and of one's neighbor.” (Gaudium et Spes, no. 16)


Desire To Be Ethical: Claiming and Committing

!  The ethical desire is innate, built into us, an essential component of human existence. But claiming and committing to it is a social process.

!  Both organizations and individuals have to go

through the intentional process of claiming and committing to ethical desires.

!  The “claimed and committed desire to be ethical” begins the journey of action/reflection.

6



Sacramento, CA


Desire To Be Ethical: The Journey

!  “Claiming and committing” to an ethical desire means an ethical desire becomes the co-desire of every other desire.

!  The organizational ethical desire unfolds

into policies/structures/decision-making, etc.


Desire To Be Ethical: The Journey

!  What are some signs that your organization has “claimed and committed” to an ethical desire?

!  What are some signs that you have “claimed and committed” to an ethical desire?


Moral Muteness

!  Frederick B. Bird & James A. Waters, “The Moral Muteness of

Managers,” California Management Review (Fall, 1989), pp. 73-88.

!  Normative Expectations – Honest communication – Fair treatment – Provision of safe and worthwhile services and

products – Etc.

!  Present but implicit, unarticulated

7



Sacramento, CA


Moral Muteness

!  Causes of Moral Muteness

– Threat to Harmony

– Threat to Efficiency

– Threat to Image of Power and Effectiveness


Moral Muteness

!  Causes of Moral Muteness

– Threat to Harmony

– Threat to Efficiency

– Threat to Image of Power and Effectiveness


Moral Muteness

!  Consequences of Moral Muteness – Moral Amnesia

– Narrowed Conception of Morality

– Moral Stress

– Neglect of Abuses

– Decreased Authority of Moral Standards

8



Sacramento, CA


Moral Muteness

!  Remedies of Moral Muteness – Create safe Harbors for dissent – Find shared commitments – Learn ethical talk – Have patience


Moral Muteness

!  From our experience: – Is moral muteness a problem? If not, why not? – If it is, what are some of the causes? – If it is, what are some of consequences?

– If it is, what are some of the remedies?


The Ethical Nose

!  Identify one work situation that kept you “awake at night” (caused you a great deal of concern - fretting, worrying, uncertain, etc.) and for which you feel you came up with a good solution?

9



Sacramento, CA


The Ethical Nose

!  How would you describe the situation? !  Who was involved (avoid specific names)? !  What values did you believe were at stake? !  How was the issue resolved? !  Who participated in the resolution? !  What made it a good solution for you? !  What do you wish you had available to you at the

time you were trying to resolve the problem? !  What are some of the learnings from this

experience?


The Ethical Nose

Something is amiss, but what is it? –  “Oh! It’s a moral problem!” –  Different sensibilities –  “She/he doesn’t get it.” –  “Houston, we have a problem.” –  Intuitive –  A feeling of dis-ease –  A whiff –  A suspicion

!  An embedded ethical dimension


The Ethical Nose

Injunctions –  Slow Down

–  Drill Down

–  Walk Around

–  Smoke It Out

10



Sacramento, CA


Tendencies in Thinking That Affect Ethical Decision-Making

!  Examine research on unexamined tendencies in how we think about the world, about other people, and about ourselves.

!  Prioritize tendencies according to how relevant they are to us and to our team’s decision-making processes.


Tendencies in Thinking That Affect Ethical Decision-Making

!  Decide on a common tendency. – General discussion with an emphasis on

which tendency received the most “5”s.

!  Design a question for a check list to vet decisions on whether or not this common tendency is involoved.

Cooperation,

Joint Ventures, & Partnerships

11



Sacramento, CA


Some Theological Perspectives

!  We inhabit a morally ambiguous world !  Evil, our own and others, is unavoidable

!  Principles of engagement – Double Effect – Choice of Lesser Evil – Cooperation


Ethical Permissibility of Actions: Three Theological Principles

!  Double Effect – Not intrinsically evil – Do good not evil – Choice of lesser evil

!  Cooperation

Principle of Cooperation

Experience

Tradition Culture

12



Sacramento, CA


Principles of Cooperation

!  Formal Explicit

Implicit

!  Material Immediate Proximate Mediate Remote


Material Cooperation Acceptable When

!  Sufficient Reason

!  No Scandal


Brackenridge Hospital

!  A Catholic health care system found itself involved in implicit formal cooperation

!  Subsequently, the system moved through a questionable form of immediate material cooperation into an acceptable form of mediate material cooperation

13



Sacramento, CA


Definition

!  A joint venture is defined as any formal relationship with another organization in which the parties share a common mission or business purpose and share the risk and reward, regardless of the extent or allocation of governance control. While not specifically addressed, this concept has potential applicability to other collaborative relationships (including, but not limited to networks, management contracts, and routine contractual relationships).


Forming New Partnerships Directive 67 �Decisions that may lead to serious consequences for the identity or reputation of Catholic health care services, or entail the high risk of scandal, should be made in consultation with the diocesan bishop or his health care liaison.�


Forming New Partnerships Directive 68 �Any partnership that will affect the mission or religious and ethical identity of Catholic health care institutional services must respect church teaching and discipline. Diocesan bishops and other church authorities should be involved as such partnerships are developed, and the diocesan bishop should give the appropriate authorization before they are completed. The diocesan bishop's approval is required for partnerships sponsored by institutions subject to his governing authority; for partnerships sponsored by religious institutes of pontifical right, his nihil obstat should be obtained.�

14



Sacramento, CA


Forming New Partnerships Directive 69 �If a Catholic health care organization is considering entering into an arrangement with another organization that may be involved in activities judged morally wrong by the Church, participation in such activities, must be limited to what is in accord with the moral principles governing cooperation.�


Forming New Partnerships

Directive 70 �Catholic health care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization.�


Forming New Partnerships Directive 71 �The possibility of scandal must be considered when applying the principles governing cooperation. Cooperation, which in all other respects is morally licit, may need to be refused because of the scandal that might be caused. Scandal can sometimes be avoided by an appropriate explanation of what is in fact being done at the health care facility under Catholic auspices. The diocesan bishop has final responsibility for assessing and addressing issues of scandal, considering not only the circumstances in his local diocese but also the regional and national implications of his decision.�

15



Sacramento, CA


Forming New Partnerships

Directive 72 �The Catholic partner in an arrangement has the responsibility periodically to assess whether the binding agreement is being observed and implemented in a way that is consistent with Catholic teaching.�


Questions The reasons for the joint venture. – Does the proposed joint venture enhance and

extend our ministry, Mission and Values and improve quality of services?

– Is there community need for this joint venture?

– Can the need be met only by the joint venture? – If a primary reason is to generate capital, is

this at odds with Mission and Values?


Questions Activities of the joint venture, and the activities and reputation of the potential partner? –  Are the proposed partner�s core business

and core practices aligned with our Mission and Values?

– What is the partner�s reputation and would it affect our ministry positively or negatively?

16



Sacramento, CA


Questions

Behind all of these practical concerns sits a unifying moral concern: With whom can we legitimately be involved?


March of Dimes Case

!  What is the issue?

!  What are the options?

!  What should you do? Why?


Ethical Decision Making Models

!  Making good ethical decisions requires a trained sensitivity to ethical issues and a practiced method for exploring the ethical aspects of a decision and weighing the considerations that should impact our choice of a course of action. Having a method for ethical decision-making is absolutely essential. When practiced regularly, the method becomes so familiar that we work through it automatically without consulting the specific steps. –  Markkula Center for Applied Ethics at Santa Clara

University

17



Sacramento, CA


Ethical Decision Making Models

!  Have you ever used an EDMM? !  If so, how would you evaluate the

experience?

!  Do you use a shorter way to make sure a decision is ethical?


Five Questions to Ask

!  Which option will produce the most good and do the least harm? (The Utilitarian Approach)

!  Which option best respects the rights of all who have a stake? (The Rights Approach)

!  Which option treats people equally or proportionately? (The Justice Approach)

!  Which option best serves the community as a whole, not just some members? (The Common Good Approach)

!  Which option leads me to act as the sort of person I want to be? (The Virtue Approach)


Who is the Ethical Leader?

!  Picture a leader you consider to be ethical.

!  Listen to qualities of ethical leaders from the Business Roundtable Institute for Corporate Ethics.

!  Name two pre-eminent qualities of “your” ethical leader.

18



Sacramento, CA


Business Roundtable Institute for Corporate Ethics: Developing Ethical Leadership

!  Ethical Leaders 1.  Articulate and embody the purpose and

values of the organization. 2.  Focus on organizational success rather than

on personal ego. 3.  Find the best people and develop them. 4.  Create a living conversation about ethics,

values and the creation of value for stakeholders.


Business Roundtable Institute for Corporate Ethics: Developing Ethical Leadership

!  Ethical Leaders 5.  Create mechanisms of dissent. 6.  Take a charitable understanding of others’

values. 7.  Make tough calls while being imaginative. 8.  Know the limits of the values and ethical

principles they live. 9.  Frame actions in ethical terms. 10. Connect the basic value propositions to

stakeholder support and societal legitimacy.

Copyright © 2013 Ministry Leadership Center

Sacramento, CA

19


The Zumanda Refrigerator You are a member of the top corporate strategy team for the Zumanda Corporation, a leading producer of consumer appliances for commercial and home use. Founded in 1934, Zumanda has succeeded through constant technological innovation of products that make consumers’ lives easier. For example, in 1949, it was the first company to manufacture a combination refrigerator-freezer.

Competition in the appliance industry has been intensifying since the mid-1990s. The prevalence of “big box” retailers has severely eroded margins; moreover, consolidation among manufacturers has heightened the intensity of rivalry across all segments of the industry. Over the past several years, introducing technological innovations rapidly and gaining first-mover advantage has become critical to profitability. Securing large volume orders has also become necessary for companies to recoup the cost of developing those innovations. As a market leader with a strong, core identity as a technological innovator, Zumanda is acutely aware of the changing competitive dynamics. It has therefore spent hundreds of millions of dollars over the past several years to develop a new, energy efficient refrigeration technology.

Zumanda has been preparing to introduce their new line of “Opti-Fresh” refrigerators. The Opti-Fresh refrigerator preserves food better, consumes much less electricity, and creates more storage space in the same refrigerator shell than models that are currently available from any manufacturer. The key innovation that provides the Opti-Fresh with this greater level of efficiency is using the chemical R-510B as a new, high-tech refrigerant, which will be marketed as “Super-Freon” technology. Describing his vision for the new product line, the Zumanda CEO made a company-wide announcement that, “The Opti-Fresh is not to use more than 250 kWh of energy per year and not cost a cent over $1,000 to produce."

Given its energy efficiency, Opti-Fresh refrigerators were expected to be particularly attractive to consumers in developing countries where electricity supplies are expensive and have to be backed up by precious battery power. Because it extends the shelf life of perishable foods, which contain vital nutrients not available in processed counterparts, the Opti-Fresh refigerator could considerably reduce the high levels of malnutrition and infant mortality in developing countries. Also, refrigeration is important for many pharmaceutical products designed to combat diseases in these countries. Extending perishables and pharmaceuticals with highly energy efficient refrigeration means that the Opti-fresh actually could save lives. No refrigerators currently on the market have the same storage capacity or are as energy-efficient (and cost-effective) as the Opti-Fresh.

Zumanda’s primary competitor, European-based Vortex, is also working on new cooling technology, so Zumanda has been anxious to bring this product to market as quickly as possible, ideally with an initial high-volume contract. Zumanda was therefore thrilled when S.H.A.R.E., a UN sponsored foreign assistance organization, inquired about purchasing 12.5 million refrigerators for distribution in the equatorial regions. This deal would allow Zumanda to introduce its Opti-Fresh refrigerators alongside an announcement of its deal with S.H.A.R.E., highlighting the benefits of Super-Freon over the technology used by Vortex. Although an improvement over the status quo, Zumanda had learned that Vortex’s new technology consumed more energy than the use of Opti-Fresh’s Super-Freon, making it likely that people in developing countries could not use Vortex’s refrigerator as effectively.

20


Original plans called for the Opti-Fresh refrigerators to be rolled out in May, 2011. To win the contract, however, Zumanda agreed to sell S.H.A.R.E. 12.5 million refrigerators for just $995 per unit, with an earlier delivery date of October, 2010. The $995 unit price provides a profit margin of only $20 per unit, but the volume helps Zumanda recoup higher than expected development costs and the publicity associated with the contract made Zumanda eager to seal the deal. S.H.A.R.E. also was very pleased with the deal, but it let Zumanda know that it had just edged out Vortex, which promised that it could easily meet the November delivery date but had initially proposed a slightly higher price. To have the refrigerator ready for delivery by the date promised, Zumanda cut its normal drafting-board-to-production time from forty-three to just twenty five months. As a result, the production line was tooled immediately, and any changes in the product at this point would mean the line would have to be retooled, increasing costs and causing significant delays.

In April of 2010, the first refrigerators rolled off production lines. Zumanda tested various prototypes against the safety standards proposed by the U.S. Consumer Product Safety Commission (CPSC), the federal agency charged with protecting the public from unreasonable risks of serious injury or death from consumer products. The CPSC standards suggested that all refrigerators must withstand a range of extreme temperatures without premature corrosion of its parts, thus preventing dangerous toxic leaks of chemicals such as Super-Freon. Because they are heavier than air, Super-Freon vapors may cause asphyxiation if inhaled. At flame temperatures Super-Freon may decompose to hydrogen fluoride, which can be lethal when released at high concentrations. Thus, product malfunctions creating Super-Freon discharges could be catastrophic; they could cause serious illness requiring hospitalization to anyone within a 6 foot (2m) radius and almost always be fatal to anyone within a 3 foot (1m) radius of the refrigerator at the time of the leak. Once the gas is discharged, however, it dissipates rapidly, eliminating the chance of larger scale health consequences.

Zumanda’s prototypes passed all tests without problems within the temperature ranges specified for testing by the CPSC, which covered climactic conditions normally found in the United States. However, when the new models coming off the production line were tested in conditions likely to be encountered in equatorial climates – where average daily temperatures can range from well over 105 degrees Fahrenheit (40° C) during the day to below 25 degrees Fahrenheit (-5° C) at night, with extremes of dryness and humidity, and relatively little air conditioning or heating to regulate intra-day conditions – the refrigerators encountered two significant problems. In simulated desert climates, the sealant on the hoses containing Super-Freon at times dried out and cracked, whereas in simulated humid climates, the hoses swelled; both conditions resulted in the potential for Super-Freon leaks. The only way to ensure that all refrigerators would perform flawlessly would be to modify the production line and reinforce the heat/humidity resistant insulation on the hoses.

Zumanda was fairly sure that the unmodified model of the refrigerator would present a fatal toxic hazard if the sealant corroded and the hose broke. Based on initial tests, however, Zumanda determined that the frequency of such corrosion would be low, occurring with a probability of 0.00017. Replacing the corroded hoses in the field, as needed after a hose was noticed to have cracked or swelled but before any leakage of Super-Freon, would cost approximately $700 per unit. Additionally, the engineering report estimated the probability of hospitalization as a result of hose failure and leakage of Super-Freon for those within a 6 foot (2m) radius of a malfunctioning unit at 0.000014. A similar number of incidents were predicted

21


to be fatal to those within a 3 foot (1m) radius of the refrigerator during a sealant or hose malfunction.

Zumanda’s legal department estimated the financial liability associated with Super-Freon leakage accidents would be $200,725 for each death and $67,000 for each hospitalization. In estimating the expected costs associated with the potential loss of life Zumanda’s engineers and legal team considered the costs typically associated with a death in the developing world, although their report stated that it would be extremely unlikely that the company would actually face any enforceable legal liability due to accidents that occurred in developing countries.

If installed on the production line, Zumanda engineers estimated the cost of technical improvements to prevent Super-Freon leaks based on extreme temperatures and humidity to be $11 per unit. Moreover, this change to the production line would cause at least a 6 month delay in delivery of the refrigerators, and S.H.A.R.E. probably would cancel the contract.

Putting together all the data, the report arrives at the following overall assessment of costs:

Expected Financial Costs of not reinforcing the heat/humidity resistant insulation

• Unit cost: o $700 per retrofit; $200,725 per death, $67,000 per hospitalization

• Probability:

o Probability of corrosion requiring retrofit of hoses = 0.00017 (2100 field repairs) o Probability of an under 3 foot (1m) radius exposure to Super-Freon = 0.000014

(175 toxic deaths) o Probability of a within 3-6 foot (2m) radius exposure to Super-Freon = 0.000014

(175 toxic inhalation hospitalizations)

• Total: (2,100 × $700) + (175 × $200,725) + (175 × $67,000) = $48.32 million Expected Financial Costs of reinforcing the heat/humidity resistant insulation

• Sales: 12.5 million refrigerators

• Unit cost: $11 per refrigerator

• Total: 12.5 million × $11 = $137.50 million

22


Zumanda did a thorough evaluation of the likelihood of adverse media, activist, legislative or regulatory action directed at the company in Zumanda’s primary markets in the developed world. They determined that the likelihood of any significant indirect impacts from the extremely small number of accidents in the developing world would be minimal, particularly because it would be very difficult for the media or the public to identify the refrigerator as the source of any health issues. Moreover, the delay caused by retooling the production line to modify the insulation on the hoses would likely cause S.H.A.R.E. to cancel the contract with Zumanda and give the contract to Vortex instead. Losing this contract could very well mean that Zumanda would never recoup the cost of its investment in the Super-Freon technology, and it could have severe repercussions for the organization: There would almost certainly be layoffs throughout the company and your own team would definitely be affected by downsizing. You’re also convinced the increased energy consumption of the Vortex technology would prevent it from providing the same level of benefit to those in desperate need of energy-efficient refrigeration in developing countries. For these reasons and because the costs of the suggested safety improvements outweighed their benefits, the development team working on the Opti-Fresh project recommended against any improvements. It is now May, 2010, just following the submission of the development team’s report and you have an important decision to make. Should they go ahead and deliver the refrigerators on schedule to S.H.A.R.E., or stop production and most likely lose the contract with S.H.A.R.E?

BEFORE THE SESSION BEGINS, PLEASE COMPLETE THE SURVEY THAT FOLLOWS AND

BRING IT WITH YOU

23


Circle your decision: YES – go ahead and deliver the refrigerators as is

NO – stop production

In the space below, please explain why you chose the option you circled above. Provide and briefly explain at least three reasons why you believe your decision is the right one.

1.

2.

3.

*** ADDITIONAL QUESTIONS ON THE NEXT PAGE (OR ON THE BACK) ****

24


How convincing or unconvincing are the following arguments for and against production of the refrigerator?

Very Slightly Slightly Very unconvincing unconvincing convincing convincing

GO: All things considered, it would save more lives than it would kill people

¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: Going ahead with production could ruin trust in the company in the future

¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: The company has an obligation to its shareholders, and analyses show that it will be a profitable product

¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: The company has an obligation to consumers, and some may be hurt or killed

¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: Improves quality of life for users overall

¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: If people learn about leaks and stop using the it, there would be lots of waste

¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: Refrigeration will save lives by storing food and medicine

¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: Leaks will kill some people ¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: Other refrigerators won’t work as well ¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: Regardless of what the research says, the possibility of legal liability is too high

¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: Every product has some injury rate ¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: People in developing countries deserve to have safe products

¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: Production saves local jobs ¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: Watchdog groups could create a public relations nightmare

¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: It provides immediate help to poor people

¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: The company has a solution to the problem so they must implement it

¦ ¦ ¦ ¦ ¦ ¦ ¦

GO: Other companies survive or even thrive after scandals

¦ ¦ ¦ ¦ ¦ ¦ ¦

STOP: Reactions to the problem are unknowable, so it’s a mistake to consider the potential costs and benefits of the outcome

¦ ¦ ¦ ¦ ¦ ¦ ¦

25


`

The Kidney Case

The Transplant Review Board of the State Hospital Association has called for an emergency session to assess the proper assignment of a kidney that will become available in the next few days. As the demand for kidneys far exceeds the supply, the Transplant Review Board must carefully consider each candidate and their history in order to determine who of eight potential transplant recipients will receive the available kidney. Please read over each candidate's profile and rank order each candidate with 1 receiving the highest priority and 8 receiving the lowest priority. Each number rank can only be assigned to one candidate.

26


Patient A: Patient A is a 34 year old veteran of Desert Storm and a Purple Heart recipient. As part of the lead company in the ground attack, he was exposed to a chemical warfare agent similar to Agent Orange, which, among other things, is known to be nephrotoxic. Since returning from the war, he has experienced a slow but steady decline in renal function and has now reached end-stage renal disease. He suffers from post-traumatic stress disorder/depression and therefore may be less likely to comply with the rigorous post-transplant regimen. However, he is improving in counseling, and his psychiatrist argues that much of his depression stems from his poor health and may be partially or completely resolved when he is restored to health after transplant.

Patient B: Patient B is a 62 year old fusion physicist whose career has been dedicated to developing alternative fuel sources. His prototype fusion reactor could pave the way to the development of fuel cell technology that would replace fossil fuels. This would revolutionize energy for the entire world, making it abundantly available in a cleaner, more environmentally sound form. His work is being closely followed by the Nobel Laureate Society, as the impact of his research could be felt globally.

Patient C: Patient C has only been on the wait list for 5 months, but the available kidney is an excellent match and therefore has the best chance for a successful outcome. She suffered from high blood pressure for several years, but as a busy mother of four young children, she was negligent about taking her medication which hastened her renal failure. In spite of her track record, she vows that she will be compliant with all medications involved in the transplant, and because the kidney is an exact match, she won't have to take many immuno suppressants and will therefore avoid many of the health complications that the average kidney recipient experiences.

Patient D: Patient D's renal failure is thought to be due to intravenous drug use, which he engaged in during his college days some twenty years ago. Fortunately, he was able to overcome his addiction by going through a rehab program. Since that time, he has led an exemplary life, finishing college and raising his family. He has dedicated both his time and personal assets to organize and support Narcotics Anonymous chapters throughout the county, and has been a tireless mentor to many other recovering addicts. Through his selfless efforts, countless narcotics abusers have found their way to sobriety.

27


Patient E: Patient E developed renal failure due to adult polycystic kidney disease, which is a dominantly inherited disease. She watched her father die of the same disease and is concerned about her younger siblings who inevitably will develop the same condition. After attending Catholic elementary and high schools, she joined a commercial real estate firm and later founded Capital Realty, currently the region's highest grossing privately owned real estate firm. She has already donated millions of dollars towards both Catholic education and kidney research, and should she survive her disease with a transplant. She has pledged to convert her company to a non-profit entity and donate all profits to Catholic schools and kidney research.

Patient F: Patient F is a 44 year old steel worker who suffers from kidney disease as a result of long-standing diabetes. Since being diagnosed with diabetes twelve years ago, he has only had intermittent access to healthcare due to underhanded management tactics aimed at increasing profits by cutting healthcare coverage. He has been on hemo-dialysis for five years and is now completely disabled. He has been on the transplant wait list for over four years and has worked his way to the top of the list. Although he has been a model patient and has seniority on the list, he has been passed over several times due to more urgent cases that have supplanted his position. He has continued to wait patiently, but he is desperate to regain his health so that he can return to work to support his family, and this kidney would afford him that opportunity. The available kidney is not an ideal match, but could do well with an aggressive post-transplant treatment regimen.

Patient G: Patient G is the 15 year old daughter of the former Saudi Arabian ambassador to the U.S. She is a straight-A student and is a volunteer tutor for learning-disabled children back in her home community. Her renal failure is caused by a rare condition that will likely return in a transplanted kidney, necessitating a further renal transplant in the distant future. Long-term dialysis at such a young age is not likely to preserve any quality of life; consequently, the transplant will not only spare her life in the long run, but help maintain a standard of health that will enable her to function as an independent, successful adult.

Patient H: When he was in his twenties, Patient H donated a kidney to his brother. At the time, doctors informed him that there was a small risk that he might someday develop the same disease as his brother, but as his kidney was an excellent match, he was willing to do whatever he could to aid his brother's health. Now, fifteen years later, Patient H has unfortunately developed the same disease as his brother, and although his case is less severe, his only remaining kidney is overwhelmed and beginning to fail.

28


Name:

Please rank the candidates from 1 (highest rank) to 8 (lowest rank) in terms priority for receiving the kidney. Every candidate must be ranked and ties are not allowed.

Candidate Rank A (Soldier)

B (Physicist)

C (Mother)

D (Drug user)

E (Catholic)

F (Steelworker)

G (Saudi girl)

H (Donor)

29


THE BRACKENRIDGE HOSPITAL CASE

Since&1884,&Austin's&public&hospital,&Brackenridge,"treated&patients&regardless&of&ability&to&pay.&But&in&a&state&where&one&in&five&people&has&no&health&coverage,&leaving&public&and&charity&hospitals&to&assume&most&of&the&resulting&cost,&the&burden&became&too&great&for&BrackenridgeAAa&crushing&$38&million&debt.&Austin's&solution&in&1995&was&to&lease&Brackenridge&and&the&adjacent&Children's&Hospital&to&the&Catholic&Seton&Healthcare&Network.&Seton&Healthcare&Network&is&part&of&Ascension&Health.&

But&trouble&of&one&sortAAfinancialAAwas&succeeded&by&trouble&of&another&sortAAethical.&Brackenridge&had&provided&sterilization&and&contraceptive&services&as&an&option&for&its&134,666&patients&treated&annually.&

Seton&Healthcare&could&not&provide&those&services.&The&initial&solution&reached&by&Seton&and&the&city&of&Austin&in&1995&was&a&"wall&of&separation"AAmeaning&that&Seton&staff&didn't&provide&proscribed&services,&city&staff&did.&

In&1995&Seton&Healthcare&Network&entered&into&a&30Ayear&Lease&Agreement&with&the&city&under&which&Seton&assumed&responsibility&to&govern&and&operate&the&city’s&Brackenridge&Hospital.&According&to&Seton’s&administrators,&this&was&done&to&respond&to&a&request&made&by&the&city&and&to&expand&the&health&care&ministry&to&the&poor&of&the&Daughters&of&Charity.&Seton&did&not&need&to&assume&this&responsibility&to&secure&its&own&viability&or&to&respond&to&market&pressures.&However,&many&in&the&community&had&speculated&that&the&city&might&be&forced&to&close&Brackenridge&because&of&its$precarious&financial&condition.&The&proposed&Lease&Agreement&was&approved&by&the&thenAbishop&of&Austin,&who&did&so&on&the&advice&of&three&different&moral&theologians.&

A&year&later,&the&bishop&was&told&that&the&Holy&See&had&reviewed&the&arrangement&and&judged&it&to&be&morally&illicit.&Seton&could&not&simply&abrogate&the&contract&lest&it&suffer&a&significant&financial&penalty&for&nonperformance.&In&light&of&some&of&the&other&initiatives&undertaken&by&Seton,&a&termination&of&the&contract&would&have&resulted&in&a&severe,&perhaps&crippling&material&impact&on&its&ministry.&The&Holy&See&insisted&that&a&solution&be&found&to&extricate&Seton&from&the&illicit&cooperation&in&which&it&found&itself&and&to&which&it&was&contractually&committed.&

Seton,&before&entering&into&the&Brackenridge&Lease&Agreement,&desired&to&avoid&culpable&cooperation&with&the&certain&practices&that&had&been&taking&place&at&Brackenridge&Hospital.&As&a&condition&for&accepting&management&of&the&hospital,&Seton&insisted&that&abortions&cease&there.&That&practice&was,&indeed,&eliminated.&However,&the&city&of&Austin&would&not&countenance&the&elimination&of&surgical&sterilizations&of&women&at&Brackenridge&because&it&regarded&such&procedures&as&a&community&service,&despite&Seton’s&beliefs&to&the&contrary.&For&the&sake&of&the&contract&allowing&it&to&serve&the&poor&and&for&the&sake&of&eliminating&abortion,&Seton&agreed&to&permit&surgical&sterilizations&to&continue&at&Brackenridge&and&tried&to&remove&Seton&personnel&from&any&type&of&culpable&cooperation.&One&of&the&problems,&however,&is&that&while&Seton&had&isolated&its&personnel&from&cooperation,&it&had&not&sufficiently&isolated&management&from&cooperation.&The&management&arrangements&established&by&the&agreement&ensured&that&the&direct&sterilizations&would&continue&to&take&place.&This&solution&that&was&approved&by&the&new&ordinary.&

30


A&number&of&circumstances&concerning&the&Seton/Brackenridge&agreement&were&unique:&• Brackenridge&is&a&cityAowned&hospital,&not&a&CatholicAowned&one,&even&though&it&

is&being&leased&and&managed&by&a&Catholic&health&care&system.&• Seton&was&locked&into&a&30Ayear&lease,&the&violation&of&which&would&have&had&

severely&adverse&material&consequences&for&its&health&care&ministry.&

By&1997&it&was&clear&that&the&Vatican&believed&that&the&current&situation&entailed&unacceptable&cooperation&and&Seton&needed&to&stop&its&participation&in&these&activities.&For&several&years&Seton&looked&for&alternatives.&Simultaneously&the&public&concern&about&the&elimination&of&women’s&services&gained&momentum.&The&city&began&months&of&solutionAseeking&negotiations&with&Seton,&plus&a&coalition&of&community&groups&that&included&Planned&Parenthood,&the&Religious&Coalition&for&Reproductive&Choice,&Consumers&Union,&the&Texas&Women's&Political&Caucus,&the&League&of&Women&Voters,&the&National&Council&of&Jewish&Women,&the&Gray&Panthers,&the&National&Organization&for&Women,&the&American&Civil&Liberties&Union,&and&the&Texas&Abortion&and&Reproductive&Rights&Action&League.&

In&2002,&Seton&and&the&city&reached&a&second&agreement:&The&city&would&take&back&the&fifth&floor&of&Brackenridge&Hospital&and&construct&its&own&New&City&HospitalAA&"hospital&within&a&hospital"&for&services&Seton&would&not&provide.&Texas&law&allows&what&might&be&called&“hospital&within&a&hospital”&arrangements,&according&to&which&licensure&is&granted&to&two&separate&and&unrelated&corporate&entities&that&operate&in&the&same&building.&Such&arrangements&can&be&found&in&cases&in&which&one&hospital&has&special&expertise&(e.g.,&longterm&acute&care)&not&provided&by&the&other&and&for&which&the&other&cannot&obtain&licensure.&Under&such&arrangements,&one&hospital&can&provide&its&licensed&services&within&another&general&acute&care&hospital.&

Conceptually,&the&revision&of&the&Seton/Brackenridge&Lease&Agreement&was&not&complicated.&The&city&agreed&to&take&back&management&of&a&portion&of&its&own&hospital,&deciding&that&it&would&itself&provide&expanded&obstetric&services&in&that&portion.&The&city&will&hold&the&license&for&its&hospital,&which&will&have&its&own&separate&managers&and&governing&body.&The&city&further&agreed&to&finance&the&structural&reconfiguration&of&the&plant&necessary&to&accomplish&these&objectives.&And&it&agreed&that&no&abortions&would&take&place&in&its&own&hospital&within&Brackenridge&Hospital.&

At&this&point,&the&negotiators&realized&that&Brackenridge&would&have&to&provide&certain&services&to&City&Hospital&for&the&proposed&arrangement&to&work.&Consequently&the&city&and&Seton&proposed&to&enter&into&an&Ancillary&Services&Agreement&for&this&purpose.&However,&concerns&surfaced&that&some&of&the&services&required&by&City&Hospital&might&prove&to&be&immediate&material&cooperation&in&evil,&whereas&others&were&only&mediate.&Seton’s&provision&of&electricity&and&water&would&not,&for&example,&contribute&anything&essential&to&City&Hospital’s&anticipated&surgical&sterilizations.&However,&the&provision&of&sterilized&surgical&kits&would&contribute&something&essential,&as&could&the&provision&of&pharmacy&or&laboratory&services.&Seton&consequently&excluded&those&functions&from&the&Ancillary&Services&Agreement,&as&well&as&anything&else&which&might&be&seen&as&contributing&essentially&to&inappropriate&cooperation&in&the&new&City&Hospital.&

31


March of Dimes Issues

Recently St. A’s hospital has been bombarded from questions about its support of the March of Dimes (MOD). Staff and the community have made allegations that the March of Dimes supports policies that are antithetical to Catholic Church Teaching and the ERDs. They are demanding that all relationships with the March of Dimes cease. A review of relationships indicates the following cooperation:

1. The March of Dimes (MOD) is currently selecting a NICU in each state which will be permitted to use the MOD-developed program and educational materials aimed at reducing the incidence of prematurity and improving infant health and mortality. Being the MOD designated NICU will provide St.A with the valuable program and educational materials and will also serve as an excellent marketing opportunity. Also, patient outcome data will be collected and compiled by the MOD which will benefit our own initiatives and be shared with perinatal services nationwide. There are currently two NICU's in the state are being considered.

2. The March of Dimes provides grant funding for perinatal and pediatric health initiatives. St. A’s has been a grant recipient in the past. One of the MOD grants provided funding for a St. A prenatal education and care initiative in a nearby county that has no Medicaid OB providers. The grant project was aimed at two populations of patients: (1) Spanish speaking childbearing families that seek treatment at an outreach clinic at a Catholic church; and (2) childbearing women in a rural area in the same county. The grant funding allowed St. A to provide education and prenatal services to these under served populations. The other participant in this grant initiative was the local Catholic Nursing School

3. During previous years, the St. A’s Marketing Dept. has paid an annual fee to MOD in order to have the St. A’s name and logo appear on banners and materials associated with the MOD infant health campaigns. St. A has also sponsored booths at MOD fund-raisers. The purpose of our presence was two-fold: (1) to advertise the excellent perinatal services available at St. A; and (2) to support the MOD efforts aimed at improving infant health and decreasing infant mortality.

4. Two of St. A's perinatal program leaders currently serve on MOD boards. The boards are aimed at infant health initiatives rather than MOD research activities.

5. St. A does makes contributions to the MOD fund-raising campaign though employee contributions and other fund raising events.

We have been working with the March of Dimes for several years without complaint from the Catholic community. However, we have become aware of the fact that another Catholic provider in town does not seem to have any relationship to the MOD, so we thought we would run it by you for your opinion and advice. Which forms of cooperation are permissible?

32


Ethical and Religious Directives PART SIX

Forming New Partnerships with Health Care Organizations and Providers

Introduction

Until recently, most health care providers enjoyed a degree of independence from one another. In ever-increasing ways, Catholic health care providers have become involved with other health care organizations and providers. For instance, many Catholic health care systems and institutions share in the joint purchase of technology and services with other local facilities or physicians' groups. Another phenomenon is the growing number of Catholic health care systems and institutions joining or co-sponsoring integrated delivery networks or managed care organizations in order to contract with insurers and other health care payers. In some instances, Catholic health care systems sponsor a health care plan or health maintenance organization. In many dioceses, new partnerships will result in a decrease in the number of health care providers, at times leaving the Catholic institution as the sole provider of health care services. At whatever level, new partnerships forge a variety of interwoven relationships: between the various institutional partners, between health care providers and the community, between physicians and health care services, and between health care services and payers.

On the one hand, new partnerships can be viewed as opportunities for Catholic health care institutions and services to witness to their religious and ethical commitments and so influence the healing profession. For example, new partnerships can help to implement the Church's social teaching. New partnerships can be opportunities to realign the local delivery system in order to provide a continuum of health care to the community; they can witness to a responsible stewardship of limited health care resources; and they can be opportunities to provide to poor and vulnerable persons a more equitable access to basic care.

On the other hand, new partnerships can pose serious challenges to the viability of the identity of Catholic health care institutions and services, and their ability to implement these Directives in a consistent way, especially when partnerships are formed with those who do not share Catholic moral principles. The risk of scandal cannot be underestimated when partnerships are not built upon common values and moral principles. Partnership opportunities for some Catholic health care providers may even threaten the continued existence of other Catholic institutions and services, particularly when partnerships are driven by financial considerations alone. Because of the potential dangers involved in the new partnerships that are emerging, an increased collaboration among Catholic-sponsored health care institutions is essential and should be sought before other forms of partnerships.

The significant challenges that new partnerships may pose, however, do not necessarily preclude their possibility on moral grounds. The potential dangers require that new partnerships undergo systematic and objective moral analysis, which takes into account the various factors that often pressure institutions and services into new partnerships that can diminish the autonomy and ministry of the Catholic partner. The following directives are offered to assist institutionally based Catholic health care services in this

33


process of analysis. To this end, the United States Conference of Catholic Bishops has established the Ad Hoc Committee on Health Care Issues and the Church as a resource for bishops and health care leaders.

This new edition of the Ethical and Religious Directives omits the appendix concerning cooperation, which was contained in the 1995 edition. Experience has shown that the brief articulation of the principles of cooperation that was presented there did not sufficiently forestall certain possible misinterpretations and in practice gave rise to problems in concrete applications of the principles. Reliable theological experts should be consulted in interpreting and applying the principles governing cooperation, with the proviso that, as a rule, Catholic partners should avoid entering into partnerships that would involve them in cooperation with the wrongdoing of other providers.

Directives

67. Decisions that may lead to serious consequences for the identity or reputation of Catholic health care services, or entail the high risk of scandal, should be made in consultation with the diocesan bishop or his health care liaison.

68. Any partnership that will affect the mission or religious and ethical identity of Catholic health care institutional services must respect church teaching and discipline. Diocesan bishops and other church authorities should be involved as such partnerships are developed, and the diocesan bishop should give the appropriate authorization before they are completed. The diocesan bishop's approval is required for partnerships sponsored by institutions subject to his governing authority; for partnerships sponsored by religious institutes of pontifical right, his nihil obstat should be obtained.

69. If a Catholic health care organization is considering entering into an arrangement with another organization that may be involved in activities judged morally wrong by the Church, participation in such activities, must be limited to what is in accord with the moral principles governing cooperation.

70. Catholic health care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization.44

71. The possibility of scandal must be considered when applying the principles governing cooperation.45 Cooperation, which in all other respects is morally licit, may need to be refused because of the scandal that might be caused. Scandal can sometimes be avoided by an appropriate explanation of what is in fact being done at the health care facility under Catholic auspices. The diocesan bishop has final responsibility for assessing and addressing issues of scandal, considering not only the circumstances in his local diocese but also the regional and national implications of his decision.46

72. The Catholic partner in an arrangement has the responsibility periodically to assess whether the binding agreement is being observed and implemented in a way that is consistent with Catholic teaching.

34

�

REFLECTIVE EXERCISE

In�advance�of�the�meeƟng,�each�parƟcipant�should�reflect�on�the�following,�and�make�some�personal�notes�(not�to�be�shared)�to�bring�to�the�meeƟng.�

1.� What�are�my�hopes�related�to�this�quesƟon:�

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

2.� �What�are�my�fears�related�to�this�quesƟon?�

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

3.� What�are�my�biases�related�to�this�quesƟon?�(biases�are�hard�to�idenƟfy;�try�to�be�honest)�

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

�Spend�some�Ɵme�idenƟfying�your�top�one�or�two�hopes,�fears�and�biases.��Bring�these�to�the�meeƟng,�ready�to�share.��All�will�respecƞully�listen�as�each�person�shares.��No�one�will�comment.�� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

ValuesǦBased�Discernment�Dignity Health’s founders are women religious, for whom contemplation and action are linked in every decision. That tradition has come down to us in the way we go about making important, valuesǦbased decisions, specifically in the use of a discernment process that requires significant aspects of the decision be weighed in the light of our core values….This process is especially important when decisions are complex, or when the values involved may conflict. When issues…arise between Dignity Health and its partners, we expect all to contribute to a decision that serves the common good.

Ǧ Dignity Health’s Statement of Common Values

Page 1 of 8

35

�

�

“Courage�is�what�it�takes�to�stand�up�

and�speak.�Courage�is�also�what�it�

takes�to�sit�down�and�listen.”�

�K Winston Churchill J

�

NOTES:��________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

Page 2 of 8Dignity Health

36

�

SAMPLE VALUES QUESTIONS�

Mission

x� How�does�this�proposal�fit�within�our�organizaƟonal�mission�of�healing,�advocacy�and�partnering�for�improved�community�health?��

Dignity

x� Who�will�be�aīected�by�this�proposal,�both�inside�and�outside�the�organizaƟon?�x� Who�of�these�has�direct�influence�in�the�decisionͲmaking�process?�x� Can�we�provide�for�input�and�influence�by�people�who�will�be�most�aīected?�x� Can�we�miƟgate�the�eīect�of�this�decision�on�people�who�are�negaƟvely�aīected�by�it?�x� How�does�this�decision�recognize�all�dimensions�of�the�human�person—body,�mind,�spirit?�x� Does�this�proposal�contribute�in�some�way�to�the�common�good?�x� Does�this�proposal�promote�healing?�

CollaboraƟon

x� How�do�we�collaborate�with�the�proposed�parƟes�to�create�and�sustain�mission�and�values�for�the�new�organizaƟon�that�honor�Dignity�Health’s�legacy?�

x� What�mechanisms�can�we�put�in�place�to�ensure�that�Dignity�Health�retains�adequate�talent�and�resources�to�manage�the�ongoing�relaƟons?�

x� Will�employees�having�a�voice�in�the�condiƟons�of�their�work?�

Stewardship

x� What�organizaƟonal�resources—money,�personnel,�space,�technology,�management�Ɵme—are�inͲvolved�in�the�proposal?�

x� How�does�the�decision�benefit�our�organizaƟon�financially�(directly�or�indirectly,�long�term�or�short�term)?�

x� Who�will�benefit?�x� Who�will�bear�the�burden?�x� Will�resources�be�diverted�from�some�other�use?�x� How�do�we�ensure�compliance�with�the�law?�

JusƟce�x� Does�this�decision�directly�aīect�those�who�are�poor,�unemployed,�disadvantaged�in�some�way?�x� Will�this�decision�strengthen�or�weaken�our�voice�in�advocacy?�x� Does�this�decision�seem�fair?�

Excellence�x� What�does�this�proposal�do�to�promote�high�quality�work?�x� Will�this�decision�enhance�or�risk�our�reputaƟon?��What�can�we�do�to�protect�it?�x� Are�there�structured�opportuniƟes�to�improve�our�work�built�in�to�this�proposal?��

There may be other relevant values to consider when making a decision. Discussion of values, and

specific quesƟons tailored to reflect them, need not be limited to these.

�

ValuesͲBased Discernment Process

�

“He�was�surprised�to�learn�he�had�been�speaking�prose�all�his�life.”�� Moliere, The Imaginary Invalid

Like�the�character�in�Moliere’s�play,�most�of�us�use�our�values�in�making�decisions�every�day�and�may�be�surprised�to�learn�that�there�is�a�special�process�called�ValuesͲBased�Decision�Making.�The�diīerence�between�our�ordinary�decision�making�and�this�one�is�in�three�areas.�

CollaboraƟve.��Not�every�decision�that�execuƟves�make�needs�a�genuinely�mulƟͲdisciplinary�examiͲnaƟon.��We�prize�leaders�who�can�size�up�a�situaƟon�and,�thinking�with�the�values�of�the�organizaƟon,�come�to�a�decision�to�act�in�a�Ɵmely�manner.�Some�decisions,�however,�because�of�their�complexity�or�impact,�are�best�made�in�conversaƟon�with�others.��When�it’s�important�that�a�range�of�viewpoints�is�considered,�the�ValuesͲBased�Discernment�Process�may�be�helpful.�

ReflecƟve. �Especially�when�an�organizaƟon’s�core�values�are�at�stake,�and�when�a�decision�at�hand�makes�it�likely�that�our�core�values�may�conflict�or�appear�to�conflict,�it’s�important�to�give�reflecƟve�Ɵme�to�a�decision,�so�that�our�first�convicƟons�are�not�our�only�ones.�When�a�decision�seems�obvious�but�may�involve�conflicƟng�values,�it’s�even�more�important�to�slow�down�enough�to�invite�the�“second�thought”�to�surface.�

Explicit. Big�decisions—ones�that�aīect�many�people�or�involve�much�in�the�way�of�resources�or�seem�more�directly�to�touch�an�organizaƟon’s�core�values—will�be�scruƟnized�more�carefully�than�more�rouͲƟne�decisions,�by�ourselves,�by�the�government,�by�the�public.�For�this�reason,�an�explicit�decision�proͲcess�is�a�good�way�to�be�sure�all�the�bases�have�been�covered,�and�it�can�serve�as�a�record�of�our�thinkͲing�when�the�raƟonale�behind�a�decision�is�quesƟoned.��

Here are some examples of when a leader may choose to uƟlize the formal ValuesͲBased Discernment Process:

x� When�significant�resources—either�human�or�financial—will�be�aīected�by�a�decision,�a�leader�may�uƟlize�the�process�to�be�sure�the�decision�has�been�reviewed�from�a�values�perspecƟve�by�experts�other�than�ones�in�the�leader’s�field.

x� When�a�partnership�opportunity�presents�itself�that�has�the�potenƟal�to�aīect�a�fundamental�aspect�of�Dignity�Health’s�mission,�the�process�may�be�used�in�advance�of�a�Board�or�SponsorͲship�Council�meeƟng�to�invite�a�mulƟͲdisciplinary�group�to�examine�its�impact�on�the�mission,�values�and�responsibiliƟes�of�the�organizaƟon.�

x� When�a�program�or�partnership�that�is�strongly�associated�in�employees’�or�the�public’s�mind�with�the�basic�mission�of�the�organizaƟon�will�end�or�transiƟon.

x� Any�Ɵme�a�significant�decision�aīects�not�only�the�business�of�the�organizaƟon�but�its�values�or�when�opƟons�inherent�in�a�decision�may�result�in�a�conflict�between�or�among�core�values.

�


37

�

PROCESS A�ValuesͲBased�Discernment�Process�is�not�an�ordinary�problemͲsolving�meeƟng.�What�disƟnguishes�it�is�dedicated�Ɵme�for�reflecƟon�on�the�values�implicaƟons�of�any�decision.�Since�values�are�implicit�in�any�decision,�this�process�asks�us�to�make�them�explicit. Here�is�an�outline�of�the�basic�process:�

1.� PreparaƟon�x� Focus��and�frame�the�quesƟon.�What�exactly�will�the�group�consider?�x� Distribute�to�parƟcipants�a�summary�of�factual�or�objecƟve�descripƟon,�with�outline�of�quesƟon�

to�be�discussed.�x� Oīer�to�answer�factual�quesƟons�in�advance,�via�email�or�phone.�x� ParƟcipants�complete�reflecƟon�exercise�in�advance�of�meeƟng,�and�be�prepared�to�share�

(exercise�is�on�a�separate�page�following).�x� Develop�values�quesƟons�parƟcular�to�the�decision�at�hand,�using�subject�maƩer�experƟse�with�

mission�department�help.�

2.� Welcome��

3.� ReflecƟve�Exercise�(see�last�page):�each�parƟcipant�selects�top�one�or�two�items�from�each�category�(hopes,�fears,�biases)�and�shares.��Group�listens�without�discussion.�

4.� Brief�overview�of�the�facts;�all�parƟcipants�should�receive�fact�digest�well�in�advance�of�the�meeƟng�and�have�all�factual�quesƟons�answered�before�the�meeƟng.�

5.� Discussion�of�values�quesƟons.�

6.� Silent�reflecƟon.�

7.� Tap�voƟng�for�consensus;�revisiƟng�points�of�diīerence.�

8.� Landing�the�plane:�aŌer�suĸcient�discussion,�group�makes�a�recommendaƟon�that�honors�the�most�salient�values.��Just�as�important,�group�addresses�the�values�that�didn’t�“win�the�day”�to�see�how�any�negaƟve�impact�on�them�can�be�miƟgated.�

9.� EvaluaƟon�of�the�process.�

GROUND RULES The�more�(appropriate)�disciplines�are�represented,�the�richer�the�discussion.��

Every�voice�is�important.�No�one�person’s�voice�is�authoritaƟve,�regardless�of�the�posiƟon�that�person�holds�in�the�organizaƟon.�ValuesͲBased�Discernment�relies�on�a�group�of�concerned�persons�thinking�together�and�equally�about�a�challenging�situaƟon.�

Careful�listening�and�openness�to�another�view�is�essenƟal�to�a�posiƟve�outcome.�PonƟficaƟng�and�speechifying�are�not�helpful.��

During�this�dialogue,�no�piece�of�informaƟon,�no�one’s�perspecƟve�and�no�suggesƟon�for�acƟon�should�be�censored.��It�is�possible�that�someone�will�oīer�a�piece�of�irrelevant�informaƟon,�but�beƩer�to�cast�the�net�widely�than�to�miss�something�important.�

�

THE ROLE OF LEADERSHIP The�leader’s�role�in�this�process�is�to:�

x� Select�a�broad�range�of�parƟcipants,�a�small�enough�group�to�have�meaningful�dialogue�but�large�enough�to�contain�mulƟple�perspecƟves,�especially�perspecƟve�that�may�diīer�from�the�leader’s�own.

x� Determine�who�is�making�the�decision;�if�the�group�doing�the�reflecƟve�process�is�diīerent�from�the�decision�making�group�or�person,�leader�should�make�clear�the�reason�for�the�reflecƟve�process.

x� Prepare�(or�have�prepared)�a�digest�of�the�relevant�facts�of�the�situaƟon,�in�a�way�that�will�be��accessible�to�the�group�and�verifiable�by�others.�Debated�facts�derail�a�process.�

x� Prepare�(with�help�from�mission�colleagues)�quesƟons�specific�to�the�decision�at�hand,�using�the��Dignity�Health�core�values�or�other�values�relevant�to�the�decision.��See�below�for�samples,�which�may�or�may�not�be�useful�in�any�parƟcular�decision. �

THE ROLE OF THE FACILITATOR�The�facilitator’s�role�in�this�process�is�to:�x� Stand�back�from�the�content�of�the�decision�and�be�sure�parƟcipants�are:�

i� Listening�to�one�another�i� Focusing�on�the�values�aspect�of�the�quesƟons��i� ResisƟng�the�temptaƟon�to�discuss�assumpƟons�or�relevant�facts�i� Keeping�track�of�Ɵme�

x� Welcome�parƟcipants;�introduce�parƟcipants�if�they�don’t�all�know�each�other.�x� Lead�the�process,�including�the�hopes,�fears,�biases�reflecƟon�at�the�beginning.�x� Build�in�Ɵme�for�silent�reflecƟon,�so�that�parƟcipants�can�hear�and�integrate�all�values�perspecƟves.�x� Tap�the�group�for�consensus,�using�techniques�that�will�not�lend�the�group�to�“majority�rules”�but�to�

hear�the�convergences�in�the�discussion,�as�well�as�the�serious�sƟcking�points.�x� Help�bring�group�to�consensus.�x� LiŌ�up�the�values�that�may�have�been�subordinated�in�the�recommendaƟon;�ask�group�to�address.�x� Sum�up�where�the�group�lands—what�has�been�clarified,�what�remains�open�or�in�need�of�further��

reflecƟon.�

THE ROLE OF THE PARTICIPANT The�parƟcipant’s�role�in�this�process�is�to:�x� Bring�an�open�mind�to�the�conversaƟon.�x� Bring�to�the�group�both�a�concern�for�the�general�good�of�the�organizaƟon�as�well�as�the�parƟcipant’s�

experƟse�in�his�or�her�domain�.�x� Help�uncover�potenƟal�conflicts�of�values�and�ways�to�manage�or�miƟgate�the�conflicts.�x� Focus�on�the�relevance�of�decision�to�the�overall�mission�of�the�organizaƟon.�

THE ROLE OF THE SCRIBE The�scribe’s�role�in�this�process�is�to:�x� Take�notes�to:�

i� record�date,�topic,�and�names�of�parƟcipants�in�the�process��i� capture�the�points�of�agreement�or�consensus;�capture�the�points�of�stress�or�tension�i� document�any�recommendaƟon�along�with�the�raƟonale�


38

�

PROCESS A�ValuesͲBased�Discernment�Process�is�not�an�ordinary�problemͲsolving�meeƟng.�What�disƟnguishes�it�is�dedicated�Ɵme�for�reflecƟon�on�the�values�implicaƟons�of�any�decision.�Since�values�are�implicit�in�any�decision,�this�process�asks�us�to�make�them�explicit. Here�is�an�outline�of�the�basic�process:�

1.� PreparaƟon�x� Focus��and�frame�the�quesƟon.�What�exactly�will�the�group�consider?�x� Distribute�to�parƟcipants�a�summary�of�factual�or�objecƟve�descripƟon,�with�outline�of�quesƟon�

to�be�discussed.�x� Oīer�to�answer�factual�quesƟons�in�advance,�via�email�or�phone.�x� ParƟcipants�complete�reflecƟon�exercise�in�advance�of�meeƟng,�and�be�prepared�to�share�

(exercise�is�on�a�separate�page�following).�x� Develop�values�quesƟons�parƟcular�to�the�decision�at�hand,�using�subject�maƩer�experƟse�with�

mission�department�help.�

2.� Welcome��

3.� ReflecƟve�Exercise�(see�last�page):�each�parƟcipant�selects�top�one�or�two�items�from�each�category�(hopes,�fears,�biases)�and�shares.��Group�listens�without�discussion.�

4.� Brief�overview�of�the�facts;�all�parƟcipants�should�receive�fact�digest�well�in�advance�of�the�meeƟng�and�have�all�factual�quesƟons�answered�before�the�meeƟng.�

5.� Discussion�of�values�quesƟons.�

6.� Silent�reflecƟon.�

7.� Tap�voƟng�for�consensus;�revisiƟng�points�of�diīerence.�

8.� Landing�the�plane:�aŌer�suĸcient�discussion,�group�makes�a�recommendaƟon�that�honors�the�most�salient�values.��Just�as�important,�group�addresses�the�values�that�didn’t�“win�the�day”�to�see�how�any�negaƟve�impact�on�them�can�be�miƟgated.�

9.� EvaluaƟon�of�the�process.�

GROUND RULES The�more�(appropriate)�disciplines�are�represented,�the�richer�the�discussion.��

Every�voice�is�important.�No�one�person’s�voice�is�authoritaƟve,�regardless�of�the�posiƟon�that�person�holds�in�the�organizaƟon.�ValuesͲBased�Discernment�relies�on�a�group�of�concerned�persons�thinking�together�and�equally�about�a�challenging�situaƟon.�

Careful�listening�and�openness�to�another�view�is�essenƟal�to�a�posiƟve�outcome.�PonƟficaƟng�and�speechifying�are�not�helpful.��

During�this�dialogue,�no�piece�of�informaƟon,�no�one’s�perspecƟve�and�no�suggesƟon�for�acƟon�should�be�censored.��It�is�possible�that�someone�will�oīer�a�piece�of�irrelevant�informaƟon,�but�beƩer�to�cast�the�net�widely�than�to�miss�something�important.�

�

THE ROLE OF LEADERSHIP The�leader’s�role�in�this�process�is�to:�

x� Select�a�broad�range�of�parƟcipants,�a�small�enough�group�to�have�meaningful�dialogue�but�large�enough�to�contain�mulƟple�perspecƟves,�especially�perspecƟve�that�may�diīer�from�the�leader’s�own.

x� Determine�who�is�making�the�decision;�if�the�group�doing�the�reflecƟve�process�is�diīerent�from�the�decision�making�group�or�person,�leader�should�make�clear�the�reason�for�the�reflecƟve�process.

x� Prepare�(or�have�prepared)�a�digest�of�the�relevant�facts�of�the�situaƟon,�in�a�way�that�will�be��accessible�to�the�group�and�verifiable�by�others.�Debated�facts�derail�a�process.�

x� Prepare�(with�help�from�mission�colleagues)�quesƟons�specific�to�the�decision�at�hand,�using�the��Dignity�Health�core�values�or�other�values�relevant�to�the�decision.��See�below�for�samples,�which�may�or�may�not�be�useful�in�any�parƟcular�decision. �

THE ROLE OF THE FACILITATOR�The�facilitator’s�role�in�this�process�is�to:�x� Stand�back�from�the�content�of�the�decision�and�be�sure�parƟcipants�are:�

i� Listening�to�one�another�i� Focusing�on�the�values�aspect�of�the�quesƟons��i� ResisƟng�the�temptaƟon�to�discuss�assumpƟons�or�relevant�facts�i� Keeping�track�of�Ɵme�

x� Welcome�parƟcipants;�introduce�parƟcipants�if�they�don’t�all�know�each�other.�x� Lead�the�process,�including�the�hopes,�fears,�biases�reflecƟon�at�the�beginning.�x� Build�in�Ɵme�for�silent�reflecƟon,�so�that�parƟcipants�can�hear�and�integrate�all�values�perspecƟves.�x� Tap�the�group�for�consensus,�using�techniques�that�will�not�lend�the�group�to�“majority�rules”�but�to�

hear�the�convergences�in�the�discussion,�as�well�as�the�serious�sƟcking�points.�x� Help�bring�group�to�consensus.�x� LiŌ�up�the�values�that�may�have�been�subordinated�in�the�recommendaƟon;�ask�group�to�address.�x� Sum�up�where�the�group�lands—what�has�been�clarified,�what�remains�open�or�in�need�of�further��

reflecƟon.�

THE ROLE OF THE PARTICIPANT The�parƟcipant’s�role�in�this�process�is�to:�x� Bring�an�open�mind�to�the�conversaƟon.�x� Bring�to�the�group�both�a�concern�for�the�general�good�of�the�organizaƟon�as�well�as�the�parƟcipant’s�

experƟse�in�his�or�her�domain�.�x� Help�uncover�potenƟal�conflicts�of�values�and�ways�to�manage�or�miƟgate�the�conflicts.�x� Focus�on�the�relevance�of�decision�to�the�overall�mission�of�the�organizaƟon.�

THE ROLE OF THE SCRIBE The�scribe’s�role�in�this�process�is�to:�x� Take�notes�to:�

i� record�date,�topic,�and�names�of�parƟcipants�in�the�process��i� capture�the�points�of�agreement�or�consensus;�capture�the�points�of�stress�or�tension�i� document�any�recommendaƟon�along�with�the�raƟonale�


39

�

SAMPLE VALUES QUESTIONS�

Mission

x� How�does�this�proposal�fit�within�our�organizaƟonal�mission�of�healing,�advocacy�and�partnering�for�improved�community�health?��

Dignity

x� Who�will�be�aīected�by�this�proposal,�both�inside�and�outside�the�organizaƟon?�x� Who�of�these�has�direct�influence�in�the�decisionͲmaking�process?�x� Can�we�provide�for�input�and�influence�by�people�who�will�be�most�aīected?�x� Can�we�miƟgate�the�eīect�of�this�decision�on�people�who�are�negaƟvely�aīected�by�it?�x� How�does�this�decision�recognize�all�dimensions�of�the�human�person—body,�mind,�spirit?�x� Does�this�proposal�contribute�in�some�way�to�the�common�good?�x� Does�this�proposal�promote�healing?�

CollaboraƟon

x� How�do�we�collaborate�with�the�proposed�parƟes�to�create�and�sustain�mission�and�values�for�the�new�organizaƟon�that�honor�Dignity�Health’s�legacy?�

x� What�mechanisms�can�we�put�in�place�to�ensure�that�Dignity�Health�retains�adequate�talent�and�resources�to�manage�the�ongoing�relaƟons?�

x� Will�employees�having�a�voice�in�the�condiƟons�of�their�work?�

Stewardship

x� What�organizaƟonal�resources—money,�personnel,�space,�technology,�management�Ɵme—are�inͲvolved�in�the�proposal?�

x� How�does�the�decision�benefit�our�organizaƟon�financially�(directly�or�indirectly,�long�term�or�short�term)?�

x� Who�will�benefit?�x� Who�will�bear�the�burden?�x� Will�resources�be�diverted�from�some�other�use?�x� How�do�we�ensure�compliance�with�the�law?�

JusƟce�x� Does�this�decision�directly�aīect�those�who�are�poor,�unemployed,�disadvantaged�in�some�way?�x� Will�this�decision�strengthen�or�weaken�our�voice�in�advocacy?�x� Does�this�decision�seem�fair?�

Excellence�x� What�does�this�proposal�do�to�promote�high�quality�work?�x� Will�this�decision�enhance�or�risk�our�reputaƟon?��What�can�we�do�to�protect�it?�x� Are�there�structured�opportuniƟes�to�improve�our�work�built�in�to�this�proposal?��

There may be other relevant values to consider when making a decision. Discussion of values, and

specific quesƟons tailored to reflect them, need not be limited to these.

�

ValuesͲBased Discernment Process

�

“He�was�surprised�to�learn�he�had�been�speaking�prose�all�his�life.”�� Moliere, The Imaginary Invalid

Like�the�character�in�Moliere’s�play,�most�of�us�use�our�values�in�making�decisions�every�day�and�may�be�surprised�to�learn�that�there�is�a�special�process�called�ValuesͲBased�Decision�Making.�The�diīerence�between�our�ordinary�decision�making�and�this�one�is�in�three�areas.�

CollaboraƟve.��Not�every�decision�that�execuƟves�make�needs�a�genuinely�mulƟͲdisciplinary�examiͲnaƟon.��We�prize�leaders�who�can�size�up�a�situaƟon�and,�thinking�with�the�values�of�the�organizaƟon,�come�to�a�decision�to�act�in�a�Ɵmely�manner.�Some�decisions,�however,�because�of�their�complexity�or�impact,�are�best�made�in�conversaƟon�with�others.��When�it’s�important�that�a�range�of�viewpoints�is�considered,�the�ValuesͲBased�Discernment�Process�may�be�helpful.�

ReflecƟve. �Especially�when�an�organizaƟon’s�core�values�are�at�stake,�and�when�a�decision�at�hand�makes�it�likely�that�our�core�values�may�conflict�or�appear�to�conflict,�it’s�important�to�give�reflecƟve�Ɵme�to�a�decision,�so�that�our�first�convicƟons�are�not�our�only�ones.�When�a�decision�seems�obvious�but�may�involve�conflicƟng�values,�it’s�even�more�important�to�slow�down�enough�to�invite�the�“second�thought”�to�surface.�

Explicit. Big�decisions—ones�that�aīect�many�people�or�involve�much�in�the�way�of�resources�or�seem�more�directly�to�touch�an�organizaƟon’s�core�values—will�be�scruƟnized�more�carefully�than�more�rouͲƟne�decisions,�by�ourselves,�by�the�government,�by�the�public.�For�this�reason,�an�explicit�decision�proͲcess�is�a�good�way�to�be�sure�all�the�bases�have�been�covered,�and�it�can�serve�as�a�record�of�our�thinkͲing�when�the�raƟonale�behind�a�decision�is�quesƟoned.��

Here are some examples of when a leader may choose to uƟlize the formal ValuesͲBased Discernment Process:

x� When�significant�resources—either�human�or�financial—will�be�aīected�by�a�decision,�a�leader�may�uƟlize�the�process�to�be�sure�the�decision�has�been�reviewed�from�a�values�perspecƟve�by�experts�other�than�ones�in�the�leader’s�field.

x� When�a�partnership�opportunity�presents�itself�that�has�the�potenƟal�to�aīect�a�fundamental�aspect�of�Dignity�Health’s�mission,�the�process�may�be�used�in�advance�of�a�Board�or�SponsorͲship�Council�meeƟng�to�invite�a�mulƟͲdisciplinary�group�to�examine�its�impact�on�the�mission,�values�and�responsibiliƟes�of�the�organizaƟon.�

x� When�a�program�or�partnership�that�is�strongly�associated�in�employees’�or�the�public’s�mind�with�the�basic�mission�of�the�organizaƟon�will�end�or�transiƟon.

x� Any�Ɵme�a�significant�decision�aīects�not�only�the�business�of�the�organizaƟon�but�its�values�or�when�opƟons�inherent�in�a�decision�may�result�in�a�conflict�between�or�among�core�values.

�


40

�

�

“Courage�is�what�it�takes�to�stand�up�

and�speak.�Courage�is�also�what�it�

takes�to�sit�down�and�listen.”�

�K Winston Churchill J

�

NOTES:��________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��

�_______________________________________________________________________________��


41

�

REFLECTIVE EXERCISE

In�advance�of�the�meeƟng,�each�parƟcipant�should�reflect�on�the�following,�and�make�some�personal�notes�(not�to�be�shared)�to�bring�to�the�meeƟng.�

1.� What�are�my�hopes�related�to�this�quesƟon:�

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

2.� �What�are�my�fears�related�to�this�quesƟon?�

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

3.� What�are�my�biases�related�to�this�quesƟon?�(biases�are�hard�to�idenƟfy;�try�to�be�honest)�

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

� ______________________________________________________________________________��

�Spend�some�Ɵme�idenƟfying�your�top�one�or�two�hopes,�fears�and�biases.��Bring�these�to�the�meeƟng,�ready�to�share.��All�will�respecƞully�listen�as�each�person�shares.��No�one�will�comment.�� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

� _________________________________________________________________________________��

ValuesǦBased�Discernment�Dignity Health’s founders are women religious, for whom contemplation and action are linked in every decision. That tradition has come down to us in the way we go about making important, valuesǦbased decisions, specifically in the use of a discernment process that requires significant aspects of the decision be weighed in the light of our core values….This process is especially important when decisions are complex, or when the values involved may conflict. When issues…arise between Dignity Health and its partners, we expect all to contribute to a decision that serves the common good.

Ǧ Dignity Health’s Statement of Common Values


42

Daughters of Charity Health System Page Ethical Decision Making of 12 Pages

1

ETHICAL DECISION-MAKING IN THE FRAMEWORK OF VINCENTIAN DISCERNMENT Approved by the DCHS Board of Directors July 2010

43


2

TABLE OF CONTENTS Introduction.......................................................................................1 The Four Pillars of Vincentian Discernment.....................................5 Thinking Ethically..............................................................................6 Constitutive Elements in Ethical Decision-Making...........................8 Core Ethical Values.............................................................................9 The Framework for Ethical Decision-Making..................................10 Working Document............................................................................11

44


3

INTRODUCTION

To properly situate Ethical Decision-Making in the Framework of Vincentian Discernment, it is necessary to understand what discernment meant for St. Vincent de Paul and his followers. St. Vincent practiced discernment in accordance with two basic principles: the Will of God, and Divine Providence. Seeking God’s will was Vincent’s principal virtue, and the one he admired most in Jesus Christ.1 God’s will was so important for Vincent, following it would lead us to perfection and produce in us wonderful results, for example, serenity, peace of mind, happiness, and great blessings on the apostolate. Vincent came to discover God and His Will through certain events reflecting the suffering of those living in poverty. Serenity was the touchstone for Vincent’s discernment, as he wrote, “Be submissive rather than active; and in this way God alone will do for you what all men together could not do for you without His help.2 Submissiveness for Vincent meant “let God act, be an instrument in his hands.” To discern means to select, to interpret, to decide, to recognize: that is, to make a judgment which ultimately leads to action. If we practice discernment, it is in order to gain knowledge and then act accordingly. The scriptures give many examples of discernment, for instance, Abraham (should I leave this country or stay here?),3 Moses (is God really asking me to lead the people out of Egypt?),4 Elijah (how am I going to denounce the injustice that those in power are committing?),5 Jesus (should I identify with the Servant of Yahweh through the cross, through vulnerable love, through meekness and humility of heart?).6 The wisdom of Solomon states it clearly, “Give your servant a heart to understand how to discern between good and evil” (1 Kings 3:9). Discernment is of the very essence of the Christian faith. St. Paul insisted, “Do not model yourselves on the behavior of the world around you, but let your behavior change, modeled by your new mind. This is the only way to discover the will of God and know what is good, what it is that God wants.” (Romans 12:2; see also 1 John 4:1). Discernment is a process of searching for the will of God in a particular situation, a process that is carried out in a context of prayer and through sharing. People become aware of God’s presence as they examine different insights and realize what has to be done, as well as the way in which it is to be done. Discernment is an encounter with God leading to a decision about what has to be done.

1 This introduction is gleaned from these sources: Javier Alvarez, C.M., Community Discernment, Echoes of the Company, no. 3, May-June 2004, 177-193; Hugh O’Donnell, C.M., Vincentian Discernment, Vincentian Heritage Journal, vol. 15:1 (1994), 8-22; Padraig Regan, St. Vincent and Discernment: Vincentian Study Group, 1984, 346- 352; and Elizabeth Vermaelen, S.C., Decision Making in the Life of Elizabeth Ann Seton, Vincentian Heritage Journal, vol. 18:2 (1997),214-222. 2 Coste IV, 123. 3 Genesis 12. 4 Exodus 3. 5 1 Kings 21: 17-21. 6 Matthew 4: 1-11.

45


4

Vincent spoke of “interior motions” which are inspired by the Holy Spirit. We need to pay close attention to these “enlightenments,” these feelings and inclinations. Discernment comes more from the heart than from the head. Certain problems or conditions militate against discernment, for example, power over others, seeking only one’s own interests, divisions, defensiveness. Discernment calls for an act of abandonment, of listening, and of trust in God. Discernment can only take place when we let ourselves be entirely penetrated and influenced by the Holy Spirit. There are four conditions necessary for discernment:

• We must want to discern: we must be willing and determined to move away from our own inclinations, prejudices, ideas, interests, and so on, in order to concentrate on GodÕs interests.

• An attitude of poverty and interior freedom: we must abandon our self-sufficiency and our desire to impose our will on others. Everything else takes second place to God and those living in poverty.

• An atmosphere of prayer: in order to advance in poverty and interior freedom. Prayer makes God’s will known to us by creating an atmosphere of peace and serenity.

• Seeing things in the light of faith: this is a critical and indisputable principle that the presence of God can be sought and found.

Vincent suggested a simple methodology to enable these four conditions:

• Create an atmosphere of faith. • State clearly the issues to be discerned. • Take the time to acquire personal convictions and to be aware of “interior motions.” • Come to a prayerful decision.7

At the heart of Vincentian discernment is the Holy Spirit’s guidance to honor and respect each individual who is unique and in communion with others. Both Vincent and St. Louise de Marillac had a great sense of trust that God mediates his will through other persons. This point was placed into sharp focus by Father Richard McCullen, C.M., former Superior General of the Vincentians and Daughters of Charity, “A saint is someone who has time to be present to God and to us.” When we enter discernment, we believe that God can get us to a place far better than if we were left alone. This is what Vincent meant by acquiring Òunrestricted readiness.Ó When St. Louise went on her first mission, Vincent wrote to her, ÒGo, therefore, Mademoiselle, in the name of our Lord. I pray that his divine goodness may accompany you, be your consolation along the way, the shade against the heat and the sun, your shelter against the rain and the cold, your soft bed in your weariness, your strength in your toils, and finally that he may bring you back in perfect health and filled with good works.8 Les evenements, cÕest Dieu: God is here in every event in life and God is especially present in the poor who are our masters

7 The group might feel discouragement or sadness if unanimity is not reached. Vincent suggested, however, that unanimity should not become an obsession. If unanimity cannot be reached, this is not serious, but the minority group cannot separate itself from the majority who have brought about the decision(s). 8 Vincent de Paul to Louise de Marillac, May 6, 1629, in Saint Vincent de Paul: Correspondence, Conferences, Documents, vol. 1, Brooklyn, 1985, 64-65.

46


5

THE FOUR PILLARS OF VINCENTIAN DISCERNMENT

1. The Gospel 2. Our Mission In the spirit of our founders, St. Vincent de Paul, St. Louise de Marillac, and St. Elizabeth Ann Seton, the Daughters of Charity Health System is committed to serving the sick and the poor. With Jesus Christ as our model, we advance and strengthen the healing mission of the Catholic Church by providing comprehensive, excellent healthcare that is compassionate and attentive to the whole person: body, mind and spirit. We promote healthy families, responsible stewardship of the environment, and a just society through value-based relationships and community-based collaboration. 3. Core Vincentian Values The Charity of Christ urges us to: RESPECT ~ recognizing our own value and the value of others. COMPASSIONATE SERVICE ~ providing excellent care with gentleness and kindness. SIMPLICITY ~ acting with integrity, clarity and honesty. ADVOCACY FOR THE POOR ~ supporting those who lack resources for a healthy life and full human development. INVENTIVENESS TO INFINITY ~ being continuously resourceful and creative. 4. The Ethical and Religious Directives for Catholic Health Care Services [revised 2009] In difficult decisions we may be uncertain about which option is best or how we weigh values that appear to be in conflict. We use the ETHICAL DECISION-MAKING PROCESS to help us come to judgments that are consistent with the Gospel, DCHSÕs Mission, the Core Vincentian Values, and the Ethical and Religious Directives for Catholic Health Care Services (ERDs).

47


6

THINKING ETHICALLY

ETHICS is critical to promoting and supporting the identity [character and culture] and integrity [behavior] of Catholic health care. The primary role of Vincentian ethics is to help nourish, sustain, and promote the Mission and Core Values of DCHS. Ethics engages in the ongoing formation of Associates in terms of identity and integrity. Ethics asks whether or not the organization and its Associates reflect and promote the values and beliefs of the Gospel, the Mission, the Core Vincentian Values, and the ERDs. Ethical decision-making in a DCHS facility affirms: 1. That our care furthers the healing mission of Jesus Christ. 2. That we imitate St. Vincent and St. Louise who were driven in their decisions by the vision of Jesus Christ as one who empowered and liberated those living in poverty. 3. That love of God and love of neighbor are integrally linked. 4. Our “unrestricted readiness” to care for the needs of others in imitation of Jesus Christ.St. Vincent de Paul translated “unrestricted readiness” as our openness to accept God’s will without restrictions. Do not worry yourselves over much. Grace has its moments. Let us abandon ourselves to the Providence of God and be very careful not to run ahead of it. If it pleases God to give us consolation in our calling, it is this: That we have tried to follow His great Providence in everything. (St. Vincent de Paul) Ethics always seeks to answer two interrelated questions: who we ought to become as a people (being), and how ought we to act in relation to others (doing). Consequently, ethics considers these important points:

• The goal(s) of human life, e.g., love of God, love of others, right relationships, a just social order.

• The virtues or character traits, attitudes, feelings, and dispositions that should define us as people and shape how we act in relation to others, e.g., love, compassion, honesty, mutuality.

• The principles that should guide our decision-making, conscience formation, and discernment in concrete situations, e.g., fundamental human dignity, justice, solidarity, especially with the vulnerable and those living in poverty.

• The circumstances, the facts surrounding the situation and the consequences of our actions.

Ethics is not just about what we do but also, and simultaneously, about who we are becoming as people, as a community, as a society, as a Catholic health system. As a human endeavor concerned with who we ought to become and how we ought to act, ethics requires:

48


7

1. A Normative Basis: the Gospel, our Mission, Core Vincentian Values, and the ERDs. 2. Knowledge: we need correct information to make wise decisions. 3. Responsibility: we are responsible for the types of people we become and for the consequences of our actions. 4. Reasoning and Discernment: we must sustain the ability to reason through a situation and to discern which action, among various options, best reflects Gospel values, our Mission, Core Vincentian Values, and the ERDs.

49


8

CONSTITUTIVE ELEMENTS IN ETHICAL DECISION-MAKING

1. Mirror the person of Jesus as presented in the Gospels. 2. Promote and Defend Fundamental Human Dignity: every person is created in the image of God (Genesis 1:27) and is therefore sacred and possessing inalienable worth. All persons must be treated with profound respect. 3. Attend to the Whole Person: every person is an inseparable unity of body and spirit/soul (1 Corinthians 15:44) and this unity demands that they be treated wholistically: in their physical, psychological, social, and spiritual dimensions. 4. Care Vulnerable Persons and Those Living in Poverty: because Jesus, St. Vincent, and St. Louise had special affection for the vulnerable and those living in poverty, we must always be their advocates. 5. Promote the Common Good: the health and well-being of each person is intimately related to the health and well-being of the broader community. We must always promote the economic, political, and social conditions that protect the fundamental rights of all individuals to enable them to fulfill their common purpose and reach their common goals. 6. Act on Behalf of Justice: since justice is an essential component of the Gospel (Matthew 5:1-12), we promote basic human needs for all persons, including accessible and affordable healthcare. 7. Steward Resources: because all creation is a gift from God, we are called to use all resources responsibly. Material things and human capacities are resources for the benefit of the community and not personal or organizational possessions. 8. Act in Communion with the Church: since we participate in the healing ministry of Jesus and acknowledge healthcare as an essential element of the Church, we always work in harmony with the institutional Church and the local Bishop.

50


9

CORE ETHICAL VALUES

COMPASSION . Treat each person with dignity . Honor the individuality of each person . Evidence humility, grace and care RESPECT . Encourage and value the contributions of each person Listen well Communicate honestly INTEGRITY . Foster trust by being truthful, empathetic and consistent Be authentic and courageous . Be responsible for my/our decisions SPIRITUALITY . Embrace the Core Vincentian values and our Mission Statement . Honor the dignity of every person as created in GodÕs image . Honor the Mission and heritage of our Catholic sponsor STEWARDSHIP . Seek ways to appropriately utilize our human and financial resources . Act responsibly, taking only those actions that align with our Mission and Core Vincentian values Be accountable for our actions IMAGINATION . Look beyond the challenges of the present and envision what is possible Cultivate innovation Embrace continuous learning EXCELLENCE Put forth our personal and professional best Provide the highest quality of care

Commit ourselves to continuous improvement, delivering a superior experience to all our associates, patients, and customers

51


10

THE FRAMEWORK FOR ETHICAL DECISION-MAKING

The process of Vincentian Discernment comprises six important steps: 1. PREPARATION: a. Prayerful reflection and time for silence. b. Who will facilitate this process? c. What is the issue or question? d. What are the key facts? e. What circumstances are unique to this issue? f. Who should be involved in this decision? g. When should a decision be made? 2. OPTIONS: a. Review the main points in the PREPARATION. b. What options are present for our action? i. What option promotes the most good and the least harm? ii. What option best serves our community? c. How do these options affect the issue, Gospel values, our Mission, our Core Vincentian Values, our stakeholders, including the vulnerable and those living in poverty, and DCHS itself? 3. VALUES: a. How might our Mission and Core Vincentian Values be affected by our decision? b. Which Core Vincentian Values and ERDs relate to this situation? c. How are the Mission and Core Vincentian Values evidenced in our decision? 4. DECISION: a. Do we need “time out” before reaching a decision, e.g., for prayer and personal reflection? b. Have we carefully considered our situation, our options, Gospel values, our Mission, Core Vincentian Values, and the ERDs? c. Carefully describe the collective judgment. d. Should we proceed? 5. IMPLEMENTATION: a. How will we communicate our decision? i. Our commitment to ethical decision-making. ii. Key stakeholders. iii. Timing. b. How will we implement the decision: i. Inform and educate. ii. Manage transition. iii. Establish accountability for the decision. 6. EVALUATION: a. How well did we decide, communicate, and implement the decision? b. Did the decision achieve the desired result? What lessons did we learn?

52


11

WORKING DOCUMENT

PREPARATION: 1. Choose/appoint the facilitator: Name: _________________________________ 2. Who will be part of this discernment process? 3. Choose/appoint a leader for prayer: Name: _________________________________ 4. List: A. The main issue or question: B. What are the key facts? C. What are the circumstances? D. Should others be a part of this decision-making process? E. When should the decision(s) be made? OPTIONS: 1. Are we in agreement with the decisions made in the PREPARATION? Yes ______ No ______ 2. What option(s) promote the most good? 3. What option(s) would be harmful? 4. What option(s) best serves our community? 5. How does the chosen option(s) affect: a. Gospel Values? b. Our Mission? c. Core Vincentian Values? d. Our stakeholders? e. Those living in poverty and the vulnerable? f. DCHS? g. The local church? VALUES: 1. Which Core Vincentian Value relates to the chosen option(s)? 2. Which ERDs relate to the chosen option(s)?

53


12

DECISION: 1. Do we need time for prayer and reflection? 2. Have we considered all necessary factors? 3. Carefully describe our collective judgment/decision: 4. Should we proceed? IMPLEMENTATION: 1. How will we communicate our decision(s)? 2. Who should be notified of our decision? 3. Who must approve our decision? 4. How do we educate our publics about our decision? 5. What transition(s) is necessary to facilitate our decision? 6. Who is accountable for our decision? 7. Has the local Ordinary (Cardinal, Archbishop, Bishop) been brought into the discussion? EVALUATION: 1. How well did we do: a. In our Preparation? b. In listing our option(s)? c. In evaluating our values? d. In coming to a decision? e. In implementing our decision? f. In communicating our decision? 2. Did the decision achieve the desired result?

54

PeaceHealth Page

Ethical Discernment Process of 3 Pages

1

Ethical Discernment A System Ethics Reflection Process

Ethical discernment is a reflective process embedded in an organization’s operations and strategic planning which identifies services, programs, partnerships and alliances that are consistent with the mission and values of PeaceHealth and responsive to the interests of PeaceHealth’s multiple stakeholders (system and regional) and the health needs of the community. Ethical discernment is integrated into the strategic planning process and business plans throughout PeaceHealth to help ensure mission fulfillment and accountability. The Ethical Discernment Process begins at the inception of a proposal in a business/strategic plan which significantly impacts the organization, its stakeholders or the community. The Ethical Discernment Process should be initiated when considering the following:

• Addition or deletion of service lines;

• Acquisitions and affiliations;

• Joint Ventures;

• The offering of insurance products; or

• Major human resource initiatives. When To Utilize the Discernment Process: If a proposal will significantly impact the organization, its staff, stakeholders or the community, the Ethical Discernment Process should be a part of the project throughout planning and implementation. Ethical discernment is a dialogic process to which every participant can contribute. The dialogue around ethical discernment must be documented to enable focused reflection at each step of the approval process (e.g., management, regional board, PeaceHealth system board).

55

PeaceHealth Page


2

The Ethical Discernment Process I. Describe the proposed initiative in detail.

• Describe the desired end result of the initiative.

• Who are the parties involved, what are their interests and how are they affected?

• How does the initiative fit into the strategic visions of both the regions and PeaceHealth System?

II. Identify additional information not presently available, which may be necessary to

evaluate the proposed initiative.

• What assumptions/considerations make the initiative important to the fulfillment of the mission and vision of PeaceHealth as well as the other parties involved?

• Are there considerations—such as resource allocation or service to the poor, the under-served or the elderly—that are latent in the initiative and which require special attention in the Ethical Discernment Process?

III. As you reflect on the following aspects of ethical discernment, a variety of issues

inevitably will arise. The Ethical Discernment Process is intended to facilitate operational and strategic planning processes which identify plans that are:

A. Consistent with the mission and core values of PeaceHealth at regional and

system levels… Mission

1. Sponsorship 2. Catholic Identity 3. Individual Regional Identity 4. Ethical Concerns

Collaboration

1. Quality of Partners 2. Quality of Services

Stewardship of Financial Resources

1. Strategic Analysis 2. Financial Analysis 3. Legal Analysis

B. Responsive to the interests of our multiple stakeholders…

Stewardship of Human Resources

1. Physicians

56

PeaceHealth Page


3

2. Employees/Volunteers 3. Other Providers 4. Insurance Companies and Other Payors 5. Vendors 6. Others

C. And responsive to the needs of the community…

Social Justice/Human Dignity

1. Care of the Poor 2. Community Health 3. Community Benefit/Services

57

Preparation Options Values Decision Implementation Evaluation

What are the presenting issues or questions?

What are the key facts (who, what, when, where, why, how)?

How does the situational context affect analysis (market, social, religious, financial, legal, political)?

Who should be involved and how (who is affected, has needed expertise, has responsibility or authority to decide)?

By when should the decision be made?

Will a facilitator or an ethicist be helpful?

What are the options for action (doing nothing is an option)?

How do the options:

values?

including the poor and vulnerable?

within the system?

What can we learn from experience (our own, others)?

Consider the issues and options in light of our

this issue or appear to be in conflict?

values be affected positively or negatively?

values are affected or appear to be in conflict?

Do we need a “time-out” for reflection or prayer to find a creative space or to access our spiritual resources?

Considering…

effects on stakeholders,

values, and operating commitments,

What is our best judgment on how we should proceed?

How will we…

to our stakeholders and others?

decision?

those affected?

for action?

and process?

How well and how timely did we decide, communicate, and implement the decision?

Did the decision achieve the desired result?

metrics?

What lessons did we learn?

Should we revise our decision based on what we have learned?

The Providence Ethical Discernment Process should be used

and core values in all we do, but with more difficult decisions we may be uncertain

We use the discernment process in such situations to help us come to a judgment that

Providence Health and Services Ethical Discernment Process

Page 1 of 2 Pages

58

The Providence Ethical Discernment Process

Values signal what matters, and explicitly or implicitly they guide every decision we make. In Providence Health & Services what matters to us is expressed in our Mission, core values, and operating commitments. These should guide every decision we make as Providence leaders. But not every decision requires a formal discernment process. Boards and leadership teams should use the Providence Ethical Discernment Process when:

We must weigh important values that appear to be in conflict,

The reputation or strategic direction of the ministry is at stake, or

Facing a major decision, we are uncertain about which of the options is most consistent

Examples of major decisions include:

Committing significant resources for capital projects,

This process may be used by itself or integrated into wider decision processes. If you use a facilitator, he or she may augment this process with others tools. The process is intended to:

Facilitate meaningful and open dialogue,

operating commitments,

If you have questions about the discernment process or would like to utilize the services of an ethicist, please contact your region’s ethics or mission leader, or the system ethicist at 425-525-3036.

Providence Health and Services Ethical Discernment Process

Page 2 of 2 Pages

59

Ethical Decision Making

St. Joseph Health System Ethical Decision Making

Page 1 of 260

Ethical Decision Making

St. Joseph Health System Ethical Decision Making

Page 2 of 261

1

VALUES-BASED DISCERNMENT and DECISION MAKING PROCESS (VBDDM)

(Revised, October 2013) Ken Homan, PhD, SCL Health System, VP Ethics & Theology

SCLHS Core Values

SCLHS carries out its healing ministry today through its commitment to the following core values: Caring Spirit We honor the sacred dignity of each person.

Excellence We set and surpass high standards.

Good Humor We create joyful and welcoming environments.

Integrity We do the right thing with openness and pride.

Safety We deliver care that seeks to eliminate all harm for patients and associates.

Stewardship We are accountable for the resources entrusted to us.

SCLHS Values-Based Discernment and Decision Making

SCLHS believes that its mission to be a healing presence to its patients and communities can be preserved and enriched through values-based discernment and decision-making by all SCLHS boards, executives, managers and staffs. Values-based discernment and decision making is an opportunity to continue to develop organizational culture and strategic implementation through engaged dialogue around the core values and mission. Discernment among various and competing goods is foundational to this process and always precedes decision-making.

62

2

The Elements of the SCLHS Values-Based Discernment and Decision-Making are: 1. SCLHS Core Values

• Caring Spirit • Excellence • Good Humor • Integrity • Safety • Stewardship

2. Inclusiveness All SCLHS discernment and decision-making is representative of all affected persons and interests.

3.Truthfulness All SCLHS discernment and decision-making is fully and straightforwardly communicated.

4.Reasonable Consistency All SCLHS discernment and decision-making treats similar cases and situations similarly.

5.Collaboration All SCLHS discernment and decision-making is conducted in a collegial and cooperative manner.

Introduction

Values-based discernment and decision-making is an opportunity to continue to develop organizational culture and strategic implementation through engaged dialogue around the core values and mission. Values-based discernment and decision-making reflects a learning organization by:

• Discerning congruence between mission, values and behaviors

• Utilizing reflexive learning from past decisions and outcomes

• Bringing wisdom and new knowledge to bear on changing circumstances and opportunities.

• Emphasizing shared values and the common good

The method of values-based discernment and decision-making adds value to organizational decision-making processes by

• Anchoring strategy in the mission, vision, and values

• Making our values explicit when important decisions are made

• Creating a mechanism for competing values to be addressed

• Generating a forum for exploring and evaluating alternatives

• Fostering consensus decision-making

63

3

Values-based discernment and decision-making builds an ethical culture and creates a trustworthy process by

• Creating a forum for all voices to be heard

• Establishing observable rules so that all individuals can understand how and why decisions were made

• Developing a process of accountabilities

• Forming an integrated organizational memory of mission-based, values-driven decision-making.

Purpose

The SCLHS Values-Based Discernment and Decision-Making Process is a reflective process. This process intends to create and sustain a Mission-based and Core Values-driven framework to stimulate discussion among decision-makers that will enable them to identify and report, in mission and values terms, an exploration and evaluation of alternative courses of action yielding an explicit rationale for a particular proposed course of action. SCLHS, like other faith-based and not-for-profit organizations, measures its accomplishments as an organization in relation to its success in realizing its Mission and Core Values.

The SCLHS Values-Based Discernment and Decision-Making Process is intended to ensure that, in the course of making major decisions, appropriate business and clinical analyses, and alternatives, are evaluated in light of the Mission and Core Values. SCLHS believes that patient quality of care, clinical services, and business practices will be of highest quality when they are rooted in and motivated by the SCLHS Core Values of Caring Spirit, Excellence, Good Humor, Integrity, Safety and Stewardship, as SCLHS lives out its mission to reveal God’s healing love by improving the health of the communities it serves.

Application

The SCLHS Values-Based Discernment and Decision-Making Process is to be used whenever SCLHS or one of its care sites is confronted with a significant decision, including decisions that:

• Might alter or appear to affect the Catholic identity or mission of an entity;

• Might positively or negatively impact the mission of the organization;

• Would significantly affect the status of groups of employees;

• Would affect local communities, vulnerable populations, or the environment.

More explicitly, the SCLHS Values-Based Discernment and Decision-Making Process should be used for:

• Decisions where there are values in tension, or confusion around which values are operative in a given context

64

4

• Major partnerships, particularly with potential other-than-Catholic partners.

• Selected major capital requests;

• Addition or deletion of a major clinical service line.

How can Human Resources, Mission Services, and Communications assist and support the SCLHS system and Care Sites in improved alignment of our Mission and our Values with mission-critical business decisions? When could/should this VBDM tool will be used?

Depending on the magnitude of a decision, the long range implications of a decision, examples might include talent management assessments, redeployment of associates, safety for associates, HR planning, decisions about make/buy training and education programs, care site patient care skill mix conversions (RN-LPN-PCT), review of open positions- to recruit or to freeze ongoing recruitment efforts, discussions regarding changes in associates’ employment status (FT, PT, On Call), succession planning, performance management, mission critical/ market sensitive positions, compensation and benefit design, impactful HR policies, productivity planning, and reductions-in-force.

Additional areas might include designing and using “rites of passage” for initiating or concluding programs or services, due diligence planning with prospective health care system partners, self-evident ethical issues in business decisions, entering/exiting a community, announcing changes and major modifications that impact stakeholders, major capital expenditures, and significant organizational or structural changes within in Care Sites.

For all of the above areas, what is/are the communications strategies both for internal and external stakeholders?

Value of the Process

The consistent use of the SCLHS Values-Based Discernment and Decision-Making Process assures the synthesis and integration of the mission, business and clinical impacts of proposed initiatives, thereby promoting responsible decisions.

The process cannot offer perfect solutions to complex situations, but it can assist senior leadership and boards in identifying and addressing potential growth and benefit areas as well as indicate potential harm that might occur as a result of SCLHS’s pursuit of its strategic activities. It will enable SCLHS to make consistent steps in more faithfully fulfilling its mission. The SCLHS Values-Based Discernment and Decision-Making Process will also help leaders and staffs become more adept at identifying mission and values issues in the life and work of the organization.

The SCLHS Values-Based Discernment and Decision-Making Process adds value to strategic decision making because it brings mission and values clarity to the strategic conversations. This process adds value through its structured transparency by demonstrating how strategic decisions are mission-based and values-driven.

The SCLHS Values-Based Discernment and Decision-Making Process is depicted below. The outline is generic and may need to be modified to meet the needs of a particular project and/or the structure of the organization in which the process is done. In some cases, particularly partnerships

65

5

with other-than-Catholic entities, inclusion of key elements from the Ethical and Religious Directives for Catholic Health Care Services (2009) should be explicitly attended to.

Process Timing

The SCLHS Values-Based Discernment and Decision-Making Process should begin as soon as leaders believe that an initiative has moved from being a possibility to being a project for which time and labor will be dedicated. The process should proceed in tandem with the other components of the project. Insights and issues that arise can then be integrated or addressed in a timely way as other aspects of the initiative are still forming. This can improve decisions significantly. The purpose and value of the SCLHS Values-Based Discernment and Decision-Making Process is missed if the process is employed after all other elements of the deliberation have been concluded. The proactive

SCLHS Values-Based Discernment and Decision-Making Process aids in identifying activities and decisions that put the mission and organizational integrity at risk. Early identification of such risks fosters an ethical climate, yielding sound decision-making, and enhances public perception of SCLHS as mission focused and values driven.

Participants

SCLHS Values-Based Discernment and Decision-Making Process is the responsibility of the leaders who will be making the decision. This includes determining the appropriate group to engage in the process. Certain evaluations will be done by a small group of senior leaders because of the need for confidentiality or the need for timeliness. More often, the work will be delegated to a committee as are other explorations related to the decision.

Persons with access to pertinent information and the skills to analyze the data are needed in the process. Mission, operations, planning, clinical services and financial services staff need to be trained in the process so that they can gather relevant information and identify issues that will need to be resolved

If appropriate, the committee should include no more than ten to twelve persons; in many instances fewer persons may be required. In projects that move through several steps prior to approval, mid-level managers could be responsible for the work. As the project moves to the next appropriate administrative level, these managers serve as staff to more senior officials. At such transition points, the findings of the first group should be documented in writing for those who will continue the SCLHS Values-Based Decision Making Process. A template (SCLHS VBDM Report Template) has been designed to aid in this process.

Report and Integration into Business Plan

At the conclusion of each step in the approval process, a written report should document the outcomes. The final report provides information about how the process was conducted and an analysis of the proposed initiative in light of the mission and values. The report is not intended

to include a recommendation to the decision-makers. The final report should be part of an integrated business plan, identifying the rationales in support and/or opposition to the proposed initiative, as well as indicating alternatives that might surface in the process. A summary of the

66

6

report should be included within the final proposal considered by the decision makers, whether it is the senior leadership group or the board.

The SCLHS Values-Based Discernment and Decision-Making Process report should be given to the senior leader who convened the group at the local care site. If the decision will be made by the SCLHS Senior Leadership Team or the SCLHS Board, a copy of the report also should be given to the care site CEO for the care site leadership team.

Steps in SCLHS Values-Based Discernment and Decision Making

1. Assemble the right participants:

SCLHS discernment and decision making, except for emergent circumstances when time is of the essence, calls for participants who represent relevant interests, who possess relevant technical knowledge, who may provide relevant information, and who represent SCLHS mission and ministry functions. SCLHS board members, administrators, and managers have responsibilities for SCLHS Core Values integration, along with designated SCLHS mission leaders.

2. Assemble the right facts:

SCLHS values-based discernment and decision making is characterized by its factual basis and accuracy. The facts of any case or situation will determine the appropriate application of SCLHS Core Values. Facts will also determine whether previous decisions in similar circumstances will again be applied, or an exception granted. Assembling the relevant information for a decision is itself a values-based activity.

3. Clarify the Core Values:

SCLHS Core Values are made explicit in the discernment and decision making process. This occurs in two ways. First, the meanings of the Core Values are extended to fit the factual situation. Second, a determination is made whether the factual situation dictates any priority among the Core Values.

SCLHS values-based discernment and decision-making is clear on what the Core Values actually mean in “these circumstances” and on whether “these circumstances” make it more important to promote some Core Values over others (for example, Caring Spirit over Stewardship).

4. Reach a collaborative consensus:

SCLHS values-based discernment and decision-making aims at consensus, but not necessarily unanimity, among decision makers. In SCLHS values-based discernment and decision-making, perfect consensus involves agreement among all decision makers regarding the outcome dictated by the Core Values. Imperfect consensus involves disagreement over outcome, where all decision makers are satisfied that the Core Values were properly considered and that the decision making process was appropriate. All decisions require at least imperfect consensus, except in emergent circumstances and/or for extraordinary reasons.

5. Broadcast the values-based decision:

67

7

SCLHS values-based discernment and decisions end with effective and clear communication to affected shareholders of the decision; the Core Values rationale for the decision, and the outcome of the decision making process. Shareholders are shareholders precisely because they believe in and are committed to the mission and core values of SCLHS. These shareholders carry the reputation and integrity of SCLHS. It is the story they tell of their experience of SCLHS.

Confidential information may be excluded from any communication.

Communications must avoid suggesting justifications for the decision that were not actually involved in the decision making.

It is ethically inappropriate to make a decision and then use the SCLHS Values-Based Discernment and Decision Making Process as a way to justify the decision. Such activity erodes trust, creates a loss of respect, and compromises organizational integrity. These are losses from which it is impossible for the organization to recover. Inappropriate application of the SCLHS Values-Based Discernment and Decision Making Process diminishes the perception of ethical leadership by both internal and external publics and creates a loss of an ethical culture.

SCLHS VALUES-BASED DECISION MAKING PROCESS

(Note: model adapted in part from the Holy Cross Health, which is now part of the Trinity Health System)

These questions are designed to assist senior leadership and board members in evaluating a proposed initiative relative to the SCLHS mission and its core values. Evaluation involves the preparatory assessment ahead of the actual discernment and decision-making process. This process can be developed in parallel with the tool “SCLHS DECISION-MAKING TOOL FOR EVALUATING ALTERNATIVES.” which is depicted later in this document.

1. Describe the proposed initiative in detail.

2. How does the initiative fit into the strategic framework of the care site and SCLHS?

We reveal and foster God’s healing love

3. Identify the major stakeholders who might be affected by the action under consideration. List those who might be harmed by the action, starting with those likely to suffer the most harm.

4. How does the initiative present SCLHS with opportunities to demonstrate and foster its

Mission and Core Values? Which core values might be demonstrated by this proposed course of action? Which might be threatened or harmed? • Caring Spirit • Excellence • Good Humor • Integrity • Safety

68

8

• Stewardship

5. Does the action under consideration pose any issues associated with the Catholic identity of

the organization? Is the action consistent with the Ethical and Religious Directives for Catholic Health Care Services (2009)?

6. If applicable, what is the responsibility to the diocesan bishop regarding the proposed action (to seek advice, to inform, to seek approval, none?) What has been done thus far? Relative to Part Six of the ERDs, is there a risk of scandal?

7. How does the proposed initiative demonstrate collaboration with: • Other Catholic providers and sponsors? • Other values-based or faith based providers? • Other Catholic entities (Catholic Charities, parishes, schools)? • Other-than-Catholic partners

8. Does the project risk the self-identity, history of service or reputation of SCLHS or any of

its members? 9. Has a detailed communications/public relations plan been developed to present the value

of the proposed action and to address any negative consequences associated with it?

by improving the health…

10. How will the project impact SCLHS’s ability to assure operational excellence, patient care and quality outcomes?

11. Will the proposed initiative enhance SCLHS’s ability to provide holistic care?

12. Is the quality of services provided by a potential collaborator on a par with those provided by SCLHS?

13. How does the proposal affect the ability of the SCLHS organization to provide spiritual care?

14. Is there physician support and collaboration for the initiative? If not, will it be obtained?

of the people and communities we serve…

15. What will the impact be on the health of the community if this project goes forward?

16. If the community has identified its health needs, how does the proposed initiative relate to those needs?

69

9

17. Will any services be eliminated from the community? How will the community be impacted by the loss of these services?

18. Does the project entail duplicating services in the community? If yes, why proceed with it?

19. If the project goes forward, what responses can be expected from the community and other providers within it?

20. What impact might this proposed initiative have on human resources? Will current staff be downsized? What provisions are being made for them? (e.g. internal transfers, retraining, out placement assistance, etc.)

21. Does the proposal have any environmental impact? If negative, how will it be mitigated?

especially those who are poor and vulnerable

22. What will the impact be on the ability of SCLHS to provide services to women and children?

23. Will there be a loss of or a reduction in services to the medically underserved or at-risk populations?

24. Have any issues of mission and values been raised in the strategic, legal or financial

analyses? If so, how are they being resolved?

SCLHS VALUES-BASED DISCERNMENT AND DECISION-MAKING TOOLS

70

10

SCLHS ETHICAL DISCERNMENT and DECISION-MAKING TOOL FOR EVALUATING ALTERNATIVES

Briefly state the issue or question:

ALTERNATIVES

Briefly state alternatives

Alternative 1

Alternative 2

Alternative 3

Alternative 4

Core Values: How does this alternative promote or detract from the SCLHS core values?

SCLHS Mission: How does this alternative promote or detract from the SCLHS mission?

Catholic Identity:What implications does this alternative have for the Catholic identity of SCLHS and its care site(s)?

Improving The Health Of The Community:How does this alternative promote or detract from the health of the community?

Professional Relationships: How does this alternative affect short and long-term relationships with colleagues, donors, volunteers, and the public?

The Poor And Vulnerable: How does this alternative affect short and long-term impact on the poor and the vulnerable?

SCLHS Organizational Integrity: In what ways does this alternative help or not help SCLHS develop into the sort of Health care ministry it wants to be?

Personal Integrity: In what ways does this alternative help or not help you develop into the sort of person you want to be?

Based on information from the discernment grid, which alternative demonstrates the greatest overall acceptability?

Notes:

71

11

SCLHS ETHICAL DISCERNMENT AND DECISION-MAKING TOOL TO EVALUATE STRATEGIC INITIAVES

TO BE COMPLETED BY INITIATIVE CHAMPION AND RESPONDED TO BY APPROPRIATE STAKEHOLDERS

Ken Homan, PhD SCL Health System Health Care Ethicist

Notes:

Briefly state the original initiative:

Initiative Rationale (completed by initiative champion)

Accept

(stake-holder response)

Accept with the following

recommendations

(stakeholder response)

Reject due to the following concerns

(stakeholder response)

Core Values This initiative promotes or detracts from the SCLHS core values by …

SCLHS Mission This initiative promotes or detracts from the SCLHS mission by …

Catholic Identity What implications does this alternative have for the Catholic identity of SCLHS and its care site(s)?

Improving The Health Of The Community This initiative promotes or detracts from the health of the community by …

Professional Relationships This initiative affects short and long-term relationships with colleagues, donors, volunteers, and the public by …

The Poor And Vulnerable This initiative affects short and long-term impacts on the poor and the vulnerable by …

SCLHS Organizational Integrity This initiative helps or hinders SCLHS developing into the sort of health care ministry it wants to be by …

Name of respondent: DATE:

72

12

SCLHS VBDDM Initiative Worksheet Initiative Name: Initiative Target Start Date: Initiative Target Completion Date: Rationale: Goals: 1. 2. 3. How does this initiative fit into the strategic framework of the care site and SCLHS? Initiative Team Leader:

Initiative Team Members:

Stakeholders:

Resources Needed:

Who Needs to be Informed/Give Permission?

Tracking Progress

(add additional rows as needed)

Task

(specific & succinct)

Responsible Team Member

Hands Off To…

Target

Completion

Date

Progress Actual

Completion

Date

1.

2.

3.

What have we learned?

Flow-chart Chart Check for SCLHS Values-Based Discernment & Decision Making (VBDDM) Tool

Ken Homan, PhD SCL Health System Health Care Ethicist

73

13

START: Identify, clarify, explain the ethical or values

question

1. Summative evaluation 2. Review Process 3. Review key learnings 4. Implications for future

decisions and activities

Deliberate alternatives

Virtue; Utilitarian; Consequentialist; Ethical Egoism; autonomy; beneficence; nonmaleficence; justice

No

5. Broadcast results to stakeholders

Alternatives considered?

No

Which core value takes priority? On what basis? Which core value is advanced? Which core value is threatened?

No

No

3. Clarify the core values

Agreement on facts?

2. Assemble the right facts

Participant Criteria

Who are/should be participants?

Technical knowledge

Relevant information

Mission & ministry

(Does not apply to emergent conditions)

1. Assemble the right participants

4. Reach a collaborative consensus Pause for

reflection

Compatibility with Mission,

ERDs and CST?

CONSIDER

Likely benefits

Likely burdens

Likely risks

Perfect Consensus (all agree w/ outcome dictated by Core Values)

No

No

PREP

AR

AT

ION

PH

ASE

Clear goal or purpose in using VBDM?

Agreement on defining the ethical or values issue?

Identify guiding

ethical theory & principle:

Advances the

mission and core values?

Employ SCLHS VBDM Tool

Imperfect Consensus (not all agree w/ outcome; all believe Core Values appropriately considered)

Discern: Will this improve the health of the community? Who will benefit? Who could be harmed? Affect on poor and vulnerable?

Is there a common understanding of the meaning of each core value?

74

Organiza)onal Ethics November 2013 – Group 6


Sacramento, CA

Action|Feedback

What did I do? What was the feedback?

What did I learn?


Action|Feedback Re-cap §  Goal:

–  To more fully integrate Catholic identity into all aspects of the mission and workings of the organization

§  We support this goal by: –  Further building ‘communities of practice’ both off-site

(here) and on-site (virtually) –  Enabling peer learning through dialogue, sharing of

integration practices and growth of knowledge


Action|Feedback Re-cap

§  Hoped for Outcomes:

•  To increase individual accountability regarding integration of process - personally and organizationally

•  To increase system / local organizational integration

75



Sacramento, CA

Action|Feedback:

Reporting Out


Reporting Out §  Meet in forums to more fully express and

communicate A|F experience – FC facilitates and amends summaries

§  Gather in two forums with staff to share summaries and identify transferable learnings for leaders and organizations – MLC Staff facilitates this process

§  MLC Staff reports out on transferable leadership and organizational learnings


Meet in Forums: More Fully Describe and Communicate

A|F Experience

§  Written and Oral articulations – Written succinct and oral expansive

§  Opportunity for fuller expression of your experience

§  Opportunity for fuller communication of your experience

76



Sacramento, CA


Meet in Forums: More Fully Express and Communicate

A|F Experience §  What did I do?

– Room, number of people, context, direct and indirect speech, sequence of steps, etc.

§  What was the feedback? – How did I get it, direct and indirect speech, what

did it show about possible future formation efforts, what was my evaluation

§  What did I learn? – Prior, immediate, subsequent – About myself, my co-workers, the process –  If I had to do it again what would I do different


Gather in Two Forums

§  Wider conversation/higher level

§  Keep grounding descriptions in mind

§  Share summaries

§  Identify transferable leadership and organizational learnings


Staff Reports Out

§  MLC Staff reports out on leadership and organizational learnings

§  General Comments

77



Sacramento, CA


Action|Feedback Re-cap

§  Preparation: •  Integration Moments •  Reflective review of materials and process at session

•  A|F examples •  Booklet

•  Notes to future self •  Forum planning


Action|Feedback Re-cap §  Virtual process:

•  Discussion section will be opened for Forum to share, plan and develop your Action|Feedback (you will all receive Discussion notifications in Outlook)

•  Forum Coordinator will help moderate the discussions

•  Each person will complete their own Action|Feedback (as usual) before the noted deadline


Action|Feedback Re-cap §  Virtual process:

•  Forum Coordinators will review all of the submissions creating summaries and make suggestions in their report regarding –

“particular learnings which are important for our skills of articulation and integration…..”

•  All members will receive email alerting them of Forum Coordinator’s submission §  View other forum members work §  View Forum Coordinators draft report-out §  Engage in discussions (on-line)

78



Sacramento, CA

The Forma*on Experience Information

Formation

Transformation

Knowledge

Conviction

Action

HEAD

HEART

HANDS FEET


Action | Feedback Due DatesRe-cap

§  Deadline for AF Submissions Organizational Ethics January 17, 2014

§  Deadline for Forum Coordinator’s Report Organizational Ethics – January 24, 2014

79

Organizational Ethics Copyright © 2013 November 2013 – Group 6 Ministry Leadership Center

Sacramento, CA

Action|Feedback Preparation

One of the functions of leadership formation is to articulate and integrate ideas and get feedback. 1. Consult booklet / handouts and choose an idea(s) on Organizational Ethics. What idea(s) intrigued you? What idea(s) are relevant and usable? To help with this process finish the sentence stems….

• Of all the topics we talked about regarding Organizational Ethics, what

interested me the most was …

• When I think of sharing what interested me most about Organizational Ethics in an Action|Feedback session with a particular group / individual, I encounter the obstacle of …

• When I think of sharing what interested me most about Organizational Ethics in an Action | Feedback with a particular group / individual, I envision the benefit of …

80

Organizational Ethics Copyright © 2013 November 2013 – Group 6 Ministry Leadership Center

Sacramento, CA

Action|Feedback

Preparation 1. Describe the Action|Feedback opportunity you are thinking about and the action you will take…. 2. Working in your Forum share your Action|Feedback process. When you are listening, image you are a participant in the process you are hearing about. 3. Now that you have briefly formulated an Action|Feedback plan determine who the Forum Coordinator will be and how you might work together for you Forum Coordinator Report?

Keep in mind the Action | Feedback process – What did you do? What did you learn? What was the feedback?

81

Organizational Ethics Copyright 2013 November 2013 – Group 6 Ministry Leadership Center

Sacramento, CA

Action|Feedback Example 1 Organizational Ethics

Psychological Tendencies that Affect Ethical Decisions

We did this exercise at the Organizational Ethics session. It is built on the assumption that when we analyze situations in order to came to decision and action, a lot is going on that we may not be aware of. In particular, we may be influenced by tendencies that are relatively common, predictable assumptions that come into play and may affect our desire to be ethical. If we can bring these hidden persuaders, these tendencies, out in the open, we can relate “to” them rather than “from” them. The way we would do this is:

(1) Identify and discuss these tendencies. (2) Rate them in terms of their relevancy. (3) Create a checklist of questions that would bring them onto our radar screen

so we could decide for or against them.

For you to do this with your team, you would first go over the list of tendencies and explain them. You could be the main explainer but also invite others to join in. Then determine, using the 1-5 rating system, which ones are the most germane to your work. Finally, choose the ones that received the highest rating and create questions that would be added to a checklist and become consistent companions as you analyze and decide on how to act in situations.

The full list of tendencies will be on the MLC Website in the Organizational Ethics section. But the full list might be too much to do in a reflection with your staff. You might want to limit the number of tendencies by making an educated guess on which ones would be most relevant.

For example, there are 18 tendencies on the full menu, but you might want to use

only 9. Below is a model.

82


Sacramento, CA

Psychological Tendencies that Affect Ethical Decisions

1. Limiting search for stakeholders (1…………2………..3……….4……….5) “tendency to restrict the analysis of a policy’s consequences to one or two groups of visible stakeholders” 2. Discounting future (1…………2………..3……….4……….5) “tendency to more concerned about tomorrow than what we

must address next week or next year.”

3. Denying Uncertainty (1…………2………..3……….4……….5) “tendency to make things sound certain and deterministic rather than uncertain and often unpredictable” 4. Focus on Individuals (1…………2………..3……….4……….5) “tendency to blame one individual or a group for a failure” 5. Ethnocentrism (1…………2………..3……….4……….5) “tendency to see our ways as normal and preferred and other ways as inferior and to exaggerate difference between ‘them’ and ‘us’ 6. Stereotypes (1…………2………..3……….4……….5) “tendency to rely on stereotypes rather than information and evidence 7. Illusion of Favorability (1…………2………..3……….4……….5) “tendency to highlight our positive characteristics and discount our shortcomings 8. Illusion of Control (1…………2………..3……….4……….5) “tendency to exaggerate the extent to which we can determine outcomes 9. Self-Serving Fairness Bias (1…………2………..3……….4……….5) “ tendency to overestimate what we fairly deserve - credit ourselves for effort and others only for achievement”

83


Sacramento, CA

Create a Checklist of Questions

Please create a checklist question for any psychological tendency you gave a “5.” For example, if you gave a “5” to “limiting the search for stakeholders,” a checklist question might be: “Have we identified all the people whom this decision will affect? If you gave a “5” to “the illusion of control,” a checklist question might be: “Once this decision is made, what can we reasonably control and what is beyond efforts?”

84


Sacramento, CA

Action|Feedback Example 2 Organizational Ethics

Dealing with Situations Ethically

We worked with this exercise at Organizational Ethics session. Its value is that it:

(1) Practices reflecting and learning from experience. (2) Focuses on a challenging experience that has an ethical dimension. (3) Allows the group to learn from the experience of one of its members.

This exercise is very dependent on group size and time allotment. It could be spread over a number of meetings so everyone would get a chance to tell an experience in story form. Or it could be processed one on one (in dyads) and then significant learning brought into the large group. Identify one work situation that kept you “awake at night” (caused you a great deal of concern) and for which you feel you came up with a good solution?

§ Describe the situation and the issue. § Who was involved (avoid specific names)? § What was your major concern? § What values did you believe were at stake? § How was the issue resolved? § Who participated in the resolution? § What made it a good solution for you? § What do you wish you had available to you at the time you were trying

to resolve the problem? Finally and most importantly, what are some of the learning’s from this experience?

85

Org Ethics Master Booket 2013.pdf

Documents

Transcript of Org Ethics Master Booket 2013.pdf