Infection Control Today - 05/2003: Trust and Ethics

Trust and Ethics: Essential Ingredients

By Bryant Broder, ACSP

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

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

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

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

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

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

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

A good friend of mine battling cancer provided me with examples of ethical dilemmas of even greater scope to think about, including "Are things always ethical even when they are against the law? What about euthanasia, use of experimental drugs, or the use of life extending procedures that aren't FDA approved? How do we justify the death penalty as morally ethical, when individuals at the end of their lives cannot freely elect to limit or end their own misery?" These are difficult questions about huge issues and almost impossible to provide "rubber stamp" answers in that every situation is unique. However, some of the business-related issues could be addressed by using common sense and acting in a trustworthy manner.

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

• Be proactive in reporting problems or errors -- be the first to report your own mistakes
• Accept responsibility to fix what is wrong even if you were not responsible for making it wrong
• Apologize
• Show that the event was an exception
• Tell how you will prevent its recurrence -- focuse on fixing the problem, not the blame
• Invite public scrutiny of the issue and your proposed responses
• Don't do it again

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

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

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

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

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

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