- Values
‘Underlying attitudes and beliefs that determine individual behaviour’ (Viinamäki, 2012, p. 29)
As a leader, it is important to reflect upon questions like the following: Who does your organisation hold as its heroes? Does your organisation reward competitiveness, while espousing collaboration? What symbols represent your organisation, and what do they say about your organisation’s actual values? What rituals does your organisation adhere to?
Organisational values and values systems provide employees with norms that guide decision-making and behaviour in the workplace (Edwards & Cable, 2009). It is therefore important to give them careful attention.
- Values system
The ordering of values on the basis of their relative importance to individuals or organisations
In large and complex organisations, shared, common values, or values congruence, is recognised as an important factor in forming a coherent and successful organisation in ways that benefit individual staff and the organisation itself (Howell, Kirk-Brown & Cooper, 2012). Buchko (2007, p. 37) further explains, ‘Values are the glue that binds people together in organisations. When a group of people share a set of beliefs about the goals that need to be achieved and the means to be used to attain those goals, there is a basis for organisation. In fact without some common beliefs or values, organisations could not exist; people need a common set of beliefs to come together and create social organisations’.
In the complex context of healthcare, it is almost inevitable that those in senior leadership roles will face challenges to their personal and professional values. Indeed, Graber and Kilpatrick (2008, p. 186) argue that ‘challenges and crises are in a sense necessary to not only test, but to evoke, the leader’s values’. In this environment, ‘ethics and values may offer a more predictable, stable and sustainable base for leadership…and provide a certain “warranty” on integrity and future prospects in organisations’ (Viinamäki, 2012, p. 28). Becoming aware of, and clearly defining, their own personal and professional values empower and equip leaders to make principle-based decisions in a way that models ethical leadership to their staff, builds trust in them as a leader and promotes confidence in their organisation.
Personal values
Judging from the work of phenomenological philosophers such as Maurice Merleau-Ponty, Charles Taylor and Paul Ricoeur, the formation of a person’s moral framework and values system is complex, multifaceted and highly individualised. Each of us, from the day we are born, experience the world on multiple different levels, each bringing knowledge, social expectations and norms which mould our moral development and values framework (Isaacs, 2003, 2010).
The experiences that shape our values arise from embeddedness in the areas discussed below. From the examples given, we can gain an appreciation of the complex factors that make up each person’s individual moral framework and values system. Through appreciation and knowledge of our personal values, we can gain insight into the motivations of ourselves and others and begin to challenge unreflective or habitual responses to various situations (Clark, 2008).
The natural world
This affects us physically, spatially and biologically. With respect to health, for example, our expectations and values concerning disability or physical incapacity are influenced by our own lived reality. How we view disability in others is prejudiced by our assumptions, which are based on personal experience.
The social world
This is the area of multiple relationships, cultures, politics, economies, nations and communities of all shapes, moral understandings and identities. With respect to health, for example, if we have been embedded in a cultural and economic norm of ‘free’ healthcare, this may shape our values and expectations when it comes to decision-making about access to high-cost care for our patients. In a culture of presumed plenty, we may feel justified in dismissing the financial considerations of health resourcing, as our expectation is that no-one will, or should, miss out.
Temporal space
The area of temporal space asks us to consider the manner in which our cultural norms relate to the historical context we are in and invites us to consider how our historical place influences our perception of the present and imagining of the future. With respect to healthcare, for example, we may value the growth in scientific knowledge and expect that this body of knowledge will continue to be pursued. We may also expect that any technological advances made will be fully implemented for the benefit of our patients.
Language
Language mediates our relationships with others. It supports understanding, shapes our identities and allows us to express our future growth and desires. With respect to health, the choice of language can alter and define clinical relationships. We may, for example, choose to call those who seek our care patients, or we may call them consumers. The language adopted defines the terms of the relationship. We may interact with a consumer, who is purchasing a product or service. The use of different language, such as the word patient, may frame the interaction as one in which a moral duty of care exists beyond the transactional nature of supplying goods or services. Hence, language shapes the moral tenor, assumptions and expectations of healthcare interactions positively and negatively.
Spiritual horizons
These give direction and meaning to life for some. Many aspects of care evoke spiritual values which impact upon patients, staff and organisations. Issues concerning withdrawal of life-sustaining measures at the end of life or a patient’s request for a termination of pregnancy may trigger challenges to the spiritual values of those involved (Isaacs, 2010).
Professional values
Once we enter a profession, another layer of socialisation is added to our existing values framework, potentially reducing some values differences among members of that profession (Hofstede, 2001). Similarly, when individuals become socialised in a particular organisation, another layer of shared experience and values is added. Like personal values, professional and organisational values are culminations of multiple layers of compounding and competing experience.
An essential first step in understanding and thoughtfully applying values-based leadership is to define one’s own core values. (A helpful tool for this can be found on the Values in Action website: http://www.viacharacter.org. While it does not provide a definitive list, it is a starting point for recognising how values shape behaviour. It also enables users to reflect upon the origins of their values and can help foster appreciation of one’s own motivations and the motivations of others’ behaviours.) As an example, imagine that one of your strong personal values is gratitude. Your leadership style will be one in which you consciously show appreciation to your colleagues, and you are likely to flourish in an environment where you feel appreciated for your contribution. However, if you find yourself in a work environment where you feel undervalued, you are likely to interpret this as a negative workplace culture and experience significant distress. In interactions with patients, those you perceive as ‘ungrateful’ may trigger emotional reactions of resentment, or counter-transference. Understanding the source of these emotions as based on one of your values – that is, gratitude – and recognising the triggers can help you to manage their consequences. For example, to minimise the impact of counter-transference on patient care, strategies such as implementing team-based care or having regular supervision or debriefing with colleagues are helpful.
As a further example, imagine that one of your strong values is truthfulness. You will flourish in organisations which have a culture of transparency and openness, and your leadership style will model honesty and promote this in others. Moral distress may arise if you perceive that information is being withheld or an adverse event not disclosed on the grounds that others believe that disclosure would be harmful to a patient. In recognising your distress as based on one of your values – that is, honesty – you can frame discussions directly in language that identifies the ethical source of your concern.
Knowledge of your own values and those of your colleagues is therefore helpful not only in enabling you to manage your own emotional reactions but also in understanding team dynamics and building values congruence within your organisation and with your colleagues.
Leadership and values
Leaders are tasked with ensuring the efficient and financially responsible management of their organisations. However, they are equally responsible for ensuring that appropriate ethical standards are promoted, modelled and upheld. Edgar Schein (1992, as cited in Graber & Kilpatrick, 2008, p. 194) notes, ‘The only thing of real importance that leaders do is to create and manage culture’. And Blanchard & O’Connor (1997, p. 3) claim that ‘no longer is values-based organizational behavior an interesting philosophical choice – it is a requisite for survival’.
As staff take their cues from the actions of those in leadership positions, the ways in which values are modelled by managers and leaders are crucial. Leaders communicate organisational values to all employees; they have the opportunity to model values in action, empower others to make principled decisions, and promote trust. Individual leaders therefore have a significant influence over the ethical culture (Buchko, 2007). Positive role-modelling promotes confidence in leaders and improves values congruence for staff, which in turn promotes loyalty and optimism (De Hoog & den Hartog, 2008). The improved ‘affective commitment’ (Howell et al., 2012, p. 732) to an organisation as a result of improved trust and values congruence has also been correlated to the improved retention of staff (Buckley et al., 2001; Olson, 1995; Schluter, Winch, Holzhauser & Henderson, 2008). This has significant implications for organisational stability, which is especially important in healthcare organisations, where workforce instability can have negative impacts on patient care (Schluter et al., 2008).
At an organisational level, the ability to articulate shared values is an important strategy in managing complex organisations, as values are the foundation of shared principles of decision-making. Promoting shared values creates a vehicle through which the diverse views and expectations of individuals within an organisation can be focused towards a commonly agreed overarching goal. Authentic alignment to a set of organisational values or core values is consistently recognised as a characteristic of successful organisations (Viinamäki, 2012).
Climate and culture
It is clear that when ethical climate, organisational culture and the values of employees align in healthcare organisation there are significant benefits, including improved organisational stability, stronger emotional commitment and trust from staff and improved quality of care, confidence and trust for the public (Olson, 1995; Schluter et al., 2008).
Ethical climate
One of the most important enablers of individual ethical behaviour is being situated in a climate that supports ethical decision-making. The ethical climate is shaped by the prevailing organisational practices, procedures and codes that have ethical content or determine ethical action. In their seminal work, Victor and Cullen (1988) claim that ethical climates centre around three dimensions: egoism, benevolence and principles. Further research has confirmed that benevolent and principled climates are more likely to reduce unethical conduct. Ego-based climates, on the other hand, are more likely to create unethical behaviour (Kish-Gephart, Harrison & Triveno, 2010; Wimbush & Shepard, 1994). Hence, a leader’s ability to promote a climate of acting on principle through values-based leadership with attention to the good of the whole can reduce unethical workplace behaviour (Kish-Gephart et al., 2010).
- Ethical climate
‘A group of prescriptive climates reflecting the organisational procedures, policies and practices with moral consequences’ (Martin & Cullen, 2006, p. 177)
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