1. How to Follow Up on Ethical Concerns An Exercise for Leaders

2. How can leaders cultivate an ethical environment and culture? The Ethical Leadership Compass was created to assist leaders in behaviors that promote an ethical environment and culture. The four compass points are: Demonstrate that ethics is a priority Communicate clear expectations for ethical practice Practice ethical decision making Support your local ethics program

3. Talk about ethics Prove that ethics matters to you Encourage discussion of ethical concerns Compass Point 1: Demonstrate that ethics is a priority

4. Leaders can prove that ethics matters Show respect for others Demonstrate honesty, forthrightness and trustworthiness Keep promises and commitments Reward ethical practices Follow up on ethical concerns

5. Why is this important? In the 2010 IntegratedEthics Staff Survey, completed by 88,605 VA health care system employees… Following up on ethical concerns was among the top four measures associated with respondents’ perceptions of the organization’s overall ethics quality. Source: Foglia MB, Cohen JH, Pearlman RA, Bottrell, MM, & Fox, E. (2013): Perceptions of Ethical Leadership and the Ethical Environment and Culture: IntegratedEthics® Staff Survey Data from the VA Health Care System, AJOB Primary Research, 4:1, 44-58

6. Session overview Introduction: 3 minutes Participants draft scripts: 5 minutes Participants pair up to deliver responses and offer feedback: 14 minutes total (7 minutes per participant) Group discussion: 8 minutes

7. Scenario 1 A staff member makes an appointment to meet with you and shares the following ethical concern: “The manager of the mental health unit asked the primary care team to cut back on referrals because they (the mental health unit) are understaffed. Many of our patients have serious mental health issues that can’t be adequately addressed in primary care.” How will you respond?

8. Scenario 2 A staff member comes forward with the following concern: “A front-line supervisor consistently comes in late or leaves early from work. Even though the supervisor works through her lunch break, staff know that she isn't at her desk during her full tour of duty. I am particularly concerned because I now see some junior staff starting to pick up the same behavior.” How will you respond?

9. Scenario 3 A staff member comes forward with the following concern: “I can’t sleep at night. Every day I work with patients I know are eligible to receive non-VA care and who need it. I have been told not to make a referral unless it is to the Veterans Choice Program. Many of my patients aren’t eligible for that program. What do I do?” How will you respond?

10. Pair up and practice Each person takes 6 to 7 minutes to practice responding and get feedback from their partner. Switch roles at the 7-minute mark. Give feedback on what was persuasive, what was left out (if anything), and whether you felt confident that your partner responded effectively to the ethical concern.

11. Tips for responding to an ethical concern Remember to thank the employee for raising the ethics issue or concern. Briefly share safety ground rules. Clarify your role up front. Be optimistic that acceptable solutions will be found. Demonstrate listening skills and show empathy. Tie the issue or concern to a value. When appropriate, acknowledge that you don’t have all the information right now. You or others you assign will have to find out more. Tell the employee who/what will be assigned to follow up on the issue. Describe the process you expect to take place in follow-up, and how long it will take. Inform the employee how he/she should expect to hear about the outcome. If the privacy of others is at stake, explain that the employee will learn when the ethical concern has been reviewed and appropriate action taken, even though details cannot be shared.

12. Share your insights What surprised you in doing this exercise? Which part of your response was most challenging to write or deliver? Which part of your response did you feel was most important or effective in conveying that ethics is a priority? What insights can you share from the experience of giving feedback?

13. THANK YOU!