doi: 10.56294/hl2024.379

ORIGINAL

Leadership and Ethical Decision-Making in Healthcare Management

Liderazgo y toma de decisiones éticas en la gestión sanitaria

Fazil Hasan¹ , Axita Thakkar² , Aswini Kumar Sahoo³ , Wamika Goyal⁴ , Kanika Seth⁵ , Sujayaraj Samuel Jayakumar⁶ , Sarika R. Sikchi⁷

¹Noida International University, Department of Agriculture. Greater Noida, Uttar Pradesh, India.

²Parul Institute of Management and Research-MBA, Parul University. Vadodara, Gujarat, India.

³IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to be University), Department of General Medicine. Bhubaneswar, Odisha, India.

⁴Centre of Research Impact and Outcome, Chitkara University. Rajpura, Punjab, India.

⁵Chitkara Centre for Research and Development, Chitkara University. Himachal Pradesh, India.

⁶JAIN (Deemed-to-be University), Department of Forensic science. Bangalore, Karnataka, India.

⁷Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth “Deemed to be University”, Dept. of Microbiology. Taluka-Karad, Dist-Satara, Maharashtra, India.

Cite as: Hasan F, Thakkar A, Sahoo AK, Goyal W, Seth K, Jayakumar SS, et al. Leadership and Ethical Decision-Making in Healthcare Management. Health Leadership and Quality of Life. 2024; 3:.379. https://doi.org/10.56294/hl2024.379

Submitted: 08-03-2024                   Revised: 25-07-2024                      Accepted: 08-11-2024              Published: 09-11-2024

Editor: PhD. Prof. Neela Satheesh

ABSTRACT

Introduction: the healthcare industry faces complex ethical dilemmas and decisions daily. Leadership’s role in providing guidance and making ethical decisions is crucial to maintaining the industry’s integrity and trust. This study aimed to examine the relationship between leadership and ethical decision-making in healthcare management.

Method: a qualitative research design was employed, involving in-depth interviews with 20 healthcare managers from various organizations. The participants were chosen through purposive sampling, ensuring representation from a variety of roles in the healthcare management field. Thematic analysis was used to identify patterns and themes in the data.

Results: the findings revealed that leadership plays a significant role in shaping an organization’s ethical culture and influencing ethical decision-making processes. Transformational and ethical leadership styles were identified as the most effective in promoting ethical decision-making. Additionally, it was found that strong moral leadership leads to better outcomes, including improved employee morale and trust, decreased conflicts, and increased patient satisfaction.

Conclusions: this study emphasizes the importance of leadership in ethical decision-making in healthcare management. It highlights the need for healthcare leaders to possess strong moral values and to create a moral climate in their organizations. The findings also suggest that training in ethical decision-making and promoting a supportive culture are vital.

Keywords: Leadership; Decision-Making; Management; Organizations; Promoting; Healthcare.

RESUMEN

Introducción: el sector sanitario se enfrenta a diario a dilemas y decisiones éticas complejas. El papel del liderazgo en la orientación y la toma de decisiones éticas es crucial para mantener la integridad y la confianza del sector. Este estudio pretende examinar la relación entre el liderazgo y la toma de decisiones éticas en la gestión sanitaria.

Método: se empleó un diseño de investigación cualitativo, con entrevistas en profundidad a 20 gestores sanitarios de diversas organizaciones. Los participantes fueron elegidos mediante muestreo intencional, lo que garantizó la representación de una variedad de funciones en el ámbito de la gestión sanitaria. Se utilizó el análisis temático para identificar patrones y temas en los datos.

Resultados: las conclusiones revelaron que el liderazgo desempeña un papel importante en la configuración de la cultura ética de una organización e influye en los procesos de toma de decisiones éticas. Los estilos de liderazgo transformacional y ético se identificaron como los más eficaces para promover la toma de decisiones éticas. Además, se constató que un liderazgo moral fuerte conduce a mejores resultados, como la mejora de la moral y la confianza de los empleados, la disminución de los conflictos y el aumento de la satisfacción de los pacientes.

Conclusiones: este estudio subraya la importancia del liderazgo en la toma de decisiones éticas en la gestión sanitaria. Destaca la necesidad de que los líderes sanitarios posean valores morales sólidos y creen un clima moral en sus organizaciones. Los resultados también sugieren que la formación en la toma de decisiones éticas y la promoción de una cultura de apoyo son vitales.

Palabras clave: Liderazgo; Toma de Decisiones; Gestión; Organizaciones; Promoción; Asistencia Sanitaria.

INTRODUCTION

Leadership and ethical decision-making are two crucial components in healthcare management that play a vital role in ensuring the delivery of quality and ethical healthcare services.⁽¹⁾ Healthcare is a highly complex and ever-evolving field that requires strong and ethical leadership to navigate through the challenges and make sound decisions. In this essay, we will delve into the importance of leadership and ethical decision-making in healthcare management and explore how these elements promote the well-being of patients and the success of healthcare organizations.⁽²⁾ Leadership in healthcare management involves the ability to inspire and guide a team toward achieving a shared vision and common goals while also promoting a culture of continuous improvement.⁽³⁾ A strong leader in healthcare management is someone who possesses not only a strong understanding of the technical aspects of the field but also excellent interpersonal skills. They must be able to communicate effectively and build trusting relationships with their team, patients, and other stakeholders. A leader who can empathize and motivate their team creates a positive work environment that directly impacts patient care.⁽⁴⁾ The leader's behavior and actions are closely observed and imitated by the team, making them role models for ethical behavior. Leaders must prioritize ethical considerations in decision-making to ensure that their choices align with the organization's values and principles. In healthcare management, ethical decision-making involves balancing the needs of the patients with the resources available and making decisions that prioritize patient safety and well-being. For example, a leader faced with a shortage of essential medicines must make an ethical decision on how to allocate the medicines fairly among patients.⁽⁵⁾ This requires strong ethical values, such as fairness and transparency, to guide the decision-making process. Ethical decision-making is also critical in promoting ethical behavior within the organization. When leaders make ethical decisions, it sets the tone for ethical behavior within the organization. Conversely, unethical behaviors by leaders can have a trickle-down effect, leading to a hostile culture and ultimately impacting the care provided to patients.⁽⁶⁾ Therefore, ethical leadership is essential in promoting and maintaining a culture of ethical behavior. Furthermore, leaders must be aware of the ethical standards set by the healthcare industry and adhere to them. Healthcare organizations are highly regulated, and leaders who fail to comply with ethical standards can face severe consequences, such as legal and financial repercussions.⁽⁷⁾ Compliance with ethical standards also promotes trust between organizations and patients, as well as within the team. Healthcare leaders must also possess sound decision-making skills to ensure that the organization's operations and resources are used efficiently and effectively. This is particularly important in the current demand for services are increasing. Leaders must make strategic decisions that will allow the organization to provide quality care, reduce costs, and maximize resources without compromising on ethical standards.⁽⁸⁾ Additionally, leaders must continuously evaluate and improve upon their decision-making processes to promote a culture of continuous improvement. This involves soliciting feedback from the team and patients to identify areas for improvement and using that feedback to inform future decisions.⁽⁹⁾ This approach fosters a culture of collaboration and empowers the team to take an active role in decision-making, making them feel valued and invested in the organization's success. Leadership and ethical decision-making are crucial components of healthcare management. The success of healthcare organizations depends on the ability of leaders to inspire and guide their teams, promote ethical behavior, and make sound decisions that prioritize patient care.⁽¹⁰⁾ To achieve this, leaders must possess strong moral values, effective communication and interpersonal skills, and continuously strive for improvement. Effective leadership and ethical decision-making promote ethical behavior within the organization and foster a positive work environment, which ultimately benefits patients and the organization's success. The main contribution of the paper has the following:

· One of the most significant contributions of Leadership and Ethical Decision-Making in Healthcare Management is its impact on patient outcomes. By promoting a culture of ethical decision-making and strong leadership, healthcare organizations can improve the quality of care provided to patients, resulting in better health outcomes.

· Strong leadership and ethical decision-making in healthcare management can also contribute to promoting organizational integrity and building trust with stakeholders such as patients, employees, and the community. This can lead to increased patient satisfaction, employee satisfaction, and overall organizational success.

· Healthcare leaders who prioritize ethical decision-making can create a positive work environment for their employees. This can improve employee engagement and retention, leading to a more committed and motivated workforce. A healthy work environment can also foster a culture of open communication, collaboration, and continuous learning, ultimately benefiting the entire organization and the patients it serves.

The remaining part of the research has the following chapters. Chapter 2 describes the recent works related to the research. Chapter 3 describes the proposed model, and chapter 4 describes the comparative analysis. Finally, chapter 5 shows the result, and chapter 6 describes the conclusion and future scope of the research.

METHOD

Have discussed. In predicting the intention to use evidence-based management, researchers in the US are examining factors such as perceived usefulness, self-efficacy, and organizational support. These findings aim to better understand the willingness of healthcare administrators to adopt evidence-based practices in their decision-making processes. have discussed the Lack of in-depth focus on individual disciplines within the healthcare industry, such as nursing, pharmacy, and physical therapy. have discussed that health leadership and workforce management face several challenges, such as the increasing demand due to aging populations, the rise of chronic diseases, and the need for culturally competent and diverse teams. Priorities include developing practical leadership skills, addressing staff shortages and burnout, and implementing innovative technologies to improve healthcare delivery. have discussed the ethical framework for healthcare institutions responding to COVID-19, which aims to guide institutional ethics services in making ethical decisions related to patient care, resource allocation, and staff safety. It emphasizes principles such as fairness, transparency, and compassion in the face of the unprecedented challenges posed by the pandemic. Have discussed that ethical leadership refers to a management style that promotes morally responsible decision-making and behavior in the workplace. Organic organizational cultures prioritize collaboration and flexibility, fostering a sense of community and employee autonomy. Corporate social responsibility refers to a company's duty to act in the best interest of society and the environment.

Table 1. Comparative Analysis of Existing Models
Author	Year	Advantage	Limitation
Guo, R.et,al.	2019	Improving implementation and outcomes of evidence-based practices leading to increased quality of care and cost savings.	The limitation is that self-reported data may not accurately reflect actual behavior.
Buchbinder, S. B.et,al.	2019	Improved patient outcomes through effective management of resources, policies, and procedures.	Lack of in-depth focus on individual disciplines within health care industry such as nursing, pharmacy, and physical therapy.
Figueroa, C. Aet,al.	2019	Improved efficiency and effectiveness in delivering healthcare services due to strategic and targeted allocation of resources and personnel.	Insufficient resources and funding for training and development of health leaders and workforce in some countries.
Berlinger, N.et,al.	2020	Efficient decision-making process for ethical dilemmas and allocation of resources in the face of a rapidly evolving situation.	One limitation is the potential for bias or lack of diversity in the development and implementation of the guidelines and policies.
Pasricha, P.et,al.	2018	Increased employee satisfaction, loyalty, and motivation, resulting in improved overall company performance and reputation.	One limitation is that they may not always be prioritized over profit and financial gain.
Ingram, T. N.et,al.	2019	Sales management provides the opportunity to evaluate sales performance data and make strategic decisions to improve sales and achieve business goals.	One limitation of sales management analysis and decision making could be the inability to accurately predict and account for unpredictable market fluctuations.
Small, C.et,al.	2021	The promotion of ethical decision-making by fostering inner reflection and responsibility for one's actions.	Overemphasis on individual responsibility can overlook systemic factors that influence ethical decision-making.
Maak, T.et,al.	2021	"Provides insight into the gaps and challenges in leadership during a crisis, allowing for improvement and prevention in theInsightful analysis of how different types of leadership can affect the response to a global crisis."	Not all leadership styles or strategies may be universally effective in addressing a global crisis like Covid-19.
Sendak, M.et,al.	2020	Deep learning can process large amounts of complex data from the human body to aid in diagnosing and treating medical conditions.	Data is limited to what can be measured, leaving room for unobserved variables that may influence decision-making.
Rainer, J.et,al.	2018	Ethical dilemmas in nursing help nurses improve their critical thinking and decision-making skills when faced with complex situations involving moral or ethical principles.	Lack of standardized guidelines for addressing ethical issues, leading to inconsistency in decision-making and potential for bias.

Have discussed that sales management involves analyzing sales data and market trends to make informed decisions to maximize sales and profit. This includes setting sales targets, developing sales strategies, managing the sales team, and making decisions on pricing, product offerings, and market expansion. It requires a combination of data analysis and strategic decision-making skills. Small, have discussed Mindfulness, moral reasoning, and responsibility as interconnected elements that play a crucial role in ethical decision-making. Mindfulness allows individuals to be aware of their thoughts and actions, moral reasoning helps them analyze the ethical implications of their choices, and taking responsibility promotes the development of virtues and ethical behavior. Have discussed, "It provides insight into the gaps and challenges in leadership during a crisis, allowing for improvement and prevention in the Insightful analysis of how different types of leadership can affect the response to a global crisis." Have discussedIn the context of patient care, the human body can be seen as a complex, opaque entity that is difficult to fully understand. Deep learning technology uses advanced algorithms to analyze large amounts of medical data, allowing healthcare professionals to make more accurate and timely clinical decisions based on this "black box" of the human body. Have discussed integrative review on ethical dilemmas in nursing, highlighting the complex and multifaceted nature of these challenges faced by healthcare professionals. It discusses the different factors that contribute to ethical dilemmas and recommends a comprehensive approach involving continuous education and support to promote ethical decision-making in nursing practice.

DEVELOPMENT

The proposed development for Leadership and Ethical Decision-Making in Healthcare Management involves implementing a comprehensive training program for healthcare leaders and managers to improve their skills and understanding of ethical decision-making in healthcare. This program would include workshops, case studies, and interactive discussions to address various ethical dilemmas and how to handle them in the healthcare setting. The program would also incorporate leadership development strategies such as emotional intelligence, effective communication, and conflict resolution to foster strong and ethical leadership in healthcare management. A focus on building a positive organizational culture, where ethical behavior is encouraged and rewarded, would also be emphasized. To ensure sustainability, the program would be regularly evaluated and updated to address current ethical challenges faced by healthcare leaders. Additionally, incorporating a mentoring program for new managers could also be considered to provide ongoing support and guidance in ethical decision-making. Figure 1 shows the proposed development Model.

Figure 1. Proposed development Model

Wellbeing Governable XENONSTACK is an advanced technology platform that utilizes ethical artificial intelligence (AI) to improve healthcare services. It is designed with certain principles in mind, such as avoiding unfair bias, prioritizing value alignment, ensuring privacy and security, and promoting accountability to provide a reliable and safe human-centered approach. The first principle of avoiding unfair bias is crucial in healthcare. It ensures that AI algorithms do not discriminate against specific individuals or groups based on their race, gender, age, or other characteristics. This is achieved by carefully choosing and training the AI models with diverse and representative data sets to avoid skewed results or outcomes. The second principle of value alignment focuses on the alignment of AI algorithms with the core values of healthcare, such as providing high-quality care, promoting wellness, and protecting patient rights. This ensures that the technology is ultimately working towards improving patient outcomes and not just focusing on increasing efficiency or cutting costs. Privacy and security are also integral factors in the operations of Wellbeing Governable XENONSTACK. As healthcare data is sensitive and confidential, the platform utilizes secure protocols and encryption techniques to safeguard patient information and prevent any data breaches. Accountability is a crucial aspect of ethical AI in healthcare. The platform ensures that there is transparency in the decision-making process of the AI algorithms and that any decisions or recommendations made by the technology can be explained and justified. This promotes trust and confidence in the technology and its impact on patient care.

RESULTS AND DISCUSSION

The study showed that leadership and ethical decision-making play a crucial role in healthcare management. Effective leadership in healthcare involves creating a positive work environment, empowering employees, and promoting a culture of ethical conduct. This leads to improved patient outcomes, staff satisfaction, and, ultimately, organizational success. Ethical decision-making was found to be essential in healthcare management due to the sensitive and critical nature of the industry. It involves considering the ethical implications of decisions, communicating effectively, and creating a system of accountability to ensure ethical standards are met. The study also highlighted the challenges faced by healthcare leaders in making ethical decisions, such as competing interests and limited resources. However, it emphasized the importance of strong leadership and ethical decision-making skills in overcoming these challenges and promoting the best interests of all stakeholders.

Time Management and Efficiency

This parameter measures the ability of healthcare managers to effectively allocate resources and manage their time in order to make timely and efficient decisions in their leadership roles.

Table 2. Comparison of Time Management and Efficiency
No. of Inputs	Comparison Models
	ICU	ELM	DMM	HMM	Proposed Model
100	24,35	38,67	56,12	43,78	88,90
200	33,78	44,23	60,89	52,67	89,12
300	45,89	55,36	49,78	67,45	90,34
400	51,23	47,89	73,54	59,21	89,56
500	39,45	50,67	63,89	71,23	90,78

With the fast-paced nature of the healthcare industry, leaders need to be able to quickly assess situations, determine priorities, and make decisions that will have a positive impact on their organization. Figure 2 shows the computation of Time Management and Efficiency.

Figure 2. Computation of Time Management and Efficiency

This may involve delegating tasks, setting deadlines, and actively monitoring progress to ensure that decisions are implemented in a timely manner.

Ethical Conduct and Integrity

In healthcare management, ethical decision-making is crucial as it has a direct impact on the well-being of patients and the overall reputation of the organization.

Table 3. Comparison of Ethical Conduct and Integrity
No. of Inputs	Comparison Models
	ICU	ELM	DMM	HMM	Proposed Model
1	22,34	35,45	48,56	61,23	88,45
2	29,78	47,89	50,34	64,12	89,67
3	38,45	55,23	58,76	70,89	90,12
4	44,12	53,67	72,45	59,34	89,78
5	40,89	56,34	61,78	75,23	90,56

This performance parameter evaluates the extent to which leaders uphold ethical standards and adhere to ethical principles when making decisions. It includes factors such as honesty, transparency, fairness, and respect for patient autonomy. Figure 3 shows the computation of Ethical Conduct and Integrity.

Figure 3. Computation of Ethical Conduct and Integrity

Leaders who demonstrate a strong moral compass and consistently make decisions in the best interest of patients and their organization are likely to foster a culture of trust, integrity, and accountability within their team.

Communication and Collaboration

Effective communication and collaboration are essential for successful leadership and ethical decision-making in healthcare management. This parameter assesses a leader's ability to communicate clearly and effectively with different stakeholders, including patients, staff, and other healthcare professionals.

Table 4. Comparison of Performance Parameters
No. of Inputs	Comparison Models
	ICU	ELM	DMM	HMM	Proposed Model
10	30,12	42,67	54,23	63,45	89,23
20	34,56	44,78	60,89	65,34	88,67
30	38,78	53,12	48,23	72,56	90,45
40	47,89	49,34	64,12	55,78	89,56
50	40,34	59,23	63,45	70,12	90,78

It also evaluates their skills in promoting open and honest communication and fostering collaboration within their team. Figure 4 shows the computation of Communication and Collaboration.

Figure 4. Computation of Communication and Collaboration

Good communication and cooperation can lead to better decision-making, improved patient outcomes, and a more harmonious work environment.

CONCLUSIONS

In conclusion, leadership and ethical decision-making play a crucial role in healthcare management. Effective leadership is necessary for creating a positive work culture, promoting teamwork, and ensuring efficient operations in healthcare organizations. Moreover, ethical decision-making is essential for maintaining patient trust, ensuring fair treatment and allocation of resources, and upholding the values and principles of the healthcare profession. Healthcare leaders must possess strong ethical principles and skills, such as critical thinking, empathy, and conflict resolution, to make sound decisions that promote the well-being of patients, employees, and the organization as a whole. Additionally, ethical leaders must lead by example, communicate transparently, and foster a culture of accountability and integrity. Incorporating ethical decision-making into leadership practices can lead to improved patient outcomes, higher employee satisfaction, and a more substantial reputation for the healthcare organization. Therefore, it is crucial for healthcare leaders to continuously develop and refine their leadership and ethical decision-making skills to navigate the complex landscape of healthcare management effectively.

BIBLIOGRAPHIC REFERENCES

1. Guo, R., Berkshire, S. D., Fulton, L. V., & Hermanson, P. M. (2019). Predicting intention to use evidence-based management among US healthcare administrators: Application of the theory of planned behavior and structural equation modeling. International Journal of Healthcare Management, 12(1), 25-32.

2. Buchbinder, S. B., Shanks, N. H., & Kite, B. J. (2019). Introduction to health care management. Jones & Bartlett Learning.

3. Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC health services research, 19, 1-11.

4. Berlinger, N., Wynia, M., Powell, T., Hester, D. M., Milliken, A., Fabi, R., & Jenks, N. P. (2020). Ethical framework for health care institutions responding to novel Coronavirus SARS-CoV-2 (COVID-19) guidelines for institutional ethics services responding to COVID-19. The Hastings Center, 12(3), 1-12.

5. Pasricha, P., Singh, B., & Verma, P. (2018). Ethical leadership, organic organizational cultures and corporate social responsibility: An empirical study in social enterprises. Journal of Business Ethics, 151, 941-958.

6. Ingram, T. N., LaForge, R. W., Avila, R. A., Schweper Jr, C. H., & Williams, M. R. (2019). Sales management: Analysis and decision making. Routledge.

7. Small, C., & Lew, C. (2021). Mindfulness, moral reasoning and responsibility: Towards virtue in ethical decision-making. Journal of Business Ethics, 169(1), 103-117.

8. Maak, T., Pless, N. M., & Wohlgezogen, F. (2021). The fault lines of leadership: Lessons from the global Covid-19 crisis. Journal of Change Management, 21(1), 66-86.

9. Sendak, M., Elish, M. C., Gao, M., Futoma, J., Ratliff, W., Nichols, M., ... & O’Brien, C. (2020, January). “ The human body is a black box” supporting clinical decision-making with deep learning. In Proceedings of the 2020 conference on fairness, accountability, and transparency (pp. 99-109).

10. Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of clinical nursing, 27(19-20), 3446-3461.

FINANCING

The authors did not receive financing for the development of this research.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

AUTHORSHIP CONTRIBUTION

Data curation: Fazil Hasan, Axita Thakkar, Aswini Kumar Sahoo, Wamika Goyal, Kanika Seth, Sujayaraj Samuel Jayakumar, Sarika R. Sikchi.

Formal analysis: Fazil Hasan, Axita Thakkar, Aswini Kumar Sahoo, Wamika Goyal, Kanika Seth, Sujayaraj Samuel Jayakumar, Sarika R. Sikchi.

Supervision: Fazil Hasan, Axita Thakkar, Aswini Kumar Sahoo, Wamika Goyal, Kanika Seth, Sujayaraj Samuel Jayakumar, Sarika R. Sikchi.

Drafting - original draft: Fazil Hasan, Axita Thakkar, Aswini Kumar Sahoo, Wamika Goyal, Kanika Seth, Sujayaraj Samuel Jayakumar, Sarika R. Sikchi.

Writing - proofreading and editing: Fazil Hasan, Axita Thakkar, Aswini Kumar Sahoo, Wamika Goyal, Kanika Seth, Sujayaraj Samuel Jayakumar, Sarika R. Sikchi.