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23rd October 2019

What Are the Factors Affecting Ethical Leadership in the NHS?

Ethical leadership is concerned with treating followers fairly, setting an ethical example to others and actively managing morality. This leadership style is especially desirable within the healthcare sector where the most vulnerable are being cared for. Ethical leadership is positively related to many desirable behaviours of both the leaders and their followers. It is associated with increased leader effectiveness, job dedication, job satisfaction and organisational commitment. It is also related to increased job performance and organisational citizenship behaviour and decreased unethical behaviour of followers [1]. High-profile scandals, such as the recent care scandals which occurred within the Mid Staffordshire and Morecambe Bay NHS Trusts, have demonstrated the disastrous effects which can occur when there is a lack of ethical leadership within a healthcare organisation, putting the care of patients at risk. A high prevalence of ethical leadership in healthcare organisations is therefore vital in creating an organisation with a strong ethical culture and to ensure high quality patient care is delivered to prevent ethical scandals.

Exploring the factors which impact the prevalence of ethical leadership is crucial in understanding how this type of leadership can be effectively employed within the healthcare environment. Hannah Evans, Assistant Business Psychologist at Impact, recently conducted an interesting study which focused on exploring factors which relate to ethical leadership in NHS employees, specifically exploring how leader’s personal ethical values, the ‘true’ ethical values of NHS Trusts, resilience and moral efficacy influence ethical leadership behaviours within various NHS organisations. A brief definition of these factors are given:

  • Leader’s Ethical Values:

    A subset of values which involve a moral element and help us to determine right from wrong. Research shows that healthcare professionals tend to have high ethical values due to sharing a common goal to provide the best treatment and care for patients.

  • ‘True’ Ethical Values of NHS Trusts:

    The combination of an organisation’s informal and formal policies on ethics. In this study, the leaders had to think about the ‘true’ ethical values which underpin the culture of their NHS Trust i.e. whether they believe that the organisation prioritises ethical issues over values such as profit (these values can often be very different to those stated on organisation’s value statements).

  • Resilience:

    The ability to be flexible and adaptive in the face of challenging demands and to bounce back from the experience of negative emotions

  • Moral Efficacy:

    The ability to feel confident in implementing and sustaining a course of action in order to act morally[2]

How did the factors explored influence ethical leadership?

  • Ethical Values

    Leader’s ethical values were found to be important in determining whether ethical leadership was displayed. This was not surprising as by definition a leader must have strong ethical values in order to demonstrate ethical behaviour and be an ethical role model to others.

What Are the Factors Affecting Ethical Leadership in the NHS? 1

The perceived ‘true’ ethical values of the leader’s NHS Trust were also found to predict ethical leadership. This is because individuals’ perceptions of their organisational culture creates an organisational atmosphere known as the climate which affects how people behave in the workplace. Previous research consistently supports this finding, showing a positive relationship between an organisation’s ethical climate and ethical leadership[3].

What Are the Factors Affecting Ethical Leadership in the NHS? 2

Findings revealed that levels of ethical leadership were the highest when both the leader’s and the perceived NHS Trust’s ethical values were high, thus low levels of both the leader’s and perceived organisational levels of ethical values had a negative impact on the prevalence of ethical leadership. The organisation’s and the leader’s ethical values appeared to have a reciprocal relationship with one another. If you increase leaders’ ethical values within your organisation, you are likely to create a climate with strong ethical values. Additionally, if you foster an ethical culture, this will influence how people behave and interact with each other, encouraging them to show ethical leadership. This suggests that a multi-faceted approach which targets both leaders’ values and the culture of the organisation works best to increase ethical leadership within an organisation.

What Are the Factors Affecting Ethical Leadership in the NHS? 3

  • Resilience

    Resilience and ethical leadership were found to have a very strong positive relationship with each other. Being an ethical leader is certainly not always the easiest style of leadership, especially if others did not have similar high ethical values. Therefore, ethical leaders need to be resilient, persevere when under threat and build up a high tolerance in situations of uncertainty[4]. In sum, a resilient ethical leader will keep going and stay true to their ethical values despite how challenging this may be.

  • Moral Efficacy

    Ethical leadership and moral efficacy were found to have a strong positive correlation in the study. Moral efficacy is important in the practice of ethical behaviour; leaders can make the correct moral judgement and can even have the urge to act on the judgement, however, if they do not have moral efficacy they will not have the confidence to act on this urge. The leader may feel they cannot act in an ethical way due to a number of reasons, for example: lack of resources, support or the skills to confront others. Therefore, this lack of self-confidence results in a lower prevalence of ethical leadership.

  • Gender

    Gender was also found to be related to ethical leadership with more female leaders showing ethical leadership than male leaders. Research consistently shows that women are more likely to be ethical leaders than men [5]. This is because on average females are more likely to adopt a strict ethical stance, exhibit ethical behaviours and call out unethical behaviour of others than males [6,7,8]

HOW can I develop as an Ethical Leader?

To be an ethical leader you have to be….
1.Honest and trustworthy
2.Care about people and society
3.Set an ethical example
As the name suggests, ethical leaders must have high ethical values and be a positive role model to others. Every decision an ethical leader makes must be guided by strong ethical values and principles. There is a link between the way people treat each other at work and the outcomes for citizens that they serve. Therefore, you must “walk the talk” and set a strong ethical example to those who you lead.

HOW can my organisation increase ethical leadership?

Now we understand which factors increase the prevalence of ethical leadership in, what can we do to target them? We have identified some key interventions which will help you to increase ethical leadership in your organisation:

  • Identify your workplace values and build them into the working culture: People often believe that ethics and profitability compete with each other, however, research shows the opposite is true. Making an organisation more ethical has been found to increase organsational performance and employee commitment [9,10]. In order to create an ethical culture, you need to clearly promote ethical values in your organisation so individuals understand the behaviours and attitudes required to achieve the company’s vision and goals. Find out how Impact can help your organisation deliver positive culture change here.
  • Take a values-based approach to your recruitment: Assess candidate’s values as part of the application process to ensure you are recruiting the ‘right’ people to work in your organisation. Recruiting individuals and especially leaders with strong ethical values such as fairness, honesty and integrity will have a positive trickle-down effect on other employees and will increase the ethical climate of your organisation. When they don’t, this can lead to undesirable behaviours which may damage the organisational culture. Find out how Impact can support you in your recruitment and development practices here.
  • Deliver Authentic Leadership Training: When leaders are rooted in authenticity it creates enormous benefits for them, those they lead, and for their organisation. Authentic leaders bring a moral perspective into work; they behave in a way that is consistent with their own moral beliefs and values which promotes a positive ethical climate. Impact offer bespoke leadership workshops whereby individuals identify their current leadership style, are taught about authentic leadership theory and are trained on how to become a more authentic leader. Find out how Impact can help your organisation develop authentic leadership skills here.
  • Increase Resilience and Moral Efficacy of Leaders: Being resilient will not stop stressful times happening but having a more resilient mindset can help you cope better in stressful situations. Impact offer 1-day resilience workshops which help increase individual and organisational resilience. These workshops teach you how to increase your confidence as a leader and handle challenging situations such as moral dilemmas. We also provide 1-1 coaching to help individuals to gain confidence and flourish at work. Find out how Impact can help you, your team and your organisation reach optimal performance here.

If you would like to know more about the findings of this study or ethical leadership, please contact [email protected].

1.Ng, T. W., & Feldman, D. C. (2015). Ethical leadership: Meta-analytic evidence of criterion-related and incremental validity. Journal of Applied Psychology, 100(3), 948.
2.Hannah, S. T., & Avolio, B. J. (2010). Moral potency: Building the capacity for character-based leadership. Consulting Psychology Journal: Practice and Research, 62(4), 291.
3.Schminke, M., Ambrose, M. L., & Neubaum, D. O. (2005). The effect of leader moral development on ethical climate and employee attitudes. Organizational behavior and human decision processes, 97(2), 135-151.
4.Southwick, F. S., Martini, B. L., Charney, D. S., & Southwick, S. M. (2017). Leadership and resilience. In Leadership today (pp. 315-333). Springer, Cham.
5.Smith, W. J., Wokutch, R. E., Harrington, K. V., & Dennis, B. S. (2001). An examination of the influence of diversity and stakeholder role on corporate social orientation. Business & Society, 40(3), 266-294.
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8.Vermeir, I., & Van Kenhove, P. (2008). Gender differences in double standards. Journal of Business Ethics, 81(2), 281-295.
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10.Frith, L. (2013). The NHS and market forces in healthcare: the need for organisational ethics. Journal of medical ethics, 39(1), 17-21.