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Building an Ethical Organizational Culture

Nelson, William A. PhD; Taylor, Emily MPH; Walsh, Thom PhD, MS, MSPT

doi: 10.1097/HCM.0000000000000008

The success of a health care institution—as defined by delivering high-quality, high-value care, positive patient outcomes, and financial solvency—is inextricably tied to the culture within that organization. The ability to achieve and sustain alignment between its mission, values, and everyday practices defines a positive organizational culture. An institution that has a diminished organizational culture, reflected in the failure to consistently align management and clinical decisions and practices with its mission and values, will struggle. The presence of misalignment or of ethics gaps affects the quality of care being delivered, the morale of the staff, and the organization’s image in the community. Transforming an organizational culture will provide a foundation for success and a framework for daily ethics-grounded operations in any organization. However, building an ethics-grounded organization is a challenging process requiring strong organization leadership and planning. Using a case study, the authors provide a multiyear, continuous step-by-step strategy consisting of identifying ethics culture gaps, establishing an ethics taskforce, clarifying and prioritizing the problems, developing strategy for change, implementing the strategy, and evaluating outcomes. This process will assist organizations in aligning its actions with its mission and values, to find success on all fronts.

Author Affiliations: Dartmouth Institute for Health Policy and Clinical Practice (Drs Nelson, Taylor, and Walsh), Dartmouth Center for Health Care Delivery Science (Drs Nelson and Walsh), Community and Family Medicine (Dr Nelson), and Master of Health Care Delivery Science Program (Dr Walsh), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

The authors have no conflicts of interest.

Correspondence: William A. Nelson, PhD, Dartmouth Institute for Health Policy and Clinical Practice, 30 Lafayette St, Lebanon, NH 03766 (

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins