American College of Healthcare Executives

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Approved by the Board of Governors Dec. 8, 2025

Statement of the Issue

Healthcare organizations are navigating a rapidly evolving and increasingly demanding environment. Persistent financial pressures, the integration of artificial intelligence, workforce burnout, and rising expectations around care access, equity and transparency are reshaping the landscape.

Organizational resilience is further strained by rising public and payer expectations, consolidations and mergers, patient safety and quality improvement issues, workforce protection and safety, recognition of social disparities of health and their negative effect on health of the population, the legitimate demand of the community for enhanced involvement in priority setting, and healthcare reform. These converging dynamics are intensifying ethical challenges, requiring healthcare organizations to navigate complex decisions with greater accountability, empathy and foresight.

Healthcare organizations must be led and managed with integrity and consistent adherence to organizational values, professional and ethical standards. This means moving beyond a compliance-based culture that focuses on fear of punishment to one that cultivates values-driven work in which ethical behavior emerges from a shared commitment to the organization’s mission and values. Doing so creates an environment where doing the right thing becomes the natural and expected choice for all.

The executive, in partnership with the governing body and clinical staff, must act with other responsible parties, such as ethics committees, to serve as a role model, fostering and supporting a culture that not only provides high-quality, value-driven healthcare but promotes the ethical behavior and practices of individuals throughout the organization.

Recognizing the significance of ethics to the organization's mission and fulfillment of its responsibilities, healthcare executives must demonstrate the importance of ethics in their own actions and seek various ways to integrate ethical practices and reflection into the organization's culture. To create an ethical culture, healthcare executives should:

• Support the development and implementation of ethical standards of behavior, including ethical clinical, leadership, management, research and quality-improvement practices.
• Ensure effective and comprehensive ethics resources, including an ethics committee, exist and are available to develop, propagate and clarify such standards of behavior when there is ethical uncertainty.
• Support and implement a systematic and organization wide approach to ethics training (including the consequences of social disparities in healthcare) and corporate compliance.
• Exemplify an inclusive environment as a core organizational value in creating an ethical culture.

It is essential that leaders understand both the formal and informal structures that are at play in an ethical culture. Healthcare executives should systematically measure both the formal components of ethical culture—including policies, codes, training programs, performance management systems and organizational structures—and the critically important informal elements such as role models, organizational norms, shared stories, and day-to-day language and behaviors. Research demonstrates that while formal systems provide necessary infrastructure, the informal cultural elements are often more powerful predictors of actual ethical behavior throughout the organization.

Furthermore, healthcare executives should recognize that ethical decision-making is influenced by complex psychological factors including cognitive biases, moral disengagement, diffusion of responsibility and social conformity pressures. This requires intentional culture-building strategies that address these human tendencies through psychological safety, clear moral frameworks and systems that support individuals in making ethical choices even under stress or competing pressures.

The ability of an organization to achieve its full potential as an ethically aligned organization will remain dependent upon the motivation, knowledge, skills and practices of each individual within the organization, including all front-line workers and support staff. Thus, the executive has an obligation to accomplish the organization's mission in a manner that respects the values of individuals and maximizes their contributions.

Policy Position

The American College of Healthcare Executives believes all healthcare executives have a professional obligation to create an ethical culture. To this end, healthcare executives should lead these efforts by:

• Demonstrating and modeling the importance of and commitment to ethics through decisions, practices and behaviors.
• Promulgating an organizational code of ethics that includes ethical standards of behavior and guidelines.
• Reviewing the principles and ideals expressed in vision, mission and value statements, personnel policies, annual reports, orientation materials and other documents to ensure congruence.
• Supporting policies and behaviors that reflect these ethics is essential to achieving the organization's mission.
• Using regular communications to help foster an understanding of the organization's commitment to ethics.
• Seeking input from the community and interested parties.
• Collaborating with other community resources to make progress on community needs.
• Communicating expectations that behaviors and actions are based on the organization's code of ethics, values and ethical standards of practice. Such expectations also should be included in orientations and position descriptions where relevant.
• Ensuring individuals throughout the organization are respected and expected to behave in an ethical manner.
• Fostering an environment in which the free expression of ethical concerns is encouraged and supported without retribution.
• Ensuring effective ethics resources—such as an ethics committee—are available for discussing, researching, and addressing clinical, organizational and ethical concerns.
• Establishing a mechanism that safeguards individuals who wish to raise ethical concerns.
• Seeking to ensure that individuals are free from all harassment, coercion and discrimination.
• Providing an effective and timely process to facilitate dispute resolution.
• Using each individual's knowledge, skills and abilities appropriately.
• Ensuring a safe work environment exists and an escalation process is in place.
• Establishing governance processes to evaluate the ethical implications of emerging technologies, including artificial intelligence, digital health platforms and data use practices.
• Promoting initiatives that support workforce well-being, reduce moral distress, and foster moral resilience through adequate staffing, psychological safety and meaningful support systems.
• Ensuring transparency in decision-making and reporting, particularly on issues that affect community trust, access to care and resource allocation.
• Embedding ethical considerations into strategic planning, innovation, mergers and business development to ensure alignment with organizational values and social responsibility.

These responsibilities can best be implemented in an environment in which each individual within the organization is encouraged and supported when adhering to the highest standards of ethics. This should be done with attention to the organization's values, code of ethics and appropriate professional codes, particularly those that stress the moral character and behavior of the executive and the organization itself.

To ensure the creation of an ethically grounded culture, leaders should regularly assess their organization's culture using a variety of practices, including employee surveys, informal job shadowing and focus groups. Executives in collaboration with clinical and administrative leaders need to recognize any barriers to maintaining an ethical culture. It is the responsibility of healthcare leaders and staff to take immediate and definite action when addressing ethical barriers. The ethical foundation of the organization depends on whether the leadership, and all associated individuals, are fulfilling its mission and values.

Policy created: March 1992
Policy updated: December 2025