Integrity is not a raincoat you put on when the business climate indicates you should. Integrity creates a condition that guides your life—not just a set of protocols. Courageous leaders don’t acquire their moral gyroscopes solely by learning general rules. They also develop them—those deliberative, emotional, and social skills that enable them to put their understanding of integrity into practice in suitable ways—through practice. Similarly, these leaders understand that they can’t “teach” ethics to others by requiring their signatures on a statement. Instead, they exemplify and model ethics in their personal and professional lives, and experience teaches them how to reapply their ethics to tough decisions as those tough calls emerge.

According to medical ethicist, Dr. Mary Pat Henman, leaders in healthcare organizations will face these dilemmas in 2024:

1. Resource Allocation: Healthcare leaders must decide how to allocate limited resources such as medical equipment, personnel, and funding. Ethical questions arise when they must prioritize certain treatments or services over others, potentially leading to disparities in care.
2. Shortage of Qualified Staff: The leading dilemma in resource allocation concerns shortages, especially the dearth of nurses. When allocating resources for medical equipment and ICU beds, the first question needs to be, “Are we paying our nurses enough to keep them in our doors so there’s someone to use the equipment and take care of the patients in the beds?”
3. Ethical Marketing and Billing Practices: Leaders must ensure their healthcare organizations engage in ethical marketing practices and transparent billing to avoid exploiting patients and the healthcare system. When was the last time your organization had an internal audit?
4. Patient Privacy and Data Security: Protecting patient privacy and ensuring the security of their medical information is a significant ethical concern, especially in the digital age. Leaders must balance the need for data sharing and accessibility with the obligation to safeguard sensitive patient data. As healthcare increasingly relies on technology and telemedicine, leaders must also consider ethical issues related to patient-provider relationships, privacy, and accessibility in virtual healthcare settings.
5. Equity and Access: Healthcare leaders face ethical questions related to ensuring that all individuals, regardless of their socioeconomic status, race, or other factors, have equitable access to quality healthcare services.
6. End-of-Life Care: Decisions about end-of-life care, including decisions to withhold or withdraw life-sustaining treatment, can be ethically complex. Leaders must ensure that appropriate protocols and ethical frameworks are in place to guide these decisions.
7. Healthcare Rationing: In times of resource scarcity or public health crises, leaders will need to make difficult decisions about healthcare rationing, including who receives care when resources are insufficient. Rationing will include but not be limited to organ transplants, ICU beds, and ventilators.
8. Environmental Responsibility: Ethical considerations related to environmental sustainability and the healthcare industry’s environmental footprint are gaining importance. Leaders must make decisions that balance healthcare delivery with environmental responsibility, medical waste, and recycling.

In my more than 40 years of consulting, I have found, without question, sound judgment ranks as the single most significant differentiator between those who can make successful ethical decisions and those who cannot. While fortitude addresses a willingness to make ethical calls, judgment involves the ability to make them. Specifically, the most crucial forecaster of executive success involves advanced critical thinking skills—the specific cognitive abilities that equip us to solve problems, make effective decisions, and keep a global perspective. These abilities equip a leader to anticipate future consequences, to get to the core of complicated issues, and to zero in on the essential few while putting aside the trivial many.

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