Health services managers have a multi-faceted role in preventing, identifying, and solving ethical problems. The importance of a personal ethic has been discussed. As a resource allocator, the health services manager is obligated to provide the support needed by the organization and its staff so that they are educated about ethics issues, have learned a methodology for addressing the ethical dimensions of management problems, and have the systems and procedures to support these efforts. Education about the HSO's values is an essential first step toward these goals; celebrating heroes of the culture and providing case examples are very useful. In addition, the manager is the driving force in ascertaining that the policies and procedures of the HSO address all of the areas where it is likely ethical problems will arise. For example, a comprehensive policy about accepting gratuities that is communicated to staff will go far to prevent conflicts of interest.
Ethics committees are required by institutional and programmatic accreditors and, thus, are ubiquitous in HSOs. Most commonly these committees are involved in clinical ethical issues and in this regard are charged with clinical case consultation, developing and reviewing clinical policies, and educating staff. Clinical staff tend to predominate on ethics committees, although social workers, clerics, and managers usually participate. Ethics committees are less likely to be involved in management ethics problems. Managers seem reluctant to allow ethics committee involvement in reviewing ethical implications of macro-resource allocation, for example. Support for ethics committees by management should include a modest budget, some staff assistance, and the prestige of recognizing their importance to the organization. Ethics committees commonly use ethicists as consultants.
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