Strengthening Hospital Management Through Ethical Leadership and Professional Integrity
Abstract
Ethical leadership and professional integrity have become increasingly important in hospital management due to the complex responsibilities associated with healthcare delivery, professional accountability, organisational fairness, and patient care. This article examines the role of ethical leadership and professional integrity in strengthening hospital management, with particular attention to ethical competence, organisational justice, ethical climate, moral courage, and healthcare quality. The analysis identifies several challenges affecting hospital management, including inconsistent ethical leadership, difficulties in maintaining professional integrity, weak ethical climates, perceptions of organisational injustice, and ethical pressures that may contribute to moral distress among healthcare professionals. The article further discusses the importance of leadership consistency, managerial accountability, professional ethical competence, fairness, and supportive organisational conditions in addressing these challenges. Strategic recommendations emphasise the establishment of clear ethical leadership practices, continuous ethical development, stronger organisational justice, supportive ethical climates, and the integration of ethical management with healthcare quality improvement. Overall, the article demonstrates that effective hospital management requires ethical principles to be embedded within leadership behaviour, professional practice, organisational systems, and quality management. Strengthening these dimensions can enhance professional responsibility, employee trust, ethical decision making, organisational effectiveness, and the quality of healthcare services.
Full text article
References
Asgari, S., Shafipour, V., Taraghi, Z., & Yazdani-Charati, J. (2019). Relationship between moral distress and ethical climate with job satisfaction in nurses. Nursing Ethics, 26(2), 346–356. https://doi.org/10.1177/0969733017712083 DOI: https://doi.org/10.1177/0969733017712083
Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, F. (2018). Ethical leadership outcomes in nursing: A qualitative study. Nursing Ethics, 25(8), 1051–1063. DOI: https://doi.org/10.1177/0969733016687157
Bayat, M., Shahriari, M., & Keshvari, M. (2019). The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian Social Security Organization. Journal of Medical Ethics and History of Medicine, 12, 8. https://doi.org/10.18502/jmehm.v12i8.1339 DOI: https://doi.org/10.18502/jmehm.v12i8.1339
Bayer, N., & Şahin, İ. (2020). The relationship between perceived ethical leadership, organizational justice, and turnover intention among general hospital nurses. International Journal of Health Management and Tourism, 5(2), 123–144. https://doi.org/10.31201/ijhmt.788675 DOI: https://doi.org/10.31201/ijhmt.788675
Brown, M. E., Treviño, L. K., & Harrison, D. A. (2005). Ethical leadership: A social learning perspective for construct development and testing. Organizational Behavior and Human Decision Processes, 97(2), 117–134. https://doi.org/10.1016/j.obhdp.2005.03.002 DOI: https://doi.org/10.1016/j.obhdp.2005.03.002
Colquitt, J. A., Conlon, D. E., Wesson, M. J., Porter, C. O. L. H., & Ng, K. Y. (2001). Justice at the millennium: A meta analytic review of 25 years of organizational justice research. Journal of Applied Psychology, 86(3), 425–445. https://doi.org/10.1037/0021-9010.86.3.425 DOI: https://doi.org/10.1037/0021-9010.86.3.425
Denier, Y., Dhaene, L., & Gastmans, C. (2010). “You can give them wings to fly”: A qualitative study on values based leadership in health care. BMC Medical Ethics, 11, 7. https://doi.org/10.1186/1472-6939-11-7 DOI: https://doi.org/10.1186/1472-6939-11-7
Epstein, E. G., Whitehead, P. B., Prompahakul, C., Thacker, L. R., & Hamric, A. B. (2019). Enhancing understanding of moral distress: The measure of moral distress for health care professionals. AJOB Empirical Bioethics, 10(2), 113–124. https://doi.org/10.1080/23294515.2019.1586008 DOI: https://doi.org/10.1080/23294515.2019.1586008
Gallagher, A. (2010). Moral distress and moral courage in everyday nursing practice. Online Journal of Issues in Nursing, 16(2). DOI: https://doi.org/10.3912/OJIN.Vol16No02PPT03
Hamric, A. B., Borchers, C. T., & Epstein, E. G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 3(2), 1–9. https://doi.org/10.1080/21507716.2011.652337 DOI: https://doi.org/10.1080/21507716.2011.652337
Horton, K., Tschudin, V., & Forget, A. (2007). The value of nursing: A literature review. Nursing Ethics, 14(6), 716–740. https://doi.org/10.1177/0969733007082112 DOI: https://doi.org/10.1177/0969733007082112
Jeon, Y., Kim, Y. H., & Son, H. M. (2019). Ethical climate and moral distress among neonatal intensive care unit RNs. Global Health and Nursing, 9(1), 28–37. https://doi.org/10.35144/ghn.2019.9.1.28 DOI: https://doi.org/10.35144/ghn.2019.9.1.28
Kalshoven, K., Den Hartog, D. N., & De Hoogh, A. H. B. (2011). Ethical leadership at work questionnaire: Development and validation of a multidimensional measure. The Leadership Quarterly, 22(1), 51–69. https://doi.org/10.1016/j.leaqua.2010.12.007 DOI: https://doi.org/10.1016/j.leaqua.2010.12.007
Kulju, K., Stolt, M., Suhonen, R., & Leino-Kilpi, H. (2016). Ethical competence: A concept analysis. Nursing Ethics, 23(4), 401–412. https://doi.org/10.1177/0969733014567025 DOI: https://doi.org/10.1177/0969733014567025
Lachman, V. D., Murray, J. S., Iseminger, K., & Ganske, K. M. (2012). Doing the right thing: Pathways to moral courage. American Nurse Today, 7(5), 24–29.
Lechasseur, K., Caux, C., Dollé, S., & Legault, A. (2018). Ethical competence: An integrative review. Nursing Ethics, 25(6), 694–706. https://doi.org/10.1177/0969733016667773 DOI: https://doi.org/10.1177/0969733016667773
Makaroff, K. S., Storch, J., Pauly, B., & Newton, L. (2014). Searching for ethical leadership in nursing. Nursing Ethics, 21(6), 642–658. https://doi.org/10.1177/0969733013513213 DOI: https://doi.org/10.1177/0969733013513213
Mayer, D. M., Kuenzi, M., Greenbaum, R., Bardes, M., & Salvador, R. B. (2009). How low does ethical leadership flow? Test of a trickle down model. Organizational Behavior and Human Decision Processes, 108(1), 1–13. https://doi.org/10.1016/j.obhdp.2008.04.002 DOI: https://doi.org/10.1016/j.obhdp.2008.04.002
Monroe, H. A. (2019). Nurses’ professional values: Influences of experience and ethics education. Journal of Clinical Nursing, 28(9–10), 2009–2019. https://doi.org/10.1111/jocn.14806 DOI: https://doi.org/10.1111/jocn.14806
Numminen, O., Katajisto, J., & Leino-Kilpi, H. (2019). Development and validation of Nurses’ Moral Courage Scale. Nursing Ethics, 26(7–8), 2438–2455. https://doi.org/10.1177/0969733018791325 DOI: https://doi.org/10.1177/0969733018791325
Numminen, O., Leino-Kilpi, H., Isoaho, H., & Meretoja, R. (2015). Ethical climate and nurse competence: Newly graduated nurses’ perceptions. Nursing Ethics, 22(8), 845–859. https://doi.org/10.1177/0969733014557137 DOI: https://doi.org/10.1177/0969733014557137
Numminen, O., van der Arend, A., & Leino-Kilpi, H. (2010). Nurses’ codes of ethics in practice and education: A review of the literature. Scandinavian Journal of Caring Sciences, 24(1), 156–166.
Olson, L. L. (1998). Hospital nurses’ perceptions of the ethical climate of their work setting. Image: The Journal of Nursing Scholarship, 30(4), 345–349. https://doi.org/10.1111/j.1547-5069.1998.tb01331.x DOI: https://doi.org/10.1111/j.1547-5069.1998.tb01331.x
Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009). Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethics, 16(5), 561–573. https://doi.org/10.1177/0969733009106649 DOI: https://doi.org/10.1177/0969733009106649
Poorchangizi, B., Farokhzadian, J., Abbaszadeh, A., Mirzaee, M., & Borhani, F. (2019). The importance of professional values from nursing students’ perspective. BMC Nursing, 18, 26. https://doi.org/10.1186/s12912-019-0351-1 DOI: https://doi.org/10.1186/s12912-019-0351-1
Schluter, J., Winch, S., Holzhauser, K., & Henderson, A. (2008). Nurses’ moral sensitivity and hospital ethical climate: A literature review. Nursing Ethics, 15(3), 304–321. DOI: https://doi.org/10.1177/0969733007088357
Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5(4), 73. https://doi.org/10.3390/healthcare5040073 DOI: https://doi.org/10.3390/healthcare5040073
Silén, M., Svantesson, M., Kjellström, S., Sidenvall, B., & Christensson, L. (2011). Moral distress and ethical climate in a Swedish nursing context: Perceptions and instrument usability. Journal of Clinical Nursing, 20(23–24), 3483–3493. DOI: https://doi.org/10.1111/j.1365-2702.2011.03753.x
Storch, J., Schick Makaroff, K., Pauly, B., & Newton, L. (2013). Take me to my leader: The importance of ethical leadership among formal nurse leaders. Nursing Ethics, 20(2), 150–157. DOI: https://doi.org/10.1177/0969733012474291
Suhonen, R., Stolt, M., Virtanen, H., & Leino-Kilpi, H. (2011). Organizational ethics: A literature review. Nursing Ethics, 18(3), 285–303. https://doi.org/10.1177/0969733011401123 DOI: https://doi.org/10.1177/0969733011401123
Treviño, L. K., Brown, M., & Hartman, L. P. (2003). A qualitative investigation of perceived executive ethical leadership: Perceptions from inside and outside the executive suite. Human Relations, 56(1), 5–37. https://doi.org/10.1177/0018726703056001448 DOI: https://doi.org/10.1177/0018726703056001448
Wong, C. A., & Cummings, G. G. (2007). The relationship between nursing leadership and patient outcomes: A systematic review. Journal of Nursing Management, 15(5), 508–521. https://doi.org/10.1111/j.1365-2834.2007.00723.x DOI: https://doi.org/10.1111/j.1365-2834.2007.00723.x
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709–724. https://doi.org/10.1111/jonm.12116 DOI: https://doi.org/10.1111/jonm.12116
Yukl, G., Mahsud, R., Hassan, S., & Prussia, G. E. (2013). An improved measure of ethical leadership. Journal of Leadership & Organizational Studies, 20(1), 38–48. https://doi.org/10.1177/1548051811429352 DOI: https://doi.org/10.1177/1548051811429352
Yusof, M. S., Salleh, M. N., & Zahari, F. M. (2020). The Relationship between Information Technology Capability and New Product Development Success: A Conceptual Framework. International Journal of Business and Technology Management, 2(1), 98-112.
Yusof, M. S., Salleh, M. N., & Zahari, F. M. (2020). The Relationship between NPD Process and NPD Strategy toward NPD Success in Malaysian Automotive Industry. Asian Journal of Research in Business and Management, 2(1), 11-26.
Zarei, A., Arab, M., Froushani, A. R., Rashidian, A., & Ghazi Tabatabaei, S. M. (2012). Service quality of private hospitals: The Iranian patients’ perspective. BMC Health Services Research, 12, 31. https://doi.org/10.1186/1472-6963-12-31 DOI: https://doi.org/10.1186/1472-6963-12-31
Authors
Copyright (c) 2025 Muhammad Omar
This work is licensed under a Creative Commons Attribution 4.0 International License.