Moral Climate and Culture
When the moral climate in an organisation is the cause of moral distress, it could seem like ‘victim blaming’ to suggest that a ‘resilience bundle’ should be provided to employees or volunteers to help them to cope. As with any risk analysis, unless you identify and address the root cause of a problem, it will recur.
Non-profit directors and managers share responsibility for creating and maintaining a moral (ethical) climate and culture, which supports staff and volunteers in a manner that boosts morale rather than eroding it.
Apart from compliance with work health and safety obligations, non-profit boards should also consider their ’employer of choice’ status, and the organisation’s cultural profile – sometimes called ‘reputation’. Having the right policies, expectations, behaviour standards, and resource levels helps, but engaging people in a manner which respects their need to express their moral values (i.e. their moral agency) is also necessary.
Moral distress risk analysis
As with any risk analysis, it is important to understand contributing factors, causes and triggers for a moral distress ‘event’.
Carina Fourie PhD (Who is experiencing what kind of moral distress? Distinctions for moving from a narrow to a broad definition of Moral Distress, AMA Journal of Ethics, June 2017, Vol 19, No.6, 578-584) has argued that moral distress may be experienced due to a range of factors. She suggests that it is helpful to distinguish between these causes, which may exist separately or in combination, depending on the circumstances in each case.
‘Constraint distress’ could arise due to such internal or external factors as under-staffing, insufficient budget, unmet demand levels, lack of equipment, or policy restrictions which prevent delivery of the ‘right’ care or service.
‘Uncertainty distress’ could eventuate where inadequate directions, supervision or training are provided.
‘Conflict distress’ can happen when two morally valid options are available, but only one can be employed. It might also arise where a more senior person gives a directive which the employee or volunteer sees as conflicting with their values and moral code.
Moral Distress Levels, Factors, and Agency
Peter and Liaschenko (2004) define moral agency and its relationship with moral distress as follows:
“Moral agency is defined as the capacity to recognise, deliberate/reflect on, and act on moral responsibilities. In order to experience moral distress an agent is required to possess at least some autonomy in recognising and reflecting upon moral concerns. Yet on the other hand, an agent’s autonomy must be at least somewhat constrained in acting upon the very moral responsibilities s/he understands him/herself to have. This apparently irresolvable contradiction is moral distress.”
Moral distress is also cumulative, and some authors have described this as a crescendo effect, in which the stress response grows as each instance or trigger event occurs, so that more serious and longer-term psychological damage is experienced. One event might produce extreme discomfort, but a series of events, and the anticipation that more will follow, can lead to PTSD, nervous breakdown, and other trauma, up to and including self-harm.
Moral Distress Prevention and Response
Certainly, for many suffering this level of moral distress, leaving their role seems to be the only option. When people leave, the organisation potentially suffers as well as the employee. The cost of selecting and inducting a replacement, and the lower productivity they are likely to offer while onboarding, are secondary harms resulting from the moral distress experienced by the staff member or volunteer.
For those who stay, disengagement from their work (presenteeism), absenteeism, depression, low productivity, compassion fatigue, or worse, deliberate sabotage of processes or systems, are just some of the possible consequences. See Part 1 of this series of posts for a chart illustrating the continuum of moral distress and injury.
The header image above illustrates some of the elements of the organisation’s moral climate likely to be considered by directors attending to their ‘duty of care’. Based on Victor and Cullen’s (1988) conception of ‘The organisational bases of ethical work climates’, this schematic uses three ethical criteria (benevolence, principle, and egoism, or self-interest) as lenses through which to consider three levels of focus (individual, organisational, and societal).
The governance mechanisms involved in preventing moral distress and promoting a positive ethical climate include your:
- Strategy – especially the section on values, but also collectively how reasonable to scale and scope of your goals might be given your resource capacity
- Code of conduct
- Governance standards regarding conflict of interest, gifts and hospitality, information privacy, information security, third party relationships, etc.
- Policies on matters such as human rights, modern slavery, equal opportunity, discrimination, bullying and harassment, performance management, complaints and grievances, sustainability, etc.
- Risk management framework and plan – especially control measures designed to prevent moral distress
- Stakeholder relations and service delivery standards
To the extent that governance and management systems and processes effectively promote a positive moral climate, directors and managers will themselves avoid experiencing moral distress.
Moral Gov Part 1