This book is subtitled ‘Building Ethical Healthcare Organizations’, and in this chapter I consider the implications of my study for doing just that. The discussion falls into three parts. First I temporarily set aside our concern with moral leadership and look at the emergence of healthcare organizational ethics as a bioethical ‘sub-specialty’. I consider the reasons for its rise, and review its current form and content. Next I consider current approaches to healthcare organizational ethics, questioning whether applied normative analysis is the best way to proceed. Readers of earlier chapters will not be surprised to discover that I find applied normative analysis to have yielded limited benefits, or that I suggest that a focus on expressive moral behaviours could enhance our understanding of how to build ethical organizations. I then ask what healthcare organizational ethics ought to be about. In the third and final part of the chapter I return to my analysis of moral leadership as an expressive moral behaviour. I ask how ethical expertise is learned, and how we might set about developing the moral leadership that secures ethical behaviour in organizational settings.

Building ethical organizations: learning from healthcare organizational ethics

My own starting point for thinking about healthcare organizational ethics is the question ‘what do patients, and those who care about them, normatively expect of healthcare organizations?’ A part of the answer is that they normatively expect their confidence and trust in healthcare organizations to be justified, and the components of confidence and trust were discussed in Chapter 5.