Strategic Planning

5 Potential Ethical Dilemmas for Healthcare Organization Lobbying

November 27, 2017 11:42 am

Ethical lobbying means remembering that the organization has obligations beyond leaders’ desires.

On the surface, lobbying and ethics may not seem to be cozy neighbors. Yet, lobbying in and of itself does not violate any ethical standards. It is the target of lobbying and how the lobbying is carried out that may violate some ethical standards.

Healthcare Spending on Lobbying

A significant amount of money is spent on lobbying in health care to influence legislation that can have an impact on regulation, payment, coverage, incentives, and penalties. The top five health plans spent $6.2 million on lobbying in the first quarter of 2017 alone (Livingston, S., “Health insurers spend big money on lobbying in early 2017,” Modern Healthcare, April 21, 2017). Spending on lobbying isn’t limited to health plans but spans the entire health sector. The Center for Responsive Politics found that the health sector was the sixth largest source of political contributions in the 2015-16 election, accounting for more than $268 million (Alonso-Zaldivar, R., “Lobbying by Hospitals, Doctors, Slows GOP Health Care Drive,” U.S. News & World Report, May 1, 2017).

An Ethical Decision-Making Model for Lobbying

No single ethical theory can fully capture the complexity and impact of lobbying on multiple stakeholders. This decision-making model identifies five possible ethical dilemmas and makes three recommendations for more responsible lobbying.

Placing organizational interests above all other interests. If boards of trustees and top management teams place their own interests above all other stakeholders, that is clearly an ethical violation. Furthermore, if boards and top management teams place the interests of their organizations above community needs (in the case of not-for-profit entities) and shareholders (in the case of for-profit entities), they are clearly making ethical violations.

Lack of focus on the common good. The common good is typically defined as that which is best for all stakeholders within a defined geographic area. Examples of the common good are ensuring that food deserts do not exist and that there are safe places for residents to engage in physical activities. Not focusing on the common good is an ethical violation, particularly for not-for-profit entities.

Failure to disclose lobbying efforts to stakeholders Failure to be transparent about the targets of lobbying efforts and the funding associated with lobbying represents ethical dilemmas. All stakeholders deserve to know how resources are being spent.

Diverting organizational resources away from organizational vision and mission. Lobbying costs money, time, talent, and energy. Thus, engaging in lobbying represents an opportunity cost. Resources diverted away from organizations’ vision and mission statements toward lobbying efforts that are not aligned with vision and mission represent ethical dilemmas.

Organizational vision and mission should be filters for lobbying agendas. Lobbying agendas that are not directly related to those visions and missions or that are tangential to vision and mission agendas are ethical dilemmas. Filtering decisions are subject to cognitive biases such as rationalizations; board members and management leaders should attempt to identify such cognitive biases in their decision-making and that of others in the organization.

Affiliating with associations and other organizations that are not aligned with organizational vision and mission. Some organizations do not lobby on their own accord because they are too small or lack lobbying infrastructures. However, those organizations may knowingly or unknowingly engage in lobbying as part of state hospital associations or national healthcare associations.

Accordingly, it is critical to determine whether annual dues have automatic line items that cover lobbying or whether there are special dues for lobbying. Hospital leaders should make it known whether organizations support all or some of the lobbying agendas of these associations.

5 Questions to Ask to Identify Ethical Dilemmas

These five ethical dilemmas represent the bases of ethical decision-making models. Hospital leaders must be able to recognize these possible ethical dilemmas and address them. To do so, they should ask the following five questions before making decisions regarding lobbying:

  • Are we overemphasizing what is beneficial for the organization and underemphasizing our role and responsibility in promoting the common good?
  • Are we placing the interests of the organization above other interests, such as the patient or the community?
  • Are we fully and proactively transparent about our lobbying agenda, efforts, and funding?
  • Are we diverting organizational resources from our vision and mission to lobbying?
  • Are our lobbying efforts aligned with the hospital’s vision and mission?

Case for Responsible Lobbying

A good starting place to engage in responsible lobbying is for hospital leaders to examine relevant documents, such as hospitals’ vision and mission statements, organizational lobbying policies, and professional association codes of ethics. Then they should consider best practices, such as the following:

  • Establish links between government affairs offices and the boards of trustees, including connections via audit committees and/or social responsibility committees.
  • Ensure that heads of government affairs report directly to CEOs.
  • Engage in public interest lobbying that is closely aligned with the common good.
  • Align lobbying efforts with findings from hospital community health needs assessments.
  • Promote participatory democracy among all stakeholders, including those with whom hospital leaders may disagree with ideologically or compete against in their healthcare markets.

Beyond Organizations

Influencing politicians, public policy, and future legislation and regulations is constitutionally protected, and its practice is an indicator of strong, vibrant democracies. Healthcare leaders who embrace corporate social responsibility and patient centricity, are obligated to represent interests beyond their organizations, boards, and top management teams. Furthermore, they are obligated to be transparent with their lobbying efforts and align them with their organizations’ vision and mission.


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