Trust in Healthcare and the Dilemma of Shared Leadership Roles

On the next HCLDR Tweetchat on Tuesday July 13th at 8:30pm ET (for your local time click here) we welcome special guest host David Campbell, PhD @david_ethics, Ethicist for Kingston Health Sciences Centre. He will be leading us in an exploration of how shared corporate leadership roles can pose ethical challenges in the form of potential conflicts of interest.

Below, Campbell has provided interesting background information on this topic. He talks about the need for trust and how important it is right now in healthcare and how shared leadership roles can erode that trust.

Shout out to the Canadian College of Healthcare Leaders (@CCHL_CCLS) for helping to make this next chat possible.


If there is one lesson the COVID-19 pandemic has taught us, it is the importance of trust. The public needs to trust the healthcare system and believe that it is will be there for them when they need it the most. The public needs to trust that those who work in healthcare are 100 percent committed to their duty to the public and that those who are making difficult decisions involving scarce resources are wholly committed to their patients, staff and community partners. Healthcare workers who have done so much to respond to this emergency and provide care for the most vulnerable need to know that their leaders are supporting them, keeping them safe, and totally committed to their organizations.

This is why conflicts of interest are so ethically damaging. They destroy our sense of trust in the healthcare system. For healthcare leaders, it is essential that their colleagues, staff, patients and clients, and community partners trust them. The fiduciary nature of healthcare, along with the largely self-regulated nature of healthcare professionals requires high ethical standards of behaviour. When healthcare professionals fail to live up to these expectations of ethical behaviour, the public’s trust can be eroded irrevocably. Conflicts of interest are especially damaging as the public starts to question the motives of healthcare professionals and institutions and whether they are working for the common good or their own self-interest.

The vast majority of literature on conflicts of interest in healthcare focuses on conflicts of interest among healthcare providers. Yet very little research has been conducted on conflicts of interest among healthcare leaders, in particular healthcare leaders who share roles within different healthcare organizations. As so much attention is paid to financial conflicts of interests and the tensions between personal self-interest and professional duties, the ethical challenges of non-financial conflicts of interests which can stem from divided professional and institutional duties and loyalties has been unexplored. Yet for healthcare leaders, it is these ethical challenges of divided loyalties which can be especially ethically challenging as they are not based on unethical behaviour or lack of professionalism or respecting professional boundaries, but instead on the lack clear boundaries themselves within the particular role and the impossible demands of providing shared leadership roles among different organizations.

Even if the roles and expectations of a healthcare leader who is sharing leadership roles for different healthcare organizations is clearly laid out, no one can clone themselves and the ethical dilemma of how to split their time and energy between different organizations and roles is bound to place even the most conscientious healthcare leader in a difficult position. Different organizations have different values, priorities, and cultures, therefore it can be very difficult to “change hats” between roles and organizations.

While there might be no clear and obvious conflicts of interest resulting from shared roles between different healthcare organizations, there is the appearance of a conflict of interest which can damage the trust. Colleagues and staff might feel that the healthcare leader is “not one of us” and not fully devoted to their organization if she is sharing a leadership role with another organization. This lack of trust can be especially amplified if the healthcare leader joins a new organization and makes comparisons to her other organization and implement changes which

The standard method of responding to possible conflicts of interests is through full disclosure. Yet full disclosure should not be seen as a perfect solution as it can be seen as a formality which pays lip service to the acknowledgment of a potential conflict of interest without actually doing anything about it.

While acknowledging bias and possible conflicts of interest is an essential element of ethical leadership, ultimately, the best way to avoid any real or perceived conflicts of interest is to not place healthcare leaders in the impossible role of having divided loyalties in the first place. If healthcare organizations continue to experiment with creating shared leadership roles, they should choose leaders who have no history with either organization so that they can be seen as being unbiased. Healthcare leaders have a hard enough time responding to multiple competing demands from one organization. It is not fair to place leaders in situations of having divided loyalties and possible conflicts of interest.

Join the next HCLDR Tweetchat on Tuesday July 13th at 8:30pm ET (for your local time click here) when we will discuss the following questions:

  • T1 Healthcare organizations are sharing senior leadership roles with partners which can create a conflict of interest. Does the type of organization matter? Example: hospital + charity? hospital + health IT company? practice + hospital?
  • T2 If hiring for a shared role, should the leader who is hired have a history with one or both organizations or should that person be external to both?
  • T3 Disclosing a conflict of interest may not be enough to mitigate risk for these leaders.  What solutions can help to create a more transparent environment for leaders when it comes to actual/potential conflicts?
  • T4 What have health leaders in your communities done (other than sharing senior leadership roles) to respond to multiple competing demands?

To find out more about this topic, check out the March edition of the HFMA Journal: Serving two masters? Shared corporate leadership and conflict of interest

Here is the abstract:

In order to reduce costs and inefficiencies, break down silos, and create smoother transitions of care, health organizations are starting to share senior leadership roles with their regional partners. While these are laudable goals, having individuals share responsibilities among two or more organizations can pose significant ethical challenges such as divided loyalties and create a conflict of interest. The risks of conflict of interest among senior health leaders who share roles within multiple health organizations have largely been ignored. This article will explore the ethical challenges of this issue and offer suggestions on how senior health leaders who are put in this uncomfortable position can identify and respond to a potential conflict of interest.

About the Author

David Campbell, PhD, is the Ethicist for Kingston Health Sciences Centre. He provides ethics leadership and support to KHSC leaders, providers, staff, patients and families. David is also he Ethics Lead for the Southeast Ontario region during the COVID-19 pandemic.

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