Perception of the ethical climate among hospital employees in a public healthcare system: a cross-sectional survey at the University Hospital of Split, Croatia

Abstract

Background: In this cross-sectional study, we assessed the ethical climate at the University Hospital of Split in Croatia and investigated its potential indicators.

Methods: We used a validated Croatian translation of the 36-item Ethical Climate Questionnaire, which we distributed online (via an e-mail sent by the hospital administration to hospital employees) and as a paper and pen survey directly to all hospital departments. We compared ECQ scores between doctors of medicine (MDs)/doctors of dental medicine (DMDs) and other employees; MDs/DMDs and nurses; employees working with patients and those not working with patients; and employees working in the ICU versus those not working in the ICU using the Mann-Whitney U test. We used linear regression to explore the relationship of each ethical climate with gender, age, degree level, and years spent working in the hospital.

Results: We collected 325 physical and 222 online questionnaires (547 responses in total), after which we excluded 146 incomplete responses. This left 401 questionnaires for analysis, primarily from doctors (n = 175; 43.6%) and nursing staff (n = 131; 32.7%). The two dominant climates were 'Company rules' and 'Laws and professional codes'. Stratified by profession, we observed higher scores for 'Personal morality' among doctors of medicine or dental medicine, whereas the group comprising other health professionals and non-medical staff had higher scores for 'Team interests', 'Efficiency', 'Social responsibility', and 'Laws and professional codes'. In comparing nurses and doctors of medicine/dental medicine, we observed the former group had higher scores for 'Social responsibility', 'Efficiency', and 'Team interest', while the latter had higher scores for 'Personal morality'. Those who worked outside of the ICU had higher scores for 'Social responsibility' compared to those who did not. In the regression analyses, age was a significant positive predictor of the 'Laws and professional codes' climates, and years spent working in the hospital acted as a positive predictor of the 'Self-interest' climate.

Conclusion: A large university hospital center in a fully publicly funded national healthcare system has a positive ethical work climate, which could be further developed by further development and implementation of codes of ethics to outline expected behaviors from all employees.

Keywords: Ethical climate; Ethical climate questionnaire; Ethics; Hospital.

Fig. 1

Theoretical ethical climates according to the ethical theory and the locus of analysis (in black font), and five common empirical derivatives of ethical climate (in coloured font), according to Martin & Cullen, 2006.