Table 3.

Six Metaphors of Values-Based Health Care Management

The Garden	Refers to the dynamic character of a values-based organisational culture, comparable with managing a large garden with a rich variety of plant life, creating the context for ethics to take place (knowledge, patience, reflection and action, undertaking and resigning, making choices, doing the right thing at the right moment …)
The Scene
Foreign Language	Just like learning and using a foreign language, the ethical reflection and action has to be practised and used continuously, in all situations and at all levels of the organization. Only thus, the ethical reflection and action can become a habitus, a spontaneous and seemingly automatic, or apparently evident, use of the ethical language by everyone within the organization.
Apparent Evidence
Trekking	Why does it have to be an ethical language? Why do the values have to be ethical values? Because providing care is not the same as providing a finished product. The care relationship is a journey that is not a planned trip but rather an unpredictable trekking, a joint search for a professional and caring answer to human vulnerability. The ethical compass with ethical values helps us to find the right track.
Why Ethics?
Credible Encounter	Health care managers create the context for a values-based organizational culture so that everyone involved can do their job in a values-based way. Most importantly in this regard is the way in which directors, managers and board members themselves embody and express certain values (like integrity, authenticity, courage and justice …) in their encounter with everyone involved. They are ethical role models.
Which Values?
Sun & Storm	This metaphor deals with the specific role and function of health care managers when ethical issues become really hard and difficult. When they feel caught between the devil and the deep blue sea. In such cases, making connection with oneself as a person, with direct colleagues in the management team, with the difficult situation itself by ‘walking around with the bots in the mud’ and by listening to people who serve as a sounding board and critic of the choices that have to be made. Let the sun shine on everyone when things go well, and be a buffer when things get rough.
When it becomes really difficult
Wings	Inspirational sources for health care managers were: working in a health care organization implies an intrinsic engagement for ethical values and values-based actions; making a difference within society, thinking in large-scale and long-term perspectives; and most importantly, lifting the spirited energy of caregivers and bringing them to a higher level, giving them wings to fly.
What inspires the manager?