In the next two chapters I shall be arguing that an important element in the practice of moral medical leadership is distinctive patterns of behaviour giving effect to important values. I call these patterns of behaviour ‘propriety’, and I shall be examining five such ways of acting: fiduciary propriety, bureaucratic propriety, collegial propriety, inquisitorial propriety and restorative propriety.

Propriety makes an important contribution towards the work of orchestrating organizational moral narrative, demonstrating approved ways of acting and signalling significant moral commitments. But medical leaders owe many overlapping moral responsibilities, and have to take into account the multiple needs of different individuals and different groups at different times. The complexity of their moral responsibilities occasionally results in the emergence of apparently irreconcilable aims and contradictory moral goods. There are insoluble moral tensions to be found at the heart of medical management and these come to the surface, I believe, in conflicting proprieties.