Ethics: The Key Component to Health Care Organizations

William Nelson, PhDwilliam.a.nelson@dartmouth.edu

June 1, 2010

International Hospital Federation

Leadership Conference

Purpose

• Describe the importance of ethics for today’s health care organizations

• Describe the ethics – quality linkage

• Identify shared ethical principles fostering a health care organization’s moral compass

• List the features of ethical health care organizations

• Identify the benefits of an ethical health care organization

Reasons to Foster an Ethics Grounded Health Care Organization

Rationale for Fostering Ethical Health Care Organizations

• To meet patient expectations

The Importance of Ethics to Health Care Organizations• To meet patient expectations

• To address the health needs of the community

The Importance of Ethics to Health Care Organizations

• To meet patient expectations

• To address the health needs of the community

• To enhance quality care

Ethics and Quality Linkage

• Ethics is the foundation of quality

• The lack of quality care can create ethics concerns

• Similarly, when ethics conflicts occur, the quality of care is affected

• Quality is linked to ethical care

Ethical Principles and Concepts

Applications of Ethical Principles to Quality Care

United States

Institute of Medicine’s

Quality Aims

Autonomy Supporting, facilitating, and respecting self-determination in shared decision-making

Patient-centered

Beneficence Promoting the patient’s beneficial health care and best interest

Effective, safe, timely, patient-centered

Nonmaleficence Avoiding and protecting patient from actions that cause harm

Safe, effective, patient-centered

Distributive and social justice Allocating fairly the benefits and burdens related to health care and promoting access to healthcare services in an equitable manner

Equitable, efficient, safe, patient-centered

The Importance of Ethics to Health Care Organizations

• To meet patient expectations

• To address the health needs of the community

• To enhance quality care

• To foster staff professionalism

The Importance of Ethics to Health Care Organizations

• To meet patient expectations

• To address the health needs of the community

• To enhance the quality care

• To foster professionalism

• To improve the organization’s culture and practices

The Importance of Ethics to Health Care Organizations

• To meet patient expectations

• To address the health needs of the community

• To enhance quality care

• To foster professionalism

• To improve organizational culture and practices

• To Improve the staff’s morale and performance

The Importance of Ethics to Health Care Organizations• To meet patient expectations

• To address the health needs of the community

• To enhance quality care

• To foster professionalism

• To enhance organization culture and practices

• To improve staff morale and performance

• To enhance the organization’s compliance to country based regulatory standards

The Importance of Ethics to Health Care Organizations

• To meet patient expectations

• To address the health needs of the community

• To enhance quality care

• To foster professionalism

• To enhance organization culture

• To improve staff morale and performance

• To enhance organization’s compliance to regulatory standards

• To decrease the impact of ethics conflicts

The Impact of Ethical Conflicts on Health Care Organizations

• Quality of patient care is eroded patient satisfaction and self-referrals diminished

The Impact of Ethical Conflicts on Health Care Organizations

• Quality of patient care is eroded

• Organizational culture is weakened Value-based culture and professionalism

undermined Community image and public relations diminished

The Impact of Ethical Conflicts on Health Care Organizations

• Quality of patient care is eroded

• Organizational culture is weakened

• Staff morale and performance suffers caregiver (moral) stress increases productivity diminished

The Impact of Ethical Conflicts on Health Care Organizations

• Quality of patient care is eroded• Organizational culture is weakened• Staff morale and performance suffers• Economic costs of ethical conflicts

Analysis suggests that ethics conflicts have significant cost implications*

Theoretical correlation between ethics conflicts and organizational costs that can impact on corporate performance, including wages, efficiency, and price

* Nelson WA, Weeks WB, Campfield JM. The organizational costs of ethical conflicts. Journal of Healthcare Management 2008 Jan-Feb;53(1):41-52.

Cost Categories Effect on Organizational Performance

Ethical Conflicts

Marketing Costs

Operational Costs

Legal Costs

Public relations costs

Low staff morale

Staff work reduction

Litigation, settlements,

awards

Loss of business

Higher staff turnover

Higher wages required

Decreased efficiency

Decreased available resources

Lower profit margin

Decreased charitable

giving

Ethical Principles are the Foundation for Health Care

• “The problems of health systems are in the last analysis ethical”*

• Health care organizations and health care reform are impeded because they lack a moral compass

• Once there is concurrence and acceptance of an ethical health care foundation, then reform and implementation becomes a technical challenge

* Berwick D, Davidoff F, Hiatt H, Smith H. Refining and implementing the Tavistock principles for everybody in health care. BMJ 2001 323:616-620

Core Values and Ethical Principles Serve as the Foundation for Provision of Ethical Health Care

• International Hospital Federation’s Core Values*

• Tavistock/Cambridge Ethics Principles*

* See handout

International Hospital Federation Tavistock/Cambridge Principles

Universality of health care

Good quality health care

Patient-centered health care

Equity and solidarity

Evidence and dignity

Core Values and Principles

International Hospital Federation Tavistock/Cambridge Principles

Universality of health care

Good quality health care

Patient-centered health care

Equity and solidarity

Evidence and dignity

Rights – to health care

Balance – individual and population health

Comprehensiveness – illness and prevention focused

Cooperation – between patients, providers and organizations

Improvement – enhance quality

Safety – avoid harm

Openness – honest and trustworthy

Core Values and Principles

International Hospital Federation Tavistock/Cambridge Principles

Universality of health care

Good quality health care

Patient-centered health care

Equity and solidarity

Evidence and dignity

Rights – to health care

Balance – individual and population health

Comprehensiveness – illness and prevention focused

Cooperation – between patients, providers and organizations

Improvement – enhance quality

Safety – avoid harm

Openness – honest and trustworthy

Core Values and Principles

International Hospital Federation Tavistock/Cambridge Principles

Universality of health care

Good quality health care

Patient-centered health care

Equity and solidarity

Evidence and dignity

Rights – to health care

Balance – individual and population health

Comprehensiveness – illness and prevention focused

Cooperation – between patients, providers and organizations

Improvement – enhance quality

Safety – avoid harm

Openness – honest and trustworthy

Core Values and Principles

International Hospital Federation Tavistock/Cambridge Principles

Universality of health care

Good quality health care

Patient-centered health care

Equity and solidarity

Evidence and dignity

Rights – to health care

Balance – individual and population health

Comprehensiveness – illness and prevention focused

Cooperation – between patients, providers and organizations

Improvement – enhance quality

Safety – avoid harm

Openness – honest and trustworthy

Core Values and Principles

International Hospital Federation Tavistock/Cambridge Principles

Universality of health care

Good quality health care

Patient-centered health care

Equity and solidarity

Evidence and dignity

Rights – to health care

Balance – individual and population health

Comprehensiveness – illness and prevention focused

Cooperation – between patients, providers and organizations

Improvement – enhance quality

Safety – avoid harm

Openness – honest and trustworthy

Core Values and Principles

International Hospital Federation Tavistock/Cambridge Principles

Universality of health care

Good quality health care

Patient-centered health care

Equity and solidarity

Evidence and dignity

Rights – to health care

Balance – individual and population health

Comprehensiveness – illness and prevention focused

Cooperation – between patients, providers and organizations

Improvement – enhance quality

Safety – avoid harm

Openness – honest and trustworthy

Core Values and Principles

Core Values and Ethical Principles

• The over-lap between IHF’s core values and the Tavistock/Cambridge ethics principles suggests a common morality: Acting in the best interest of the patient and the

community Respecting the patient Ensuring social and distributive justice

Healthcare

E T H I C S

Fostering IHF’s Core Values and Principles

IHF’s Values

Fostering IHF’s Core Values and Principles

Member Organizations

IHF’s Values

Fostering IHF’s Core Values and Principles

Health Care Facilities

Member Organizations

IHF’s Values

Fostering IHF’s Core Values and Principles

Health Care Facilities

Provider-patient Encounters

Member Organizations

IHF’s Values

The Question is: Can the Shared Common Morality be implemented?

Common morality

Health professions and associations core values

Health care organizations and facility's values

Health professional – patient interaction

Features of Ethical Hospitals and Health Care Organizations

• Ethical leadership

Features of Ethical Hospitals and Health Care Organizations

• Ethical leadership

• Shared organization mission, culture and values

Features of Ethical Hospitals and Health Care Organizations

• Ethical leadership

• Shared organizational mission, culture and values

• Ethics grounded clinical and management practices

Features of Ethical Hospitals and Health Care Organizations

• Ethical leadership

• Shared organizational mission, culture and values

• Ethics grounded clinical and management practices

• Integrated ethics program

Benefits of Ethical Hospitals and Health Care Organizations

• Enhanced patient satisfaction

• Increased employee morale and loyalty

• Improved community relations

• Fewer wasteful/unwanted treatments

Benefits of Ethical Hospitals and Health Care Organizations (continued)

• Less diverted staff time

• Enhanced professionalism

• Fewer law suits and legal issues

• Meet regulatory ethics standards

Potential Benefits of an Ethics Focused Organization

Improved quality of care

Enhanced economic status

Ethically sound culture

___________________________

A more successful, patient-centered organization!

Conclusion

• Clinical and organizational ethical conflicts occur frequently

• Ethical conflicts significantly impact patient care,

staff, the organization’s culture, and operational costs

• IHF’s core values and principles reflect a common morality in the delivery of health care

• Common morality is the foundation for health care and health care reform

Conclusion (continued)

• To fully implement such core values is a significant challenge for member organizations

• Strategies need to be developed and employed at all levels of implementation

• Despite the many barriers to implementation of IHF’s core

values:

Accepting and implementing the common morality into core values can ultimately enhance access

to quality health care for our communities