Clinical Ethics and Systems Thinking  

Oleh:

MacRae, Susan K. ; Fox, Ellen ; Slowther, Anne

Jenis: Article from Books - E-Book
Dalam koleksi: The Cambridge Textbook of Bioethics, page 313-321.
Topik: Clinical Ethics; Systems Thinking; Organizational Mandate
Fulltext: Clinical Ethics and Systems Thinking.pdf (291.66KB)

Isi artikel

A health region, with multiple hospitals and community healthcare organizations, is faced with increased pressures to improve the ethical care of patients and improve staff experience across the system. Currently the patient satisfaction scores at many of the sites are quite low and recent Health Commission inspections in some hospitals have highlighted management of consent issues and patientcentered care as areas of major concern. The staff ’s morale is waning and moral distress seems to be increasing. The CEO of the Strategic Health Authority believes that clinical ethics could potentially make a signi?cant difference to the overall culture of the system but feels that the existing mechanisms are not that effective. She begins to consult with experts in the ?eld to discuss how clinical ethics can help her to improve her health system. ‘‘ABC Health Care’’ has an established clinical ethics program that performs a variety of functions including case consultation, education, policy work, and scholarly writing. Although ABC has received positive accreditation ratings relating to clinical ethics, many within ABC – including both administrators and clinical staff – have a general sense that ABC’s current clinical ethics program may not be fully addressing the organization’s needs. For example, the program tends to focus on a narrow range of ethical concerns, mostly related to high-pro?le acute situations in the intensive care and emergency units. In contrast, staff experience a much broader range of ethical issues in their work day to day, and many issues and areas go unserved. Although the clinical ethics program devotes many hours to ethics consultation, similar ethical issues continue to recur again and again. At times, ethics program staff seems more concerned about philosophical questions and principles than about the practical realities experienced by patients and healthcare staff. Overall, the clinical ethics program’s impact on everyday behavior or on organizational culture is unclear, and no measures exist to evaluate the program’s effectiveness. The CEO feels strongly that the clinical ethics program should be held accountable for its effects on the system (or lack thereof). He looks to other organizations for models of how clinical ethics programs can be used to make systems change.

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