Ethics: The Key Component to Health Care Organizations William Nelson, PhD [email protected] June 1, 2010 International Hospital Federation Leadership Conference
Dec 18, 2015
Ethics: The Key Component to Health Care Organizations
William Nelson, [email protected]
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
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
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
• 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