Reflections on Health Care Leadership Ethics
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52 Healthcare Management FORUM Gestion des soins de santé – Winter/Hiver 2009 Although most health organizations involved in Accredi- tation Canada’s Qmentum program have well established mission, vision and values statements, the breadth of the Ac- creditation Canada ethics criteria remains challenging for some. Accreditation Canada has new and revised ethics stan- dards woven throughout the accreditation program, includ- ing ethics-related standards for governance, leaders and managers, and service delivery staff. Surveyor teams some- times encounter leadership perceptions that the ethics criteria may not be “applicable” unless the organization is engaged in research activities. In fact, the criteria are intended to ad- dress the full scope of organizational ethics issues and deci- sions: clinical; administrative; and research. Surveyors use the tracer methodology to learn about the actual ethical dilemmas faced by frontline staff and clinical teams, as well as by administrative staff. An important step in the tracer application is to establish what resources are available to staff to address ethical questions and whether those resources are readily accessible and used. Care and service staff often face questions about client participation in care decisions, informed consent, advance directives, end of life treatment, client rights, client education, privacy of client information, protective parameters for “at-risk clients” and participation in research activities. Health leaders have the responsibility to determine the type of ethics support structure (including an ethics frame- work) that is suitable to the context, size and nature of their organization. With system restructuring and transformation imperatives, there is a need for continuous re-examination of the “fit” of the ethics supports structure in health care en- vironments. Leaders must also build the organization’s capacity to ef- fectively handle ethical issues. The focus is to encourage the governing body, leaders, staff, and service providers to de- velop and enhance their ethics-related knowledge. Tips for Health Leaders • Obtain staff input to gain an appreciation of the breadth and scope of their needs, the ethics-related issues they typically face, and to obtain their suggestions to address the challenges. • Consult with an ethics expert or a health ethics network in your province. Schedule a dialogue with an ethicist to discuss potential or actual issues with a representative group of staff, physicians, clients and leaders. • Use the consultant’s expertise to develop ethics decision- making frameworks suitable for the organization. Multi- ple frameworks may be required to manage the scope of ethical issues faced by staff (e.g., clinical, administrative, research). • Build the organization’s capacity to apply the ethics frameworks. Ethics education offerings may be exter- nally or internally developed, and may be delivered by external trainers or internal staff. Consider events such as “lunch ‘n learns” or weekly rounds to identify and discuss real issues faced by staff. • Document and have the governing body adopt the or- ganization’s ethics infrastructure, so that the resources and functions of the organization’s ethics infrastructure are clear and transparent to stakeholders. Communicate the ethics infrastructure to stakeholders. • Evaluate the effectiveness of the ethics frameworks on a regular basis. Determine whether the frameworks are used and whether they are effective in helping users to handle and resolve ethics issues. Seek improvements to better meet the needs of staff, physicians, clients, and families. • Ensure that the governing body receives the trends from ethical consultations so as to inform targeted policy development. • Share the ethics trends and ethics consultation outcomes with staff, physicians, clients and community advisory groups. by Tracy Murphy, CHE and Theresa Fillatre, CHE Issue: As a senior leader in a health organization, how well is your organization meeting and practicing within the intent of Accreditation Canada’s ethics criteria? on Health Care Leadership Ethics
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Transcript of Reflections on Health Care Leadership Ethics
52 Healthcare Management FORUM Gestion des soins de santé – Winter/Hiver 2009
Although most health organizations involved in Accredi-tation Canada’s Qmentum program have well establishedmission, vision and values statements, the breadth of the Ac-creditation Canada ethics criteria remains challenging forsome. Accreditation Canada has new and revised ethics stan-dards woven throughout the accreditation program, includ-ing ethics-related standards for governance, leaders andmanagers, and service delivery staff. Surveyor teams some-times encounter leadership perceptions that the ethics criteriamay not be “applicable” unless the organization is engagedin research activities. In fact, the criteria are intended to ad-dress the full scope of organizational ethics issues and deci-sions: clinical; administrative; and research.
Surveyors use the tracer methodology to learn about theactual ethical dilemmas faced by frontline staff and clinicalteams, as well as by administrative staff. An important stepin the tracer application is to establish what resources areavailable to staff to address ethical questions and whetherthose resources are readily accessible and used. Care andservice staff often face questions about client participation incare decisions, informed consent, advance directives, end oflife treatment, client rights, client education, privacy of clientinformation, protective parameters for “at-risk clients” andparticipation in research activities.
Health leaders have the responsibility to determine thetype of ethics support structure (including an ethics frame-work) that is suitable to the context, size and nature of theirorganization. With system restructuring and transformationimperatives, there is a need for continuous re-examinationof the “fit” of the ethics supports structure in health care en-vironments.
Leaders must also build the organization’s capacity to ef-fectively handle ethical issues. The focus is to encourage thegoverning body, leaders, staff, and service providers to de-velop and enhance their ethics-related knowledge.
Tips for Health Leaders • Obtain staff input to gain an appreciation of the breadth
and scope of their needs, the ethics-related issues theytypically face, and to obtain their suggestions to addressthe challenges.
• Consult with an ethics expert or a health ethics networkin your province. Schedule a dialogue with an ethicist todiscuss potential or actual issues with a representativegroup of staff, physicians, clients and leaders.
• Use the consultant’s expertise to develop ethics decision-making frameworks suitable for the organization. Multi-ple frameworks may be required to manage the scope ofethical issues faced by staff (e.g., clinical, administrative,research).
• Build the organization’s capacity to apply the ethicsframeworks. Ethics education offerings may be exter-nally or internally developed, and may be delivered byexternal trainers or internal staff. Consider events suchas “lunch ‘n learns” or weekly rounds to identify anddiscuss real issues faced by staff.
• Document and have the governing body adopt the or-ganization’s ethics infrastructure, so that the resourcesand functions of the organization’s ethics infrastructureare clear and transparent to stakeholders. Communicatethe ethics infrastructure to stakeholders.
• Evaluate the effectiveness of the ethics frameworks on aregular basis. Determine whether the frameworks areused and whether they are effective in helping users tohandle and resolve ethics issues. Seek improvements tobetter meet the needs of staff, physicians, clients, andfamilies.
• Ensure that the governing body receives the trends fromethical consultations so as to inform targeted policy development.
• Share the ethics trends and ethics consultation outcomeswith staff, physicians, clients and community advisorygroups.
by Tracy Murphy, CHE and Theresa Fillatre, CHE
Issue: As a senior leader in a health organization, how well is your organization meeting and practicingwithin the intent of Accreditation Canada’s ethics criteria?
on Health Care Leadership Ethics
Healthcare Management FORUM Gestion des soins de santé – Winter/Hiver 2009 53
For the CCHSE Code of Ethics, please visit www.cchse.org.If you have a question for the Ethics Committee, please e-mail: [email protected].
• Continuously seek ethics questions and stories and rec-ognize those who respond.
• Involve professional practice leaders and councils in ad-dressing ethics issues so that sustainable improvementscan be made.
• Share lessons learned with others.
The literature is clear that health leaders are called uponto employ ethical decision-making whenever there is a needto balance the needs and interests of the individual, the or-ganization, and society. Justice, autonomy, beneficence andfairness, as well as professional ethical standards and codes,are the most commonly identified ethical principles. Pressuresto reduce costs, ensure service access, reduce wait lists, andmanage technological advances represent a few of the keydemands that increase the complexity of leadership ethics.As a result, leaders must assess the utility of the ethics deci-sion-making frameworks in order to shape improvementsfor tomorrow’s leaders.
It is incumbent upon health leaders to lead and behaveethically. The College’s Code of Ethics requires members topromote ethical conduct and best practices for discussing andaddressing ethical issues and concerns, while providing a safeenvironment for disclosure of ethical issues. The College’sBoard of Directors also has an Ethics Committee. Each quar-terly publication of FORUM affords opportunities to profile
a current leadership ethics question, case study or to show-case an ethics structure. In a recent call for expressions of in-terest in the work of the College’s Ethics Committee, 68respondents “stepped up to the plate” to help create organi-zational cultures that foster both ethical practices and deci-sion-making. These health leaders will help to shape andreshape the College’s ethics policies, code of ethics and ethicsdecision-making frameworks for health leaders, in collabo-ration with partner organizations such as AccreditationCanada. We call upon you as health leaders to share yourleadership ethics questions and ideas with the College’s EthicsCommittee and to provide feedback to Accreditation Canadaon its ethics criteria.
ReferencesAccreditation Canada. Standards for Sustainable Gover-
nance, Standards for Effective Organization, Service/Sector-specific Standards.
About the AuthorsTracy Murphy, CHE, is a Consultant with Accreditation
Canada, and is the CHE Program Consultant for the Cana-dian College of Health Service Executives.
Theresa A Fillatre, CHE, is the Atlantic Provinces Leader,Safer Healthcare Now! and Chair of the Ethics Committee forthe Canadian College of Health Service Executives.
