Experienced health care executives know that clinical ethics issues underlie every aspect of bedside patient care. From informed consent for treatments to patient privacy and confidentiality, from clinician-patient relationships to physician assisted suicide, clinicians, patients and families, and executives can consult a clinical ethics committee when making difficult bedside decisions or designing corporate policies and practices to assure ethically based clinical care.
But health care is not just the bedside. Bedside care quality is deeply influenced by organization level policy, leadership decisions and the organization’s culture—each of which must be specifically designed to reflect the corporate mission and values, and which may require support to assure the ethical practice of health care. Ethics concerns at the organization level may include:
How can quality improvement projects be designed to assure that patients and clinicians are treated fairly and not unduly burdened?
Are cost-based intervention projects based on racially or socioeconomically biased analytic models?
How do you ensure that programs designed to be cost-effective don’t result in unintended consequences that cause clinicians moral distress?
How do you assure that mid-level managers exhibit ethical leadership and moral courage?
How do you assure corporate ethics and values are expressed across the organizational culture?
Are organizational policies resulting in unintended ethics concerns?
How do you implement performance metrics that don’t result in unanticipated and unethical responses?
Attention to such issues in the business world outside of healthcare has grown. Scandals at Enron and Wells Fargo arose from corporate cultures that devalued ethical practices and performance metrics that encouraged inappropriate behavior. Business is recognizing that corporate hiring practices and algorithms can reflect unconscious bias that negatively impacts the likelihood of meeting broad hiring goals. Software companies are hiring chief ethics officers to ensure that ethical considerations are integrated across product development and deployment.
Such organization level corporate ethics issues afflict health care as well. Performance measure pressure within the U.S. Department of Veterans Affairs health care system resulted in inaccurate reporting. Racial bias in health care risk algorithms resulted in unfairly distributed access to valuable clinical intervention programs. Yet, health care executives may not be aware of or have programs, procedures or processes to systematically address corporate-level ethics issues.
Corporate ethics and compliance programs, despite including the word ethics in the title, tend to focus on what’s legally allowed rather than what’s the right thing to do. Such an emphasis leaves an executive with a problematic story to tell when patients and employees learn of unethical practices and demand answers. On the other hand, traditional clinical ethics committees can be designed to discuss organizational ethics topics, but if not, they may be poorly prepared to address these and other organizational ethics concerns. (1)
But solutions are available to provide practical responses to organizational ethics concerns. Options include:
Enhancing the values focus of the compliance program to assure a deep understanding of ethics, not just what’s legal.
Developing clinical ethics program expertise to address corporate-level ethics issues.
Building an ethics culture characterized by a just culture focus that assures training and support for managers at all levels in ethical leadership and responsive practices when clinicians and other staff experience moral distress.
Assure that someone with organizational ethics expertise is a trusted member of leadership decision making team.
Use a dashboard to improve the alignment of organizational decision making to core value and mission statements. (2)
Practical, cost-effective solutions are available to assure an ethics and values focus across your organization—from the bedside to the boardroom. How prepared is your organization if an organizational ethics question arose?
At Consensus Solutions we understand how programs designed to deliver better care and value for patients in a fast-paced environment can overlook important ethical considerations resulting in unintended consequences. In partnership with our ethics expert partners, from Ethics Quality Consulting, we provide program evaluation skills to assess corporate practices and identify potentially challenging ethics considerations. High quality ethics program development and deployment help assure that your organization is prepared to handle organizational and clinical ethics issues.
1. Førde R, Hansen T. Do Organizational and Clinical Ethics in a Hospital Setting Need Different Venues? HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues. 2014;26.
2. Lahey T, Nelson W. A Dashboard to Improve the Alignment of Healthcare Organization Decisionmaking to Core Values and Mission Statement. Cambridge Quarterly of Healthcare Ethics. 2020;29(1):156-162.