40 - Clinical ethics and systems thinking

Summary

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 patient-centered 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 significant 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 field 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-profile 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.[…]