Community Ethics Network Strategic Planning Results: 2008 and 2011 Kimberley Ibarra Program Evaluation Specialist | Ethics Consultant, Toronto Central CCAC & Joint Centre for Bioethics

Overview Strategic Planning Processes Objectives 2008 Key Findings and Priorities 2011 Key Findings and Differences Priorities and Work Plan 2011 - 2014

Strategic Planning Processes Outreach Project (2008) surveys and interviews to identify: Ethical issues at CEN organizations Membership learning needs CEN strengths and opportunities for improvement Future directions JCB Strategic Planning Survey (2011) to identify: Membership needs CEN value to membership Growth and changes in membership since 2008 survey 27 people participated in interviews identified from membership list from 21 of the 32 member organizations Interviews lasted around 30 minutes, attempted to elicit common themes, issues and challenges related to ethics in the CEN membership 28 of 71 invited members completed the on-line survey. The majority of interview participants held management positions in their organizations. A limited number of front-line staff were interviewed.

Key Findings 2008: Ethical Issues Majority encounter ethical issues at least weekly (70.3%); 3.7% uncertain ‘The top 5 most pressing issues in my work …’ 1 Autonomy, consent, capacity; client/family/provider conflicts 2 Moral distress & workload 3 Client advocacy issues 4 Human resources issues 5 Access to care; diversity; safety & abuse -majority of ethics leads have professional training through their graduate degrees, attendance of ethics institutes, grand rounds, and workshops -encountering an ethical issue isn't inherently bad -if one organization encounters issues on a daily basis versus never encountering them, this doesn’t mean the organization that never encounters ethical issues is more ethical, it could be that they don’t recognize the ethical issues as they arise. Conversely, the organization that encounters ethical issues on a daily basis is not more ethical than one that never does. It could be that their organizational practices are causing ethical issues to arise. What this does show is that ethical issues in community organizations are not an uncommon occurrence. Other than the 3.7% that were uncertain of how often, participants encountered ethical issues at least once a month. So what are these ethical issues?

2008 Resource Utilization ‘Which CEN ethics tools have you/your organization used?’ Code of Ethics (78.3%) Education and Training Sessions (73.9%) Ethical Decision-Making Worksheet (69.6%) Ethics in Action Newsletter (60.9%) Case Review Collection (26.1%) Org-Ethics and Capacity- Building Service (21.7%) A few participants mentioned they had heard of the case review collection but did not know where or how to access it, while others did not know the collection existed. 60.9% of survey respondents indicated that they have used the Ethics in Action Newsletter, of those 92.9% thought it was helpful. “The newsletter is terrific; it’s the beginning of getting the message out”. The specialized education and training sessions were well received by participants. Participants found the workshop sessions “helpful”, “relevant”, and “interesting”. Some commented that after participating in these sessions, they went back to their organizations and presented what they learned. Many interview participants and survey respondents were unaware of the existence of this service or what the service entails.

2008Strategic Issues Awareness & Visibility: No value added if members don’t know about or can’t access tools and resources Integration: Lost opportunities for sharing and collaboration Leadership & Development: Look to CEN to develop tools, particularly in organizational ethics Education: More training opportunities for members and front-line staff Sustainability & Accountability: Need a sustainable financial and governance structure, and way to measure success

Setting & Addressing Priorities Concentrate on education Focus on the front-line Address sustainability Inventory and share ethics resources Explore impact of Apology Act Specialized education Build community cases 2009 Fall Conference Train-the-trainer Create website Critical Path Town Hall

Key Findings 2011: Ethical Issues Majority encounter ethical issues at least weekly (72.7%); 6.1% uncertain; 3.0% never In 2008 In 2011 1 Consent, capacity; client/ family/provider conflicts Client/family/provider conflicts 2 Moral distress & workload Privacy & confidentiality 3 Client advocacy 4 Human resources issues Client advocacy; autonomy, consent, capacity 5 Access; diversity; safety -encountering an ethical issue isn't inherently bad -if one organization encounters issues on a daily basis versus never encountering them, this doesn’t mean the organization that never encounters ethical issues is more ethical, it could be that they don’t recognize the ethical issues as they arise. Conversely, the organization that encounters ethical issues on a daily basis is not more ethical than one that never does. It could be that their organizational practices are causing ethical issues to arise. What this does show is that ethical issues in community organizations are not an uncommon occurrence. Other than the 3.7% that were uncertain of how often, participants encountered ethical issues at least once a month. So what are these ethical issues?

2011: Organizational Issues In my role In my organization 1 Client/family/provider conflicts Moral distress & workload 2 Privacy & confidentiality 3 Access to care 4 Client advocacy; autonomy, consent, capacity Autonomy, consent, capacity 5 Human resources issues Client advocacy; resource allocation; safety, abuse -encountering an ethical issue isn't inherently bad -if one organization encounters issues on a daily basis versus never encountering them, this doesn’t mean the organization that never encounters ethical issues is more ethical, it could be that they don’t recognize the ethical issues as they arise. Conversely, the organization that encounters ethical issues on a daily basis is not more ethical than one that never does. It could be that their organizational practices are causing ethical issues to arise. What this does show is that ethical issues in community organizations are not an uncommon occurrence. Other than the 3.7% that were uncertain of how often, participants encountered ethical issues at least once a month. So what are these ethical issues?

Building Ethics Capacity Ethics learning needs 2008 2011 + / - I need to learn more about how to identify ethical issues in my daily work 48% 32% -16% I need to learn more about using ethical decision-making (EDM) tools/frameworks 67% 45% -22% Staff at my organization needs to learn more about how to identify ethical issues 96% 88% -8% Staff at my organization needs to learn more about using EDM tools/frameworks 80% +16%

Value of the CEN The CEN… 2008 2011 + / - Advances ethical practice in community 89% 100% +11% Supports ethical decision-making within and across member organizations 82% 97% +15% Provides an effective forum for exchanging information among members 77% 87% +10% Enables us to more successfully meet Accreditation Canada standards 74% +8% Enables us to improve staff awareness and understanding of ethics at work 90%

Resource Utilization ‘Which CEN ethics tools have you/your organization used?’ Code of Ethics (93%) +15% Ethics in Action Newsletter (90%) +29% Ethical Decision-Making Worksheet (87%) +18% Case Review Collection (73%) +48% Org-Ethics and Capacity- Building Service (43%) +21% A few participants mentioned they had heard of the case review collection but did not know where or how to access it, while others did not know the collection existed. 60.9% of survey respondents indicated that they have used the Ethics in Action Newsletter, of those 92.9% thought it was helpful. “The newsletter is terrific; it’s the beginning of getting the message out”. The specialized education and training sessions were well received by participants. Participants found the workshop sessions “helpful”, “relevant”, and “interesting”. Some commented that after participating in these sessions, they went back to their organizations and presented what they learned. Many interview participants and survey respondents were unaware of the existence of this service or what the service entails.

2011 Strategic Issues Network engagement & responsiveness: more immediate, timely, and interactive opportunities, including communication and enhanced website Expand capacity-building resources: more detailed and broader cases, online learning, particularly in org-ethics Institutional support: mentorship and business case development Evaluation & quality improvement: performance indicators and sharing leading practices

2011 Priorities Develop more tools and resources Revisit Network infrastructure Build organizational ethics capacity Continue to provide ethics education Mentor new members | Develop internal engagement strategies and evaluation tools

2012 Work Plan Activities Priority Action Items Tools and Resources Increase awareness of IDEA Framework Continue to develop case studies Infrastructure Review Review Steering Committee membership and Hub & Spokes model Revise TOR and Letter of Understanding Organizational Ethics Add organizational ethics cases Explore organizational ethics frameworks Education and Training Continue bi-annual workshops Train the trainer Leverage use of website Mentorship | engagement | evaluation Pilot mentorship program Update Members list and annual renewal letter Explore evaluation strategies