1. Ethics: The Key Component to Health Care Organizations William Nelson, PhD william.a.nelson@dartmouth.edu June 1, 2010 International Hospital Federation Leadership Conference

2. 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

3. Reasons to Foster an Ethics Grounded Health Care Organization

4. Rationale for Fostering Ethical Health Care Organizations To meet patient expectations

5. The Importance of Ethics to Health Care Organizations To meet patient expectations To address the health needs of the community

6. The Importance of Ethics to Health Care Organizations To meet patient expectations To address the health needs of the community To enhance quality care

7. 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

8. Ethical Principles and Concepts Applications of Ethical Principles to Quality Care United States Institute of Medicine’s Quality Aims AutonomySupporting, facilitating, and respecting self-determination in shared decision-making Patient-centered BeneficencePromoting the patient’s beneficial health care and best interest Effective, safe, timely, patient- centered NonmaleficenceAvoiding and protecting patient from actions that cause harm Safe, effective, patient-centered Distributive and social justiceAllocating fairly the benefits and burdens related to health care and promoting access to healthcare services in an equitable manner Equitable, efficient, safe, patient- centered

9. 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

10. 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

11. 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

12. 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

13. 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

14. The Impact of Ethical Conflicts on Health Care Organizations Quality of patient care is eroded  patient satisfaction and self-referrals diminished

15. 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

16. 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

17. 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.

18. 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

19. 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

20. 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

21. International Hospital FederationTavistock/Cambridge Principles Universality of health care Good quality health care Patient-centered health care Equity and solidarity Evidence and dignity Core Values and Principles

22. International Hospital FederationTavistock/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

23. International Hospital FederationTavistock/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

24. International Hospital FederationTavistock/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

25. International Hospital FederationTavistock/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

26. International Hospital FederationTavistock/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

27. International Hospital FederationTavistock/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

28. 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

29. Healthcare E T H I C S

30. Fostering IHF’s Core Values and Principles IHF’s Values

31. Fostering IHF’s Core Values and Principles Member Organizations IHF’s Values

32. Fostering IHF’s Core Values and Principles Health Care Facilities Member Organizations IHF’s Values

33. Fostering IHF’s Core Values and Principles Health Care Facilities Provider-patient Encounters Member Organizations IHF’s Values

34. 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

35. Features of Ethical Hospitals and Health Care Organizations Ethical leadership

36. Features of Ethical Hospitals and Health Care Organizations Ethical leadership Shared organization mission, culture and values

37. Features of Ethical Hospitals and Health Care Organizations Ethical leadership Shared organizational mission, culture and values Ethics grounded clinical and management practices

38. 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

39. Ethical Leadership Ethical Practices Ethical Culture Ethics Program

40. Benefits of Ethical Hospitals and Health Care Organizations Enhanced patient satisfaction Increased employee morale and loyalty Improved community relations Fewer wasteful/unwanted treatments

41. 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

42. Potential Benefits of an Ethics Focused Organization Improved quality of care Enhanced economic status Ethically sound culture ___________________________ A more successful, patient-centered organization!

43. 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

44. 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