1. Practicing Integrity and Advocacy Fostering an Ethical Environment and Culture

2. Learning Objectives At the end of this activity participants will be able to: – Identify the core VA values that create staff responsibility for asking questions about ethics – Explain the “3W” method and how it applies to asking questions about ethics – Model an effective approach for raising questions about ethics in a workplace scenario 2

3. Ethical Environment and Culture In IntegratedEthics, a healthy ethical environment and culture is described as one in which employees: – Appreciate that ethics is important – Recognize and freely discuss ethical concerns – Seek ethics consultation about ethical concerns – Work to address ethics issues on a systems level – View ethics as an important component of quality health care – Understand what ethical practices are expected of them – Feel empowered to behave ethically – View organizational decisions as ethical 3

4. Ethical Environment and Culture In IntegratedEthics, a healthy ethical environment and culture is described as one in which employees: – Appreciate that ethics is important – Recognize and freely discuss ethical concerns – Seek ethics consultation about ethical concerns – Work to address ethics issues on a systems level – View ethics as an important component of quality health care – Understand what ethical practices are expected of them – Feel empowered to behave ethically – View organizational decisions as ethical 4

5. ICARE Values Integrity – Act with high moral principle. Adhere to the highest professional standards. Maintain the trust and confidence of all with whom I engage. Advocacy – Be truly Veteran-centric by identifying, fully considering, and appropriately advancing the interests of Veterans and other beneficiaries. 5

6. The 3W Approach 1.What I see 2.What I am concerned about 3.What I want

7. Scenario You are standing at reception in gastroenterology sharing information with the clerk when Dr. X returns from lunch. He is clearly impaired, stumbling at the doorstep, dropping his badge as he fumbles to attach it to his coat, and nearly running down Mrs. Smith in the process. The clerk shakes her head, raises her eyebrows and says under her breath, “not the first time.” Dr. X heads behind the counter to pick up his list of colonoscopy patients for the afternoon.

8. 3W in Practice 1.What do you see? 2.What are you concerned about? 3.What do you want?

9. 3W in Practice 1.What do you see? Dr. X, you don’t seem well today. You are having trouble with your balance and coordination. 2.What are you concerned about? 3.What do you want?

10. 3W in Practice 1.What do you see? Dr. X, you don’t seem well today. You are having trouble with your balance and coordination. 2.What are you concerned about? I am concerned that you aren’t well enough to see patients today. 3.What do you want?

11. 3W in Practice 1.What do you see? Dr. X, you don’t seem well today. You are having trouble with your balance and coordination. 2.What are you concerned about? I am concerned that you aren’t well enough to see patients today. 3.What do you want? I want you to take a seat and let me call another doctor to take a look at you.

12. 3W in Practice 1.What do you see? Dr. X, you don’t seem well today. You are having trouble with your balance and coordination. 2.What are you concerned about? I am concerned that you aren’t well enough to see patients today. 3.What do you want? I want you to take a seat and let me call another doctor to take a look at you.

13. Refining and Framing the 3Ws - Tips Be respectful. Ask permission to talk and use the person’s name. State facts, not motives. Use team language (i.e., we and us) whenever possible. Be empathetic and normalize the behavior (e.g., I feel the same, anyone could). Be clear about your concern and frame it in terms of values. State your confusion over how to resolve the concern you see. Be inquisitive. Ask questions and try to understand their perspective. Invite problem solving. Ask them what they think should be done.

14. Apply the Tips with 3W SCRIPTTIPS Dr. X, may I speak to you for a minute?Respectful, use of name, ask permission I didn’t see you round on Mr. Y today. What you see, stated as fact We were all just saying how hard it is for us to care for him when there is so little we can do. Normalize behavior, use team language, empathetic I am concerned that we aren’t being respectful or honoring him properly when we cut short our clinical time with him. What you are concerned about, use team language, frame using values I would really like the team to spend a similar amount of time with Mr. Y as we do with our other patients. What you want, use team language I was hoping you might have some suggestions about how to raise the issue with the team and ensure we continue to support Mr. Y with dignity during his last days. What do you think? Be inquisitive, invite problem solving

15. Practice Choose one of the scenarios listed on the handout – Write the 3Ws in the space provided – Refine them into a script referring to the tips on the handout

16. Share your Scripts What are your 3Ws? How did you frame your questions into a safe and respectful script?

17. Takeaways Asking questions about ethics contributes positively to an ethical environment and culture by reinforcing the need to act with Integrity and by Advocating for quality treatment and services for veterans 3W Method helps us to ask questions about ethics in a way that is: – Clear and without judgment – Asks that something change to fix the problem 17

18. Questions? vhaethics@va.gov http://www.ethics.va.gov/integratedethics/index.asp 18