Ethics: The Key Component to
Health Care Organizations
William Nelson, PhD
william.a.nelson@dartmouth.edu
June 1, 2010
International Hospital Federation
Leadership Conference
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
Reasons to Foster an Ethics Grounded
Health Care Organization
Rationale for Fostering Ethical Health
Care Organizations
• To meet patient expectations
The Importance of Ethics to Health
Care Organizations
• To meet patient expectations
• To address the health needs of the community
The Importance of Ethics to Health
Care Organizations
• To meet patient expectations
• To address the health needs of the community
• To enhance quality care
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
Ethical Principles and
Concepts
Applications of Ethical
Principles to Quality Care
United States
Institute of Medicine’s
Quality Aims
Autonomy
Supporting, facilitating, and
respecting self-determination in
shared decision-making
Patient-centered
Beneficence
Promoting the patient’s
beneficial health care and best
interest
Effective, safe, timely, patientcentered
Nonmaleficence
Avoiding and protecting patient
from actions that cause harm
Safe, effective, patient-centered
Distributive and social justice
Allocating fairly the benefits and
burdens related to health care
and promoting access to
healthcare services in an
equitable manner
Equitable, efficient, safe, patientcentered
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
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
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
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
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
The Impact of Ethical Conflicts on
Health Care Organizations
• Quality of patient care is eroded
 patient satisfaction and self-referrals diminished
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
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
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.
Cost Categories Effect on Organizational
Performance
Legal Costs
Litigation,
settlements,
awards
Staff work
reduction
Ethical
Conflicts
Operational
Costs
Decreased
available
resources
Decreased
efficiency
Higher wages
required
Low staff
morale
Higher staff
turnover
Marketing
Costs
Public relations
costs
Loss of
business
Decreased
charitable
giving
Lower profit
margin
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
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
Core Values and Principles
International Hospital Federation
Universality of health care
Good quality health care
Patient-centered health care
Equity and solidarity
Evidence and dignity
Tavistock/Cambridge Principles
Core Values and Principles
International Hospital Federation
Tavistock/Cambridge Principles
Universality of health care
Rights – to health care
Good quality health care
Balance – individual and population
health
Patient-centered health care
Comprehensiveness – illness and
prevention focused
Equity and solidarity
Cooperation – between patients,
providers and organizations
Evidence and dignity
Improvement – enhance quality
Safety – avoid harm
Openness – honest and trustworthy
Core Values and Principles
International Hospital Federation
Tavistock/Cambridge Principles
Universality of health care
Rights – to health care
Good quality health care
Balance – individual and population
health
Patient-centered health care
Comprehensiveness – illness and
prevention focused
Equity and solidarity
Cooperation – between patients,
providers and organizations
Evidence and dignity
Improvement – enhance quality
Safety – avoid harm
Openness – honest and trustworthy
Core Values and Principles
International Hospital Federation
Tavistock/Cambridge Principles
Universality of health care
Rights – to health care
Good quality health care
Balance – individual and population
health
Patient-centered health care
Comprehensiveness – illness and
prevention focused
Equity and solidarity
Cooperation – between patients,
providers and organizations
Evidence and dignity
Improvement – enhance quality
Safety – avoid harm
Openness – honest and trustworthy
Core Values and Principles
International Hospital Federation
Tavistock/Cambridge Principles
Universality of health care
Rights – to health care
Good quality health care
Balance – individual and population
health
Patient-centered health care
Comprehensiveness – illness and
prevention focused
Equity and solidarity
Cooperation – between patients,
providers and organizations
Evidence and dignity
Improvement – enhance quality
Safety – avoid harm
Openness – honest and trustworthy
Core Values and Principles
International Hospital Federation
Tavistock/Cambridge Principles
Universality of health care
Rights – to health care
Good quality health care
Balance – individual and population
health
Patient-centered health care
Comprehensiveness – illness and
prevention focused
Equity and solidarity
Cooperation – between patients,
providers and organizations
Evidence and dignity
Improvement – enhance quality
Safety – avoid harm
Openness – honest and trustworthy
Core Values and Principles
International Hospital Federation
Tavistock/Cambridge Principles
Universality of health care
Rights – to health care
Good quality health care
Balance – individual and population
health
Patient-centered health care
Comprehensiveness – illness and
prevention focused
Equity and solidarity
Cooperation – between patients,
providers and organizations
Evidence and dignity
Improvement – enhance quality
Safety – avoid harm
Openness – honest and trustworthy
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
Healthcare
E
T
H
I
C
S
Fostering IHF’s Core Values
and Principles
IHF’s
Values
Fostering IHF’s Core Values
and Principles
Member
Organizations
IHF’s
Values
Fostering IHF’s Core Values
and Principles
Health Care
Facilities
Member
Organizations
IHF’s
Values
Fostering IHF’s Core Values
and Principles
Provider-patient
Encounters
Health Care
Facilities
Member
Organizations
IHF’s
Values
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
Features of Ethical Hospitals
and Health Care Organizations
• Ethical leadership
Features of Ethical Hospitals
and Health Care Organizations
• Ethical leadership
• Shared organization mission, culture and values
Features of Ethical Hospitals
and Health Care Organizations
• Ethical leadership
• Shared organizational mission, culture and values
• Ethics grounded clinical and management
practices
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
Ethical
Leadership
Ethical
Practices
Ethics
Program
Ethical
Culture
Benefits of Ethical Hospitals and
Health Care Organizations
• Enhanced patient satisfaction
• Increased employee morale and loyalty
• Improved community relations
• Fewer wasteful/unwanted treatments
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
Potential Benefits of an
Ethics Focused Organization
Improved quality of care
Enhanced economic status
Ethically sound culture
___________________________
A more successful, patient-centered organization!
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
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