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41 - Innovative strategies to improve effectiveness in clinical ethics

Published online by Cambridge University Press:  30 October 2009

By
Jennifer L. Gibson ,
M. Dianne Godkin ,
C. Shawn Tracy  and
Susan K. MacRae
Edited by
Peter A. Singer  and
A. M. Viens
Jennifer L. Gibson
Affiliation:
Assistant Professor University of Toronto
M. Dianne Godkin
Affiliation:
Clinical Ethicist and Manager Center for Clinical Ethics Toronto, Canada
C. Shawn Tracy
Affiliation:
Research Associate, Primary Care Research Unit University of Toronto, Canada
Susan K. MacRae
Affiliation:
Deputy Director and the Director of the Clinical Ethics Fellowship University of Toronto, Canada
Peter A. Singer
Affiliation:
University of Toronto
A. M. Viens
Affiliation:
University of Oxford
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Summary

A large tertiary healthcare organization has a full-time clinical ethicist who is responsible for ethics consultation, education, policy development, and research. A recent accreditation survey identified a number of gaps in clinical ethics services across the organization. The clinical ethicist is already over-extended and is at risk of burning out. The Vice-President responsible for overseeing the ethics portfolio wonders what can be done to enhance support for the clinical ethicist, strengthen ethics capacity across the organization, and improve the overall effectiveness of clinical ethics services.

What is clinical ethics effectiveness?

The ultimate goal of any clinical ethics delivery model is improved patient care. As more healthcare resources are invested in clinical ethics services, questions are increasingly raised about whether these services are effective in improving the quality of patient care and whether they justify investments of limited healthcare resources. In this chapter, we identify some key challenges to existing clinical ethics delivery models and suggest four innovative strategies to improve effectiveness in clinical ethics services in healthcare organizations.

Since 1995, when James Tulsky and Ellen Fox convened the Conference on Evaluation of Case Consultation in Clinical Ethics (AHCPR, 1995), there has been a marked increase in scholarly attention to the study and evaluation of clinical ethics, particularly related to the ethics consultation component of clinical ethics (e.g., McClung et al., 1996; Orr et al., 1996; Schneiderman et al., 2000). This has been described as a new phase in the clinical ethics movement (Aulisio, 1999).

Type
Chapter
Information
The Cambridge Textbook of Bioethics , pp. 322 - 328
Publisher: Cambridge University Press
Print publication year: 2008

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References

AHCPR (1995). Conference on Evaluation of Case Consultation in Clinical Ethics. Chicago, IL: University of Illinois press for the Agency for Health Care Policy and Research.Google Scholar
ASBH (1998). Core competencies for health care ethics consultation. Washington, DC: American Society for Bioethics and Humanities (http://www.asbh.org/publications/core.html).
Aulisio, M. P. (1999). Ethics consultation: is it enough to mean well? HEC Forum 11: 208–17.CrossRefGoogle ScholarPubMed
Aulisio, M. P., Arnold, R. M., and Youngner, S. J. (2000). Health care ethics consultation: nature, goals, and competencies. Ann Int Med 133: 59–9.CrossRefGoogle ScholarPubMed
Berchelmann, K. and Blechner, B. (2002). Searching for effectiveness: the functioning of Connecticut clinical bioethics committees. J Clin Bioethics 13: 131–45.Google Scholar
CCHSA (2004). The Canadian Health Accreditation Report 2004. Ottawa: Canadian Council for Health Services Accreditation (http://www.cchsa.ca/pdf/2004report.PDF) accessed 5 June 2006.
Chidwick, P., Faith, K., Godkin, D., and Hardingham, L. (2004). Clinical education of ethicists: the role of a clinical ethics fellowship. BMC Med Ethics 8: 5.Google Scholar
Cleary, P. D. and Edgman-Levitan, S. (1997). Health care quality: incorporating consumer perspectives. JAMA 278: 1608–12.CrossRefGoogle ScholarPubMed
Fox, M. D., McGee, G., and Caplan, A. (1998). Paradigms for clinical ethics consultation practice. Camb Q Healthc Ethics 7: 308–14.CrossRefGoogle ScholarPubMed
Godkin, M. D., Faith, K., Upshur, R. E. G., MacRae, S. K., and Tracy, C. S. (2005). Project Examining Effectiveness in Clinical Ethics (PEECE): phase 1 – descriptive analysis of nine clinical ethics services. J Med Ethics 31: 505–12.CrossRefGoogle ScholarPubMed
Griener, G. G. and Storch, J. L. (1992). Hospital ethics committees: problems in evaluation. HEC Forum 4: 5–18.CrossRefGoogle ScholarPubMed
JCAHO (2007). Overview of 2007 Leadership Standards. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations, p. 20 (http://www.jointcommission.org/NR/rdonlyres/A55ACEC4-E027-4FE0-8532-C023E8817A30/0/07_bhc_ld_stds.pdf).
MacRae, S., Chidwick, P., Berry, S., et al. (2005). Clinical bioethics integration, sustainability, and accountability: the hub and spokes strategy. J Med Ethics 31: 256–61.CrossRefGoogle ScholarPubMed
McClung, J. A., Kaner, R. S., DeLuca, M., and Barger, H. J. (1996). Evaluation of a medical ethics consultation service: opinions of patients and health care providers. Am J Med 100: 456–60.CrossRefGoogle ScholarPubMed
McGee, G. (1995). Therapeutic ethics. Uni Pennsylvania Cent Bioethics Newslet 1: 3–4.Google Scholar
McNeill, P. M. (2001). A critical analysis of Australian clinical ethics committees and the functions they serve. Bioethics 15: 443–60.CrossRefGoogle ScholarPubMed
Orr, R. D., Morton, K. R., deLeon, D. M., and Fals, J. C. (1996). Evaluation of an ethics consultation service: patient and family perspectives. Am J Med 101: 135–41.CrossRefGoogle Scholar
Pointer, D. and Sanchez, J. (2005). Leadership: a framework for thinking and acting. In Healthcare Management: Organizational Behaviour and Design, 5th edn, ed. Shortell, S. and Kaluzny, A.. Albany: Delmar, pp. 106–29.Google Scholar
Schneiderman, L. J., Gilmer, T., and Teetzel, H. D. (2000). Impact of ethics consultations in the intensive care setting: a randomized, controlled trial. Crit Care Med 28: 3920–4.CrossRefGoogle ScholarPubMed
Siegler, M. and Singer, P. A. (1988). Clinical ethics consultation: godsend or “god squad”? Am J Med 85: 759–60.CrossRefGoogle ScholarPubMed
Silva, M. (1998). Organisational and administrative ethics in health care: an ethics gap. Online J Issues Nurs3: 1–13 (http://www.nursingworld.org/ojin/topic8/topic8_1.htm) accessed 5 June 2006.
Slowther, A., Bunch, C., Woolnough, B., and Hope, T. (2001). Clinical ethics support services in the UK: an investigation of the current provision of ethic support to health professionals in the UK. J Med Ethics 27: 2–8.CrossRefGoogle ScholarPubMed
Storch, J. L. and Griener, G. G. (1992). Ethics committees in Canadian hospitals: report of the 1990 pilot study. Healthc Manag Forum 5: 19–26.CrossRefGoogle ScholarPubMed
Tracy C. S., MacRae S. K., Upshur, R. E. G., for the Clinical Ethics Group (2005). Project Examining Effectiveness in Clinical Ethics (PEECE): findings of a case study comparison of nine clinical ethics services. In Proceedings of the 2nd International Clinical Ethics Conference, Basel, Switzerland.
Woolf, S. M. (1994). Quality assessment of ethics in health care: the accountability revolution. Am J Law Med 20: 105–28.Google Scholar
Wynia, M. (1999). Performance measures for ethics quality. Effect Clin Pract2: 294–9 (http://www.acponline.org/journals/acp/novdev99/wynia.htm) accessed 3 June 2006.
Wynia, M. (2006). Who is measuring the ethical quality of care in American medicine? No one, yet. Med Gen Med8: 49 (http://www.medscape.com/viewarticle/531920) accessed 31 May 2006.

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