Preventive Ethics - National Center for Ethics in Health Care - US ...

Part II: Introduction to Preventive Ethics
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The preventive ethics team learns about systemic ethics issues from its own ongoing
monitoring and input from institutional sources, including the IntegratedEthics Council, the
facility ethics consultation service, senior leaders, service and program heads, and QM
staff. The preventive ethics team should take steps to ensure that these groups are aware
of the team’s existence, understand what the team does, and know how to refer issues to
the team for consideration.
Developing a referral network takes time and commitment—a one-time presentation, for
example, to a meeting of senior leaders, isn’t sufficient. Establishing routine communication
with key individuals, services, and programs is crucial to developing and maintaining
a vibrant referral network. Participation by the Preventive Ethics Coordinator in the
facility’s IntegratedEthics Council will help to establish relationships and ensure regular
communications with programs and offices across the institution. But the preventive ethics
team should also consider routinely getting on the agenda at key meetings as part of
ongoing efforts to market preventive ethics. Potential referral sources will want to know
what the team can do for them—and a powerful source of persuasion will be successfully
completed ISSUES cycles and accompanying storyboards.
The preventive ethics team should also clearly understand that frontline staff across
the organization can be a rich source of potential ethics quality issues. Supervisors
and managers—from clinical services to the business office to human resources to
maintenance—should encourage staff to share their ethical concerns so that managers
can refer potential ethics issues to the preventive ethics team.
A preventive ethics team shouldn’t be expected to act on every issue referred to it.
Preventive ethics involves prioritizing among the various ethics issues that need attention
and addressing the highest priority issues first. The preventive ethics team should ensure
that those who refer issues understand this. The team should also take care to “close the
feedback loop” by informing requesters when or if the team will take action on a particular
issue that has been referred to it. If the team doesn’t intend to act, it’s important that it
explains why and indicate whether the issue might become a priority later.
The preventive ethics team shouldn’t rely only on referrals to identify ethics quality issues,
however. The team should go out and seek the most pressing issues from the virtually
unlimited supply of quality improvement opportunities to be found in any health care
organization. Also, through his or her position on the local IntegratedEthics Council the
Preventive Ethics Coordinator has an excellent opportunity to identify issues proactively—
and to appreciate what issues most trouble leaders across the organization.
Accountability
Like any other important health care function, preventive ethics must have a clear
system of accountability. Day-to-day responsibility for preventive ethics should rest with
a designated individual, the Preventive Ethics Coordinator. In the IntegratedEthics model
(see Part I), this individual is accountable to the IntegratedEthics Program Officer, who is
in turn accountable to the member of the facility’s top leadership (e.g., the facility director)
who chairs the IntegratedEthics Council.
The IntegratedEthics Council provides a mechanism for oversight of preventive ethics.
The council is responsible for establishing specific goals, structures, processes, and
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