The art of improving is heading your way
Standards call for evaluation, QI
(Editor’s note: Last month’s issue of Medical Ethics Advisor included a special report on the Standards for Bioethics Consultation, a draft document prepared by a combined task force from the Cleveland-based Society for Bioethics Consultation and the McLean, VA-based Society for Health and Human Values. A final version is expected to be presented in late February and could serve as a self-regulating document for individuals and ethics committee team members within all areas of bioethics. This is the second article providing information on how the draft document will impact hospital-based ethics committees.)
No doubt you’ve heard the terms quality improvement (QI) or outcomes collection throughout the hospital halls and wondered if the philosophy would ever reach the field of medical ethics. Last month, it happened, and many in the medical ethics field viewed the move as bringing the specialty closer in line with that of the clinical practices.
One aspect of the proposed Standards for Bioethics Consultation presented at a joint meeting of three ethics organizations last November focuses on the importance of evaluation in ethics consultation. Task force members who drafted the standards cite three reasons evaluation deserves a prominent place within the document.
First, ethics consultations rarely are formally evaluated. While quality assurance and performance criteria are becoming increasingly common in other areas of the health care industry, the ethics consultation process has remained immune, according to the document. One reason for the immunity could reflect the difficulty in agreeing on measurable outcomes that adequately reflect the goals of ethics consultation, the standards point out.
Second, empirical data are lacking with regard to which methods for ethics consultation individual, team, or committee best meet the goals.
Third, because the issues demanding consultative attention will change and evolve in the coming years, there’s no guarantee that current requirements for quality ethics consultation will continue to serve well in the future. Only with an active program of thoughtful and ongoing evaluation will those conducting ethics consultations be able to make the necessary corrections to keep up with the evolving subject matter, according to the standards.
Learn from pioneers in evaluation
There are other advantages to evaluation as well, says Alvin H. Moss, MD, director of the Center for Health Ethics and Law at the Robert C. Byrd Health Sciences Center of West Virginia University in Morgantown. "We’ve been evaluating our consultations for quite some time," he says.
Ethics consultants complete a five-item survey and rate each item on a scale of one to five. (For a sample of the evaluation, see p. 7.) There are times when only a few members of the ethics committee actually consult on a particular case, and an evaluation of the consult helps other members learn from the interaction, Moss points out. Plus, problems within the hospital’s internal structure can be identified through an evaluation process.
Evaluations can be presented at committee meetings for open discussion on how to improve individual ethics consultations as well, he says. The evaluations also help improve educational levels of all committee members.
"If there’s a member with a low skill level, maybe in a clinical area, the evaluation helps to improve that member’s knowledge," he explains.
Brush up on skills
A good example of improved knowledge lies in the proposed standards themselves. They require that those conducting ethics consultations have access to physicians, nurses, and other health care professionals who have advanced clinical knowledge in particular cases. A basic level of knowledge for ethics committee members, however, is outlined as follows:
1. terms used in diagnosis, treatment, and prognosis for common medical problems;
2. abbreviations of common medical and clinical terms;
3. terms for basic human anatomy.
Having new ethics committee members or members with lower knowledge levels of clinical issues spend time with physicians and nurses is one way to increase their skill level. Attending conferences, orientation sessions, and inservices are other methods of educating new team members. (For a list of core areas, see the supplement inserted in this issue.)
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