By Stacey Kusterbeck
The work of ethics usually aligns closely with the mission of the hospital or health system. Unfortunately, hospital leaders often are completely unaware of it.
At Northwestern Memorial Hospital in Chicago, the clinical ethics program has grown and expanded its scope beyond bedside ethics consultations. Along the way, ethicists made sure hospital leaders knew about it. “We have tracked organizational-level ethics work for the purpose of accountability to leadership,” reports M. Jeanne Wirpsa, MA, BCC, HEC-C, program director for medical ethics.
Data are needed to demonstrate the effect of ethicists on organizationwide priorities. “We want to heighten visibility of the importance of including a clinical ethical perspective on issues such as drug shortages, innovative medical procedures, and diversity/equity initiatives,” says Wirpsa.
For each consult, ethicists collect data on these patient-centered “value-added” categories:
• aligning the care plan with patient preferences;
• mitigating the burden on a family decision-maker;
• protecting a vulnerable patient.
Ethicists also collect data on these institution/clinical “value-added” categories:
• facilitating timely discharge;
• guiding team members to appropriate resources.
The ethicist determines which, if any, of these outcomes were contributed to during the consult. “We seek to align our work with the priorities of the organization, while remaining true to the soul of clinical ethics,” says Wirpsa.
Ethicists also consider the organization’s mission when starting new programs or initiatives. Recently, ethicists launched a Clinical Ethics Resource Nurse Program and unit-based ethics case conferences. Ethicists surveyed clinicians about the effect these new programs had on clinicians’ own ethical competency, on their moral agency and resilience, and on the overall organizational ethical climate. “Fortunately, in many cases we were able to incorporate validated reliable measurement tools to substantiate this impact,” says Wirpsa.
Another recent change made by ethicists involves patient demographic information. Ethicists now document race, ethnicity and primary language (as reported by the patient), and economic status (disadvantaged or not, as assessed by the clinical ethicist using agreed-upon parameters). “Preliminary analysis demonstrates trends based on race/ethnicity and disadvantaged status,” notes Wirpsa. A higher portion of ethics consults for non-white patients involved concerns related to refusal of treatment, to the discharge plan, to futility/inappropriate care, to decision-making capacity, and to distrust.
“We hope the new data will enable us to align our program goals and approach with current efforts that are underway, both by our organization and in the field of bioethics, to address racism and promote equitable care,” says Wirpsa.
