Cindy Heine on building ethical competence

Integrating Ethics into a Health System

WWJD? We have all seen the license plates and bracelets – What Would Jesus Do? A quick, clever – though simplistic – way to reflect on actions against the standard set by Jesus. The Franciscan Missionaries of Our Lady Health System has taken a similar approach – albeit a bit more complicated application – as a means of addressing ethics within its faith-based organizations. The professional chaplain has skills in assisting patients and families to interpret their beliefs in light of necessary decisions. These skills are transferable to an organization’s ethical decision-making and are one additional way that chaplains can add value. Here is one story that may serve as an example.

Prior to the Enron and WorldCom scandals, seeing the ever-increasing pressures related to healthcare’s commercial environment, as well as the advancement of medical technology, our sponsors called for an examination of the ethics function. The Franciscan Missionaries of Our Lady Health System – FMOLHS – formed a multi-disciplinary ethics work group to take up this charge.

The efforts began with a review of current practices as well as an extensive literature review and ended with an integrated approach to ethics as well as a revised code of conduct entitled, “Principles of Organizational Ethics.” It became clear that as a faith-based organization our focus needed to be as broad as possible. Who we are as a faith-based organization needed to mold and shape our decisions, whether those decisions were being made at the bedside, boardroom, or billing office. Therefore, our efforts encompassed medical ethics as well as compliance, social responsibility, and business practice issues. We began by defining organizational ethics as who we are and how we ought to act.

This understanding was depicted in a conceptual model* and was followed by a revised code of conduct**. Having been approved at the highest levels of the organization, this approach builds ethical competence in the organization to read the signs of the times and reflect our history and tradition in the current realities. It is also believed that such an approach will allow FMOLHS to be more proactive in identifying and addressing ethical issues, thereby creating ethical standards of practice rather than being reactive to a situation or, worse yet, unaware that an issue exists.

Efforts to operationalize this approach have included annual and new hire employee education, public posting on websites, inclusion in Medical Staff by-laws, and an annual Ethics Summit designed for Executive and Governance leaders, etc. There is now cross-functional review of both traditional ethics committee information along with quality, satisfaction and compliance data being reported to the highest levels of the organization. The sharing of multiple data points allows for a more comprehensive view from which to identify trends and patterns.

There was not one particular issue or challenge that led to this approach. We were not out to fix a problem but to prevent one. It was just one more step in one health system’s efforts to follow the example of those who have gone before them in the midst of very challenging times.

* Conceptual Model

** Code of Conduct