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Preventive Ethics. Beyond the Basics. Module 1. Determining Whether an Issue Is Right for the ISSUES Approach. Learning Objectives. Describe the criteria for determining whether an issue is appropriate for a quality improvement approach such as ISSUES.
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Preventive Ethics Beyond the Basics
Module 1 Determining Whether an Issue Is Right for the ISSUES Approach
Learning Objectives • Describe the criteria for determining whether an issue is appropriate for a quality improvement approach such as ISSUES. • Apply the criteria to determine whether an issue is appropriate for a quality improvement approach such as ISSUES.
ISSUES Link IDENTIFY an Issue Be proactive in identifying ethics issues Characterize each issue Clarify each issue by listing the improvement goal Prioritize the issues and select one
Selecting Issues for a QI Approach A quality improvement approach is appropriate for issues resulting from failures caused by systems or processes that may not be reliably producing the desired outcome.
Selecting Issues for a QI Approach: Another Consideration • Appropriate for issues that require further study to accurately describe current workflow process, ethics quality gap, underlying causes of gap • Small-scale testing also needed
Tools for Assessing Appropriateness • Choosing Issues for PE—Worksheet • Choosing Issues for PE: Tracking Tool • IntegratedEthics Health Care Ethics Domains and Topics
Urgent Issue? Does the issue require urgent and immediate action by leadership? Take to leadership!!
Simple Issue? Is the issue simple, with an obvious solution? Just do it!
Another Program Responsible? Is there another program or service responsible for this issue? Refer or collaborate CAUTION
Ethics Quality Gap The disparity between what should be (best ethics practice) and what is (current ethics practice)
Best Ethics Practice • Ethics domain • Ethics topic • Ethical standard
Ethics Domain? • Clinical • Business • Research
Inconsistent with Ethical Standards, Norms, or Expectations? • Written standards • Ethics expertise
Current Ethics Practice • Measurable data • Easily collected data
Measurable Data Available? • Measure ethical practice • Express as percent or number
Easily Collected Data? • Consider data collection method required for easily collecting the data
Example: Advance Directives Issue A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.
Ethics Domain? Column 7: Is there an ethics domain related to this issue? A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff. Shared Decision Making with Patients
Ethics Topic? Column 8: Is there an ethics topic related to this issue? A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff. Advance Care Planning
Standards, Norms, or Expectations? Column 9: Is the practice inconsistent with ethical standards, norms, or expectations? A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff. VHA Handbook 1004.02 Advance Care Planning and Management of Advance Directives
Quantifiable Data? Column 10: Is quantifiable data about current ethics practice readily available? A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff. No
Quantifiable Data? Column 11: Is quantifiable data about current ethics practice easily collected? A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff. Yes, through several methods such as health record reviews or interviews of patients or staff
Appropriate for ISSUES Approach? Does this issue suggest an ethics quality gap amenable to an ISSUES approach? YES!
When Issue Isn’t Appropriate • Get back to process owner for identified issue. • Explain reasoning for PE team’s decision. • Help program or service think through where else they might turn for assistance. • Ask ethics program leadership to assist.
Preliminary Improvement Goal • Draft general statement of the desired ethical practice
Group Activity InstructionsHandouts 1.2, 1.3, 1.5–1.10 (20 min) • Answer questions 4–12 on worksheets. • Mark answers on tracking tool (Handout 1.2). Be prepared to discuss: • Is issue appropriate for PE, and why (or why not)? • If uncertain after applying criteria, what other information might help you decide? • What will you do if it is not appropriate for ISSUES approach?
Takeaways Determining whether an issue is right for the ISSUES approach • Being good stewards of your resources; excluding issues that aren’t appropriate • Using appropriateness criteria on worksheet and tracking tool • Looking for ethics quality gap • Drafting preliminary improvement goal
Module 1 Questions?
