[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Preventive ethics (PE) is a key component of IntegratedEthics (IE), an innovative model developed by the Veterans Health Administration (VA)'s National Center for Ethics in Health Care which establishes a comprehensive, systematic, integrated approach to ethics in health care organizations. Since early 2008, IE has been implemented throughout all 153 medical centers and 21 regional networks within the US Department of Veterans Affairs (VA) health care system. ISSUES: A STEP-BY-STEP APPROACH TO ETHICS QUALITY IMPROVEMENT: PE employs a systematic, step-by-step process improvement approach called ISSUES: Identify an issue, Study the issue, Select a strategy, Undertake a plan, Evaluate and adjust, and Sustain and spread. After the ethics quality gap is described, a measureable and achievable improvement goal based on the gap is developed. One of the most challenging aspects of describing an ethics quality gap is to establish an appropriate ethical standard on which to base the operational definition of best ethics practice. PRACTICAL STEPS TO DEVELOPING A PREVENTIVE ETHICS FUNCTION: Within the VA's IE model, PE is situated as a subcommittee of the IE council, which is chaired by the facility director (equivalent to a hospital chief executive officer) and oversees all aspects of the organization's ethics program, including ethical leadership, ethics consultation, and PE. Each VA medical center is required to have a PE team led and managed by a PE coordinator and may need to address ethics issues across the full range of health care ethics domains. Conclusions: The VA's IE model establishes a robust conceptual framework, along with concrete tools and resources, to integrate PE concepts into the day-to-day operations of a health care organization and is directly transferrable to other health care organizations and systems.
Joint Commission journal on quality and safety 03/2012; 38(3):103-11.
[Show abstract][Hide abstract] ABSTRACT: The IntegratedEthics model represents a fundamental departure from the traditional approach to ethics in health care organizations. IntegratedEthics was developed by the National Center for Ethics in Health Care within the United States Government‘s Department of Veterans Affairs (VA). The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, delivering health services to nearly 6,000,000 patients each year through more than 1,500 sites of care. The IntegratedEthics model was developed and refined over more than five years by a design team comprising individuals from diverse fields including bioethics, medicine, public administration, business, education, communications, nursing, and social sciences. The design team used a rigorous consensus development process that included in-depth literature reviews across multiple fields of study and extensive input from internal and external stakeholders representing numerous organizations. IntegratedEthics structures, methods, and tools have been systematically evaluated through validity testing, field testing, and a 12-month demonstration project in 25 separate health care facilities. Since early 2008, IntegratedEthics has been implemented throughout all of VA‘s 153 medical centers and 21 regional networks. The model