Making the most of disequilibrium: Bridging the gap between clinical and organizational ethics in a newly merged healthcare organization

Journal of Clinical Ethics

Volumn 10, Issue 3, 1999, Pages 194-201

  Myser, Catherine ^a   Donehower, Patricia ^b,c   Frank, Cathy ^c  

^a UNIVERSITY OF VERMONT COLLEGE OF MEDICINE   (United States)

^b Visiting Nurse Association   (United States)

^c FLETCHER ALLEN HEALTH CARE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BIOETHICS AND PROFESSIONAL ETHICS; ETHICIST; ETHICS; FLETCHER ALLEN HEALTH CARE (BURLINGTON, VT); HEALTH CARE AND PUBLIC HEALTH; HEALTH CARE COST; HEALTH CARE QUALITY; HUMAN; INSTITUTIONAL ETHICS; MEDICAL ETHICS; ORGANIZATION; ORGANIZATION AND MANAGEMENT; PROFESSIONAL STANDARD; SOCIAL BEHAVIOR; UNITED STATES;

BIOETHICS AND PROFESSIONAL ETHICS; FLETCHER ALLEN HEALTH CARE (BURLINGTON, VT); HEALTH CARE AND PUBLIC HEALTH;

COMMITTEE MEMBERSHIP; ETHICISTS; ETHICS COMMITTEES; ETHICS COMMITTEES, CLINICAL; ETHICS CONSULTATION; ETHICS, CLINICAL; ETHICS, INSTITUTIONAL; ETHICS, MEDICAL; HEALTH CARE SECTOR; HUMANS; ORGANIZATIONAL CULTURE; QUALITY ASSURANCE, HEALTH CARE; SOCIAL RESPONSIBILITY; UNITED STATES;

EID: 0033182660     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (18)

1. S. Lutz, "1995: A Record Year for Hospital Deals," Modern Healthcare 25, no. 51 (1995): 43.
2. Fletcher Allen Health Care is named after two women, Mary Fletcher and Fanny Allen.
3. P.B. Hofmann, "Hospital Mergers and Acquisitions: A New Catalyst for Examining Organizational Ethics," Bioethics Forum 12, no. 2 (1998): 46.
4. D.O. Renz and W.B. Eddy, "Organizations, Ethics, and Health Care: Building an Ethics Infrastructure for a New Era," Bioethics Forum 12, no. 2 (1998): 29-39.
5. R.L. Potter, "From Clinical Ethics to Organizational Ethics: The Second Stage of the Evolution of Bioethics," Bioethics Forum 12, no. 2 (1998): 3. According to Potter, "The growing edge is the new frontier of organizational ethics. Although it has been there all the while, only recently has it become the cauldron of ferment and change."
6. The Clinical Ethics Committee is locally referred to as the Medical Staff Ethics Advisory Committee.
7. The Board of Trustees Ethics Committee had overlapping membership with the newly merged Clinical Ethics Committee. The chair of the Board of Trustees Ethics Committee served on the Clinical Ethics Committee, and four members of the Clinical Ethics Committee served on the Board of Trustees Ethics Committee.
8. Board of Trustees Ethics Committee members include four FAHC Board of Trustee members; the president of the medical staff; four members from the Clinical Ethics Committee (including its chair); one individual knowledgeable in Judeo-Christian values; and others who have knowledge of other cultures, beliefs, and values. The chair of the FAHC Board of Trustees, chief executive officer of FAHC, and president of the medical staff are ex officio members.
9. F.W. Hafferty and R. Franks, "The Hidden Curriculum, Ethics Teaching, and the Structure of Medical Education," Academic Medicine 69, no. 11 (1994): 861-71.
10. The Ethics Task Force members were appointed by the chief medical officer. They included two FAHC Board of Trustee members, the chief financial officer, the chief medical officer, the chief nursing officer, the director of ethics, the college of medicine's dean of education, a nurse educator, two former chairs of the premerger Clinical Ethics Committees (one physician and one nurse), the director of spiritual services, and the corporate liaison sponsor of the Catholic Health Care System. Three of these task force members were also members of the Clinical Ethics Committee, and four were also members of the Board of Trustees Ethics Committee (including its chair).
11. These stakeholders include the FAHC Board of Trustees, the Board of Trustees Ethics Committee, the Medical Staff Executive Committee, the Clinical Ethics Committee, the Nursing Shared Governance Council, two University of Vermont institutional review boards, and the University of Vermont College of Medicine Instructional Design Committee.
12. C. Bosk, Forgive and Remember: Managing Medical Failure (Chicago, IL.: University ofChicago Press, 1979).
13. Approximately 40 percent of all consultations were requested by attending physicians. Residents and nurses each requested an additional 22 percent of all consultations. Patients and families, administrators, and other healthcare professionals and staff requested the remaining 16 percent or so. Approximately 30 percent of all consultations involved patients in various intensive care units.
14. Indeed, in 1997, the Board of Trustees approved a policy supporting the creation and ongoing financial support of the Ethics Program at FAHC.
15. Those sent from FAHC included a risk manager, two nurse administrators (one from the Visiting Nurse Association), a social worker, the director of patient relations, and the director of quality monitoring and improvement. Those sent from the University of Vermont included the dean of medical education, the dean of primary care, an associate professor of surgery, an assistant professor of internal medicine, the director of inpatient psychiatry, an assistant professor of nursing, the dean of allied health, and an associate professor of allied health.
16. One participant reflected, "We have moved from unconscious incompetence in ethics to conscious incompetence in ethics, and that is an important advance toward learning."
17. Membership of the Organizational Ethics Council suggested by the Ethics Task Force included two physicians (one from FAHC and one from the community); two nurses (one hospital-based, one outpatient); the director of ethics; one representative each from risk management, patient relations, pastoral care, pharmacy, human resources, quality improvement, social work, and senior management; an education expert; and two at-large members with relevant expertise (for example, experts in business ethics or organizational development). The Ethics Task Force advised that the Organizational Ethics Council chair be appointed by the chief medical officer from among the committee's members.
18. The members of the Quality Council are the chief executive officer, the chief medical officer, the chief nursing officer, the chief financial officer, the senior vice president/medical director, the director of quality/monitoring/ improvement, the vice president of quality and care management, and the director of human resources.