Organizational ethics: Creating structural and cultural change in healthcare organizations

Journal of Clinical Ethics

Volumn 10, Issue 3, 1999, Pages 187-193

  Blake, David C ^a  

^a SAINT JOHN'S HEALTH CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANALYTICAL APPROACH; ARTICLE; BIOETHICS AND PROFESSIONAL ETHICS; BUSINESS ETHICS; ETHICS; HEALTH CARE AND PUBLIC HEALTH; HEALTH CARE COST; HUMAN; INSTITUTIONAL ETHICS; MEDICAL ETHICS; ORGANIZATION; PROFESSIONAL STANDARD; SOCIAL BEHAVIOR; SOCIAL PSYCHOLOGY; UNITED STATES;

ANALYTICAL APPROACH; BIOETHICS AND PROFESSIONAL ETHICS; HEALTH CARE AND PUBLIC HEALTH;

ETHICAL ANALYSIS; ETHICS; ETHICS COMMITTEES, CLINICAL; ETHICS, BUSINESS; ETHICS, INSTITUTIONAL; ETHICS, MEDICAL; HEALTH CARE SECTOR; HUMANS; ORGANIZATIONAL CULTURE; SOCIAL RESPONSIBILITY; SOCIAL VALUES; UNITED STATES;

EID: 0033182686     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (13)

1. As a convention for this article, I use the term healthcare ethics as a substitute for bioethics. I understand either term to cover the full range of normative considerations that are raised in health policy, healthcare management and business operations, clinical practice, and medical research.
2. For example, as may have occurred with the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-1978) or the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1978-1983), or as may be occurring now with the National Bioethics Advisory Commission (1995 to the present).
3. For example, if the American Medical Association's "Education for Physicians on End-of-Life Care" (EPEC) Project (1998) were revised into a program about the ethics of, say, billing and discharge practices. EPEC is also supported by the Robert Wood Johnson Foundation, itself no stranger to professional training.
4. For example, American Medical Association, Council on Ethical and Judicial Affairs, Code of Medical Ethics: Current Opinions with Annotations, 1998-1999 ed. (Chicago: American Medical Association, 1998); American Nurses Association, Code for Nurses with Interpretative Statements (Washington, D.C.: American Nurses Association, 1985).
5. For example, American Medical Association, Council on Ethical and Judicial Affairs, Code of Medical Ethics: Current Opinions with Annotations, 1998-1999 ed. (Chicago: American Medical Association, 1998); American Nurses Association, Code for Nurses with Interpretative Statements (Washington, D.C.: American Nurses Association, 1985).
6. For example, perhaps material for a fifth edition of T.L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 4th ed. (New York: Oxford University Press, 1994).
7. Joint Commission on Accreditation of Healthcare Organizations, "Patient Rights and Organizational Ethics," in Comprehensive Accreditation Manual for Hospitals: The Official Handbook (Oakbrook Terrace, Ill.: JCAHO, 1999), RI-1 - RI-38.
8. From In re Quinlan, 355 A.2d 647 (N.J. 1976); to Washington v. Glucksberg, 117 S. Ct. 2258 (1997); to Vacco v. Quill, 117 S. Ct. 2293 (1997).
9. Although they do not assign the work as I do here, Beauchamp and Childress (see note 5 above, pp. 28-32) - and Richardson before them - set out this idea as a "specification" of principles, which is my point expressed in more theoretical terms.
10. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) may have been the beginning of this process. See SUPPORT Principal Investigators, "A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients," Journal of the American Medical Association 274, no. 20 (1995): 1591-8; See also the work of Joanne Lynn, MD, who has a Breakthrough Collaborative Series project on care at the end of life with the Institute for Healthcare Improvement (IHI), available at 〈http://www.ihi.org/collaboratives/completed/bts-endofile.asp〉.
11. For more information on the status and results of the project contact: Maura Winesburg, Vice President for Quality Management, Saint John's Health Center, 1328 22nd St., Santa Monica, CA 90404.
12. A detailed description of the model upon which this initiative is based will be presented, analyzed, and debated in an up-coming issue of HEC Forum devoted to the model: HEC Forum 12, no. 1 (March 2000).
13. In organizational ethics, I tend not to draw any hard or fast line between "values" and "ethics." Ethics as a distinct "science" - grounded, for example, in reason and thus distinguishable from traditions, heritage, and culture (the stuff of values) - may be easier to accommodate in an academic world than in the maze of structures and cultures in healthcare organizations.