The Alberta Health Services Ethics Framework

Al-Noor Nenshi Nathoo and Kimberley Stever

A Guide for AHS Staff, Physicians and Volunteers

Opportunity

• Accreditation Canada requires health organizations to have an Ethics Framework that identifies processes and tools within the organization to manage ethical issues, dilemmas, and concerns.

• Given AHS’ commitment to supporting ethical decision-making, the need for an Ethics Framework provided an opportunity to launch a cross-portfolio initiative to develop a consistent, easily understandable and resourced approach to addressing ethics issues.

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Alberta Health Services (AHS) is committed to building an ethical culture and promoting public trust. Patient and family centered care is enhanced when clinicians, patients and their families are supported in the presence of challenging ethical issues.

Build Understanding

• Over a 4-month period, an Ethics Framework Working Group solicited input from a cross-section of representatives across the organization, including front-line clinicians, patients and families, leaders, physicians, and clinical ethics committee members.

• The result of those efforts is the AHS Ethics Framework (Framework). The Framework provides a summary of the resources available to staff and patients within AHS to support ethical behaviour and decision-making, and to build the collective ‘ethics IQ’ of the organization.

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Ethics Framework - Section I

“Section I - Ethics Resources” describes AHS support available in four different

areas of ethics

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Quality Improvement &

Evaluation Ethics

Screening Tool

Research Ethics Boards

AHS Ethics & Compliance

Office

AHS Clinical Ethics Service

Ethics Framework – Section II

“Section II - Ethics Decision-Making Process” outlines a step-by-step decision-making guide to be used by staff to help identify and address ethics issues.

The Framework is available atwww.albertahealthservices.ca/9879.asp

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Patient Safety/Quality Improvement Contribution & Measurement

Central to patient safety & quality improvement is a just and trusting culture. The Framework plays a central role in:(1) Clarifying for staff and patients the significant resources that exist within the

organization to help them address ethics issues and build their ethical healthcare practices; and

(2) Supporting their own efforts in critical thinking to identify, analyze and act on ethical issues that arise everyday in delivery of healthcare.

AHS will track levels of awareness of ethics resources, requests for ethics support and consultation, requests for ethics education and capacity building, as well as quality of ethics services provided through the applicable departments beginning in 2015-16.

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PartnershipIn an organization of over 110,000 personnel, partnership amongst key stakeholders and divisions is a priority if initiatives are to effect change. A variety of groups were involved or consulted in the development of the Framework.

Representatives from AHS Clinical Ethics, Research

Ethics, Organizational/Ethic

s Compliance, and Quality

Improvement Ethics

Inclusion of patient voices as well as the

concerns of front-line clinicians

through the AHS Patient and Family Advisory Council and the Alberta Clinician Council

Final review and support from senior leaders: the Quality and Safety Executive Committee (QSEC), Co-CEOs, and the

Official Administrator

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Sustain Results

Key lessons learned from Phase I (Development) include:

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Attention to Process

• The initial goal was to develop and publish a consistent organizational approach to building an ethical culture within AHS. Ultimately, the process of development was just as valuable as the end product:• In stakeholder consultations,

a variety of issues and concerns were raised about how the organization can better support ethical decision-making.

• This input was both instrumental to the initiative and enlightening for those leading it.

Awareness

• This process uncovered gaps within AHS regarding the presence and availability of existing resources to support staff and patients in their ethical decision-making: • The majority of staff and

patients consulted were not aware of the various ethics departments or services within AHS.

• This underscores the need to ensure that the Framework is widely communicated, and that the initiative is properly resourced, in order for it to be effective.

Time

• Developing a consistent framework of this kind takes time, due to:• The number and wide range

of stakeholders relevant to the process.

• The nature and complexity of values-based decision-making.

• The difficulty in communicating information about such a complex subject to a broad audience.