Injecting Ethics into the Public Health Quality Improvement / Accreditation Movement. Kathy Vincent , LCSW Alabama Department of Public Health Ruth Gaare Bernheim , JD, MPH University of Virginia Alan Melnick , MD, MPH, CPH Health Officer, Clark, Cowlitz, Skamania, and Wahkiakum Counties.
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Injecting Ethics into the Public Health Quality Improvement / Accreditation Movement
Kathy Vincent, LCSWAlabama Department of Public Health
Ruth Gaare Bernheim, JD, MPHUniversity of Virginia
Alan Melnick, MD, MPH, CPHHealth Officer, Clark, Cowlitz, Skamania, and Wahkiakum Counties
Discussion issues we will return to in a few minutes:
Would you act any differently if:
Would you act any differently if a different water source at a high price could supply your city?
Would you act any differently if a different water source at no extra cost and without shortages could supply your city?
AccreditationOpportunity for health departments to learn and incorporate quality and performance improvement techniques
Quality ImprovementTechniques to improve performance and outcomes
“Multidisciplinary, systems- focused, data-driven method of understanding & improving the efficiency, effectiveness, and reliability of public health processes and practices.”
Rand Report ’06
Lessons from corporate management
Built to Last Collins and Porras
From Duncan & Ginter
Public Health Context
Activities and Policies
Public Health EthicsIssues
“…laws are often broadly framed, leaving much room for administrative discretion about when to use public health authority and about which intervention is more ethically appropriate when more than one alternative course of action is legally permissible.”
Bernheim RG, Nieburg P, and Bonnie RJ. “Ethics and the Practice of Public Health,” in Goodman RA (ed.), LAW IN PUBLIC HEALTH PRACTICE, 2nd ed., Oxford, New York, Oxford University Press (2005).
TB Outbreak in a Community
Rationale for including public health ethics in development of each accreditation standard
Flexibility allows public health ethics to be incorporated into different accreditation approaches
Principles of the Ethical Practice of Public Health*
Public health (PH) should address fundamental causes of disease and requirements for health
PH should achieve community health in a way respecting individuals’ rights
PH policies, programs, and priorities should be developed / evaluated with community members’ input
PH should work to empower disenfranchised community members, aiming to ensure access to basic resources necessary for health
* Principles of the Ethical Practice of Public Health, The Public Health Leadership Society (2002), http://www.phls.org
PH should seek information needed to implement effective policies / programs that protect and promote health
PH institutions should provide communities with information needed for policy / program decisions and should obtain community’s consent for implementation
PH institutions should act in timely manner within resources and mandate given by public
PH programs / policies should incorporate approaches that respect diverse values, beliefs, and cultures in community
PH programs / policies should be implemented in manner that most enhances physical and social environment
PH institutions should protect confidentiality of information that can bring harm to individual or community if made public
PH institutions should ensure their employees’ professional competence
PH institutions and their employees should engage in collaborations and affiliations that build public’s trust and institution’s effectiveness