Ethics and Quality: Improvement and Impact. SJHS – The Ministry. Serve communities in 3 States through 14 Hospitals, 3 Integrated Medical Groups, Home Health and Outreach Market Share Leader in Every Region. Humboldt County. Eastern New Mexico. Sonoma County. Napa County. West Texas.
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Integrated Medical Groups, Home Health and Outreach
Eastern New Mexico
Ethics committee members were having common complaints:
The four principles which frame the orientation of our ethics services are:
Purpose is to discover new knowledge
Focus on one large “blind” test
Try to control for biases
Gather as much data as possible--“just in case”
Can take a long time to obtain results.
Purpose is to bring new knowledge into daily practice.
Many sequential observable tests
Stabilize the biases from test to test
Gather enough data to learn and complete another cycle
Small tests of significant changes accelerate the rate of improvement.The Difference betweenResearch and Improvement
An early, ethics intervention in ICU, addressing patients on the ventilator for 96 continuous hours (some of the most challenging in ICU), in order to improve team communication and decision making in accord with patient preferences.
Mel Dowdy, et al, “At Study of Proactive Ethics Consultation for Critically and Terminally Ill Patients with Extended Lengths of Stay.” Critical Care Medicine. 1998, Vol 26., No 2.
Strength of Steel improvement?
Opening in Hull
Steel Plates Buckled on Hull
Water Filled Hull
Speed (18 knots)
Ship in Water
Cause Map Tool
Ship Hit Iceberg
Ship Couldn't Turn Quickly Enough
Size of Rudder
Saw iceberg late
Strength of Steel
Ship in Water
Business of Company
From improvement? Diffusion of Innovations by Everett Rogers:
Characteristics of People Adopting Change
Require Local Personal Trust
“Standard of Practice”
“Tried and True”