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Preventive Ethics. Beyond the Basics. Module 1. Determining Whether an Issue Is Right for the ISSUES Approach. Learning Objectives. Describe the criteria for determining whether an issue is appropriate for a quality improvement approach such as ISSUES.

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Preventive ethics

Preventive Ethics

Beyond the Basics


Module 1

Module 1

Determining Whether an Issue Is Right for the ISSUES Approach


Learning objectives
Learning Objectives

  • Describe the criteria for determining whether an issue is appropriate for a quality improvement approach such as ISSUES.

  • Apply the criteria to determine whether an issue is appropriate for a quality improvement approach such as ISSUES.


Issues link
ISSUES Link

IDENTIFY an Issue

Be proactive in identifying ethics issues

Characterize each issue

Clarify each issue by listing the improvement goal

Prioritize the issues and select one



Selecting issues for a qi approach
Selecting Issues for a QI Approach

A quality improvement approach is appropriate for issues resulting from failures caused by systems or processes that may not be reliably producing the desired outcome.


Selecting issues for a qi approach another consideration
Selecting Issues for a QI Approach: Another Consideration

  • Appropriate for issues that require further study to accurately describe current workflow process, ethics quality gap, underlying causes of gap

  • Small-scale testing also needed


Tools for assessing appropriateness
Tools for Assessing Appropriateness

  • Choosing Issues for PE—Worksheet

  • Choosing Issues for PE: Tracking Tool

  • IntegratedEthics Health Care Ethics Domains and Topics


Urgent issue
Urgent Issue?

Does the issue require urgent and immediate action by leadership?

Take to leadership!!


Simple issue
Simple Issue?

Is the issue simple, with an obvious solution?

Just do it!


Another program responsible
Another Program Responsible?

Is there another program or service responsible for this issue?

Refer or collaborate

CAUTION


Ethics quality gap
Ethics Quality Gap

The disparity between what should be (best ethics practice) and what is (current ethics practice)


Best ethics practice
Best Ethics Practice

  • Ethics domain

  • Ethics topic

  • Ethical standard


Ethics domain
Ethics Domain?

  • Clinical

  • Business

  • Research




Current ethics practice
Current Ethics Practice

  • Measurable data

  • Easily collected data


Measurable data available
Measurable Data Available?

  • Measure ethical practice

  • Express as percent or number


Easily collected data
Easily Collected Data?

  • Consider data collection method required for easily collecting the data


Example advance directives issue
Example: Advance Directives Issue

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.


Ethics domain1
Ethics Domain?

Column 7: Is there an ethics domain related to this issue?

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

Shared Decision Making with Patients


Ethics topic1
Ethics Topic?

Column 8: Is there an ethics topic related to this issue?

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

Advance Care Planning


Standards norms or expectations
Standards, Norms, or Expectations?

Column 9: Is the practice inconsistent with ethical standards, norms, or expectations?

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

VHA Handbook 1004.02 Advance Care Planning and Management of Advance Directives


Quantifiable data
Quantifiable Data?

Column 10: Is quantifiable data about current ethics practice readily available?

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

No


Quantifiable data1
Quantifiable Data?

Column 11: Is quantifiable data about current ethics practice easily collected?

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

Yes, through several methods such as health record reviews or interviews of patients or staff


Appropriate for issues approach
Appropriate for ISSUES Approach?

Does this issue suggest an ethics quality gap amenable to an ISSUES approach?

YES!


When issue isn t appropriate
When Issue Isn’t Appropriate

  • Get back to process owner for identified issue.

  • Explain reasoning for PE team’s decision.

  • Help program or service think through where else they might turn for assistance.

  • Ask ethics program leadership to assist.


Preliminary improvement goal
Preliminary Improvement Goal

  • Draft general statement of the desired ethical practice


Tracking tool advance directives issue
Tracking Tool:Advance Directives Issue


Group activity instructions handouts 1 2 1 3 1 5 1 10 20 min
Group Activity InstructionsHandouts 1.2, 1.3, 1.5–1.10 (20 min)

  • Answer questions 4–12 on worksheets.

  • Mark answers on tracking tool (Handout 1.2).

    Be prepared to discuss:

  • Is issue appropriate for PE, and why (or why not)?

  • If uncertain after applying criteria, what other information might help you decide?

  • What will you do if it is not appropriate for ISSUES approach?


Takeaways
Takeaways

Determining whether an issue is right for the ISSUES approach

  • Being good stewards of your resources; excluding issues that aren’t appropriate

  • Using appropriateness criteria on worksheet and tracking tool

  • Looking for ethics quality gap

  • Drafting preliminary improvement goal


Module 11
Module 1

Questions?