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Qual Saf Health Care. 2010 Dec;19(6):526-30. doi: 10.1136/qshc.2009.038943.

Preventing ethics conflicts and improving healthcare quality through system redesign.

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Center for Leadership and Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, Hew Hampshire 03766, USA.



Ethics and quality care are common drivers for healthcare organisations. Both are based on ethics principles that are the foundation for quality, and are synergistic with the Institute of Medicine's six quality aims. This paper describes the relationship between ethics principles and the goals of improving quality, safety and value. It demonstrates how healthcare staff, quality improvement professionals and ethics committee members could apply a quality improvement framework to address and prevent ethics issues.


Recurring ethics issues can have a detrimental impact on both the quality of patient care and the culture of a healthcare organisation. Clinical staff and ethics committee members traditionally respond to ethics issues using a reactive approach. Despite nascent interest in a system-oriented preventive approach to ethics issues, there is limited practical advice for ethics committee members regarding how to specifically implement a system redesign strategy. Using an illustrative case study, the authors demonstrate how to apply a recognised quality improvement framework, which focuses on clinical microsystems, to manage and decrease ethics issues--therefore enhancing the organisation's quality of care.


An important step in enhancing quality and ethics aims would be for the organisation's staff, including quality improvement professionals and ethics committee members, to collaborate in fostering system redesign. The authors' aim is not to examine in detail a specific quality improvement approach or method; rather, they wish to highlight the synergy they believe exists between quality improvement efforts and organisational ethics issues.

[Indexed for MEDLINE]

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