While there is a great deal of diverse literature on clinical ethics consultation, it has never been looked at through the specific lens of quality measurement.
Researchers at the Center for Bioethics and Humanities at University of Colorado Anschutz Medical Campus in Aurora recently proposed this novel approach to compile and synthesize this literature, and to derive a framework for assessing quality:1
- A scoping review will include categorizing all quality measures for clinical ethics consultation discussed in the literature, both quantitative and qualitative.
- A qualitative synthesis will generate a comprehensive analytic framework for understanding quality.
- A meta-analysis of studies will report the effects of clinical ethics consultation on pre-specified clinical outcomes.
The researchers noted there are almost 25,000 articles on clinical ethics consultation in the worldwide literature. “We decided in the scoping phase to cast a wide net, to get as much of the literature as possible. In this review, we discovered that very few measure quality,” says Jacqueline J. Glover, PhD, one of the study’s authors. Glover is professor in the Department of Pediatrics and the Center for Bioethics and Humanities at University of Colorado.
The researchers hope to integrate known consensus from the literature into quality development efforts for ethics case consultation. “Clinical ethics consultation has been around for more than 20 years, and now it is the norm for most hospitals,” notes Glover. The field is only beginning to develop standards for the activity, however.
“The field is starting to professionalize. We have moved beyond volunteers with good intentions,” says Glover, adding that there is a strong desire to assess the quality of ethics consultation efforts and the outcomes for patients, families, healthcare professionals, and institutions.
“Quality measures are also essential to provide evidence of the value of ethics consultation for institutional leadership and support,” adds Glover. She sees the following ethical implications for efforts to assess quality:
- If researchers fail to develop measures for quality assessment, there is a risk of harm to patients and healthcare professionals.
- With performance measures becoming increasingly prevalent in healthcare, there is a risk that people will focus more on getting a good score than on doing good work.
- Without quality assessment, institutions risk providing ethics consultation services that are substandard and do not provide benefit.
“We also risk wasting valuable healthcare resources spent on substandard ethics consultation, which becomes a matter of justice,” says Glover.
Glover believes bioethicists should play a critical role in the assessment and improvement of ethics consultation in the hospital setting, but can’t do it alone. “There are a limited number of professionals dually qualified in the domains of ethics consultation and quality improvement methods,” she says.
Ideally, bioethicists will collaborate with hospital QI leadership. This ensures that quality assessment of ethics consultation is developed using recognized quality measures.
“This is an activity that shouldn’t happen in a vacuum with each hospital trying to do its own thing. That is the purpose of our study,” says Glover.
Given the complex nature of ethics consultation, developing quality measures is not an easy task. “It is essential that we identify measurements that matter, and lead to the outcomes that are valued,” says Glover. Costs and risks involved in quality measurement are two important considerations.
“Inadequate quality measures may put at risk the needed financial support for these services, as well as the benefits that may accrue to patients, families, healthcare professionals, and institutions,” says Glover.
- Leslie L, Cherry RF, Mulla A, et al. Domains of quality for clinical ethics case consultation: a mixed-method systematic review. Syst Rev 2016; 5:95.
- Jacqueline J. Glover, PhD, Professor, Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Fulginiti Pavilion for Bioethics and Humanities, Aurora, CO. Phone: (303) 724-3992. Email: Jackie.Glover@ucdenver.edu.