Improving Ethics in Veterans’ Care

For health care practitioners, questions of ethics are a continual and serious concern. On a daily basis, hospital staff wrestle with ethical issues that affect patients’ care and choices.

For example, when a patient requires critical care or nears the end of life, family members may differ among themselves, or with medical personnel, about the most ethical course of action to take. Resolving these differences requires specialized knowledge and skill in ethical analysis. “People who are trained in analyzing medical conditions don’t necessarily know how to analyze ethical concerns,” explains EDC’s Rebecca Jackson Stoeckle.

EDC is working with the Veterans Administration, which has more than 8 million patients in its system, to take a holistic and preventive approach to ethics, says Stoeckle. Recognizing the need to develop both an awareness of ethical concerns and the expertise to address them across its 152 medical centers, the U.S. Department of Veterans Affairs launched IntegratedEthics in 2008.

“The VA including everyone in the organization in working on good ethics, from the leaders to the staff,” says Stoeckle. “Everyone can make a difference in providing quality care to patients and protecting patients’ rights.”

From early on, EDC has worked with the Veterans Health Administration (VHA) to develop workshop materials, print, video, and online tools to support and sustain this major organizational initiative. Training has been delivered across the country in three areas:

• Ethics consultation on specific cases involving VA patients, families, and staff
• A quality improvement system called Preventive Ethics, which empowers teams to address chronic or recurrent ethics issues on a systems level
• Ethical leadership in building an organizational culture that reflects the VA’s core values and inspires employees to “do the right thing”

A new Preventive Ethics: Beyond the Basics workshop was pilot-tested in Seattle last year. The training focuses on ways to decrease ethics quality gaps in specific areas of practice, for example, helping patients draft “advance directives” about their future care. By improving the percentage of patients who receive help in advance planning, the VA can reduce the ethical uncertainties or conflicts that may arise when patients require critical or end-of-life care. EDC is currently engaged in producing a more interactive, field-based version of the workshop, which will roll out in the fall.

“IntegratedEthics shows the VA’s commitment to quality of care for our nation’s veterans,” says Stoeckle. “They take ethics in health care very seriously. They are walking the walk.”

IntegratedEthics was named one of the “Top 25 Programs” in the 2011 Innovations in American Government Award (IAGA) competition conducted by the Ash Center for Democratic Governance and Innovation at the John F. Kennedy School of Government of Harvard University.