Lessons learned from implementing a responsive quality assessment of clinical ethics support

Abstract

Background: Various forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other's health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project. Methods: CES practitioners' experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions. Results: The main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices. Conclusions: The evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that "servant leadership" and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA.

Evaluating assessment tools of the quality of clinical ethics consultations: a systematic scoping review from 1992 to 2019

“…Assessments were carried out through: i. Self-appraisals by CEC consultants [79,82] ii. Appraisals by external CEC members not involved in the particular CECons [76,99,108,128,129] iii. Feedback from patients and family members [14,69,74,91,92,114,130,131] iv.…”

“…Longitudinal assessments that take place over many years [72] ii. Single time point assessments a. focus group interviews [14,74,76,77,84,87,90,92,98,103,127,130] b. questionnaires [33,72,74,79,85,91,92,102,111,112,114,119,127] iii. Specific appraisal of CECons decisions a. case report analysis [5,15,77,93,100,101,104,106,108,114,122,128,129,132] b. impact of CECons decisions such as via randomized controlled trials where an intervention group who received CECons were compared to a control group who did not [30,74,75,99,121,122] iv.…”

“…The primary reason for evaluating CECons was to certify [67][68][69] or accredit [9] CEC consultants to ensure that they possessed the 'necessary competencies' [70]. CECons were also assessed to determine their impact on patient care [18,[71][72][73][74][75] and benchmark their programs against prevailing standards [17,76,77].…”

“…Positive long-term impact of CECons evaluations include the development of new guidelines [15], formalization of ethics consultations [69], and increased self-reflection by CEC consultants [76,108].…”

Quality Characteristics for Clinical Ethics Support in the Netherlands

“…used the quality characteristics in order to assess the quality of CES practices in each other's health care institution by means of a responsive quality assessment (Van Baarle et al 2019). A training day was organized by the project team in order to develop and prepare for the responsive quality assessment.…”