Morisprudence: a theoretical framework for studying the relationship linking moral case deliberation, organisational learning and quality improvement

Abstract

There is a claim that clinical ethics support services (CESS) improve healthcare quality within healthcare organisations. However, there is lack of strong evidence supporting this claim. Rather, the current focus is on the quality of CESS themselves or on individual learning outcomes. In response, this article proposes a theoretical framework leading to empirical hypotheses that describe the relationship between a specific type of CESS, moral case deliberation and the quality of care at the organisational level. We combine insights from the literature on CESS, organisational learning and quality improvement and argue that moral case deliberation causes healthcare professionals to acquire practical wisdom. At the organisational level, where improving quality is a continuous and collective endeavour, this practical wisdom can be aggregated into morisprudence, which is an ongoing formulation of moral judgements across cases encountered within the organisation. Focusing on the development of morisprudence enables refined scrutinisation of CESS-related quality claims.

Culture, normativity and morisprudence: a response to the commentaries

“…We are grateful for the thoughtful replies to our article 1. We are especially encouraged that all respondents agree that it is of value to develop a theoretical framework which helps to study how clinical ethics support services (CESS) induce individual and organisational learning.…”

CESS process and outcome: expanding the theoretical understanding of CESS and its impact on QI

“…Considering this multidirectional relationship, the value of QI is not exclusively in direct measures of QI. The process itself, independent of the ‘repertory of paradigmatic cases’5 (p.6) has inherent value. We are not concerned only with the institutional memory, but also with the culture that the process produces.…”

“…That culture is the essence of the value. ‘Rationally structured deliberations concerning novel cases…’5 (p.6) does lead to development of expertise. But not culture.…”

It’s still about ethics, isn’t it?

“…In their recent work, Kok et al propose a theoretical framework for the evaluation of clinical ethical case interventions, in particular moral case deliberation (MCD) 1. According to the authors, this framework provides ‘empirically accessible hypothesis that describe the relationship between MCD and care quality at the organisational level’ 1…”