The IntegratedEthics^TMStaff Survey: A Tool to Evaluate and Improve Ethical Practices in Health Care

Abstract

Background:To improve ethics quality in health care, health care organizations need a way to characterize whether ethical practices throughout the organization are consistent with accepted ethics standards, norms, and expectations for the organization and its staff. We developed the IntegratedEthics TM Staff Survey (IESS) to fill this need. Methods: The IESS was developed and validated through a rigorous multiyear process. This process included reviews of the bioethics and health care literature to develop conceptual maps of common ethical issues in health care; focus groups and interviews with institutional stakeholders to identify key ethical concerns; cognitive testing, pilot testing, and field testing to ensure that questions were understandable and useful; and item reduction and modification to reduce respondent burden. Results:The IESS addresses staff perceptions of ethical practices in nine domains: everyday workplace, business and management, government service, patient privacy and confidentiality, resource allocation, shared decision making with patients, professionalism in patient care, end-of-life care, and research. The 2010 version of the survey consisted of 76 questions (excluding 8 demographic questions), including questions about the degree to which facility staff demonstrate behavior consistent with specific ethical practices, systems-level or organizational factors that support or interfere with ethical practices, and the ethical environment and culture. The IESS has served as a catalyst for multiple quality improvement and educational activities. Conclusions: The IESS represents an across-the-board approach to measuring ethics quality in multiple areas encompassing clinical, organizational, and research ethics. In addition to its use in quality improvement efforts, the IESS may be used to assess whether there are systematic differences across different disciplines, services, and supervisory levels; to evaluate the effectiveness of ethics programs; and to identify trends in ethical practices over time.

A Dashboard to Improve the Alignment of Healthcare Organization Decisionmaking to Core Values and Mission Statement

“…For example, the United States Department of Veterans Affairs has used an ethics staff survey to assess how employees view eight attributes of an ethical organization. 9,10 Specific ethics-relevant metrics merit additional mention. The number of clinical and organizational ethics consultations completed each year can be an informative metric to track, although judicious interpretation is required.…”

Perceived Adherence to Professional Ethics and Associated Factors Among Health Professionals in Bale Zone Public Hospitals, Oromia Regional State, South-East Ethiopia

“…Survey instruments were adapted from Patient Safety Indicators (PSIs) survey tools for provider and arealevel indicators, and patient safety culture survey instrument of Agency of Healthcare Research and Quality (AHRQ) [11] .Some of the questions are adapted from Center for Ethics in Health Care (NCEHC) integrated ethics staff survey and also using different literatures (7,9,18,27,35) Data was collected using self-administered questionnaire. Well-structured and pretested questionnaire was given for health professionals as self-administered questionnaire.…”

Perceptions of Clinical Ethics Practices: IntegratedEthicsTMStaff Survey Data from the VA Health Care System

“…Development of the IESS has been extensively reviewed elsewhere (Pearlman et al 2013). In brief, the survey questions were developed after a literature review and conceptual mapping of the four clinically relevant domains (shared decision making with patients, professionalism in patient care, patient privacy and confidentiality, ethical practices in end-of-life care), followed by an iterative process of testing the questions for content validity, relevance, clarity, shared meaning, and psychometric properties.…”

“…The response options were "Completely agree," "Agree," "Disagree," and "Completely disagree." The full set of IESS questions is presented elsewhere in this issue (Pearlman et al 2013).…”