Frequently Asked Questions
The Ethical Force program® is a credible means for developing mutual and multilateral accountability in ethics among all participants in the health care delivery system. It is charged with creating, testing, and disseminating performance measures for domains of ethics in health care. It is directed by a 23-member Oversight Body, which includes representatives from numerous relevant groups, including patients, practitioners, health plans, purchasers, government, and accrediting organizations.
Increasingly, physicians and managed care organizations are being held accountable for quality of care based on the processes and outcomes of medical care and patient satisfaction. Yet high-quality health care delivery involves more than good technical quality and acceptable customer service—it also means upholding high ethical standards. Health care is ultimately a moral enterprise, built on protecting the potential extraordinary vulnerability of patients. It is grounded in a covenant of trust, which relies on every part of the health care system living up to shared ethical norms. Measuring the full-spectrum of health care quality, therefore, requires developing explicit shared sets of expectations for ethical behavior across the full range of parties involved in health care delivery, and then learning how to measure performance in meeting these expectations. As the number of individuals and organizations involved in health care increases, it has become even more important that all participants develop reasonable and integrated expectations for each other's ethical behavior. Managed care organizations, employers, investors, patients, government, and clinicians must all be accountable to each other for setting and then living up to these expectations.
Like so-called "condition-specific" performance measures, Ethical Force performance measures for ethics quality will include questions that can be placed into practitioner and patient surveys, as well as easy-to-use site review criteria and policy review criteria. The measures will be distributed -- with grading instruction and examples of good performance -- in Ethics Performance Measurement "Tool kits," which can be easily and inexpensively used to measure organizational performance in specific domains of ethics. Unlike condition-specific measures, however, Ethical Force measures will be geared to assess the performance of all organizations involved in health care delivery--from purchasers, such as employers and the government, to provider organizations, such as managed care plans, hospitals and physician groups, and all those in-between.
The Ethical Force Oversight Body selects individual domains of ethics based on their relevance to all participants in the health care system. In fact, Ethical Force research staff have recently performed a comprehensive review of existing ethics codes and policies in a variety of health care related institutions, in part to assist the Oversight Body in its selection of domains for performance measure development (for more information on this study, contact Ethical Force research staff at (312) 464-4698). The first 2 domains that have been selected for ethics performance measure development are (1) privacy and confidentiality protections in health care and (2) processes for designing health benefits and adjudicating coverage decisions. Each of these domains involves numerous parties to health care delivery: from unions, employers, and patients to practitioners, health plans, hospitals, and government agencies. And performing well in each of these domains is very important in building a trustworthy health care system.
While there are not gold standards for many aspects of ethics in health care, this does not make ethical performance unmeasurable. Many aspects of clinical care also do not have gold standards for performance, yet performance measures are still used to assess performance in these areas. For areas with no clear gold standard for performance, measures focus on assessing (1) whether baseline expectations have been met, (2) whether progress is being made towards aspirational goals, and (3) whether acceptable processes are being used to ensure that difficult issues are appropriately addressed. This is the general approach being used by Ethical Force. Once measures assessing these issues are created, the measures will be checked for their reliability, feasibility, and validity by field-testing. No Ethical Force performance measures will be released for public use until they have been through rigorous field-testing to ensure that they are valid, reliable, and feasible to use.
Organizations interested in self-assessment and quality improvement will use the measures. In addition, organizations such as the press and consumer information groups might use the measures to disseminate information on ethics performance, as might any other organization with an interest in the performance of a purchaser, provider organization, or other health care-related entity that is covered by the measures.
No. The Ethical Force program is a performance measures development and testing organization, not an accrediting body. Accreditation entails a full review of many different aspects of quality performance, and existing accrediting organizations are very competent and effective in this regard. Indeed, individuals with experience in accreditation are on the Ethical Force Oversight Body to ensure that our work is not redundant and that it will potentially be useful for existing accrediting organizations.
The Tool kits will contain manageable sets of questions to insert into practitioner and patient or consumer questionnaires, along with scaling instructions for grading responses, which may vary depending on the type of organization that is being assessed. In addition, there will be sets of specific policy review and site review criteria with easy-to-follow grading instructions. Sample policies and protocols may be included as appropriate. Finally, a recommended reporting format will be included, which will take into account the variety of types of organizations that might be assessed using the measures as well as the audience for the type of assesment being performed (e.g., self-assessment versus for public reporting). Simplified versions of these toolkits may also be created in the form of short lists of "Questions to Ask," which will be useful for individual beneficiaries/enrollees/patients and others interested in making brief ethical assessments of organizations involved in health care regarding specific ethics topics.
Once field-testing is complete, Ethical Force Performance Measures Toolkits will be available at cost on the Ethical Force Web site and through the Ethical Force National Program Office at the Institute for Ethics at the AMA.
The costs of performing an evaluation using an Ethical Force Performance Measurement Toolkit will vary from organization to organization, but the Toolkits are being produced to minimize the cost of implementing an ethics quality measurement program. Questionnaire items will be easily inserted into existing employee/patient/practitioner surveys or they can be used as brief stand-alone surveys. Site review criteria will be straightforward, with detailed and easy-to-follow instructions so that they can be used for self-assessment.
For more information about the Ethical Force program, contact the program staff at the Institute for Ethics at (312) 464-5260.