J Clin Ethics. 2019 Fall;30(3):284-296.

Comprehensive Quality Assessment in Clinical Ethics.

Cunningham TV¹, Chatburn A², Coleman C³, DeRenzo EG⁴, Furfari K⁵, Frye J⁶, Glover AC⁷, Kenney M⁸, Nortjé N⁹, Malek J¹⁰, Repenshek M¹¹, Sheppard F¹², Crites JS¹³.

Author information

1

Director of Bioethics in the Kaiser Permanente Southern California Bioethics Program, in Los Angeles USA. thomas.v.cunningham @kp.org.

2

Regional Director for Ethics in the Theology and Ethics Department, Providence St. Joseph Health, in Spokane, Washington USA.

3

Senior Clinical Ethicist at the John J. Lynch, MD Center for Ethics at MedStar Washington Hospital Center in Washington, D.C. USA.

4

Assistant Director of the John J. Lynch, MD Center for Ethics at MedStar Washington Hospital Center in Washington, D.C. USA. Evan.G.DeRenzo@Medstar.net.

5

Associate Professor of Medicine, Division of Hospital Medicine, at the University of Colorado School of Medicine in Aurora, Colorado USA.

6

Senior Clinical Ethics Fellow at the Health Ethics Center, University of California-Los Angeles, in Los Angeles, California USA.

7

MD-MBA Candidate at Tufts University School of Medicine and Brandeis University Heller School for Social Policy and Management in Boston, Massachusetts USA.

8

Vice President, Ethics Integration and Education at Ascension in St. Louis, Missouri USA. matthew.kenney@ascension.org.

9

Assistant Professor in the Department of Critical Care at the University of Texas MD Anderson Cancer Center in Houston, Texas USA. NNortje@mdanderson.org.

10

Associate Professor in the Department of Medical Ethics and Health Policy at Baylor College of Medicine in Houston, Texas USA. jmalek@bcm.edu.

11

Vice President, Ethics and Church Relations at Ascension in St. Louis, Missouri USA. mark.repenshek@ ascension.org.

12

JD-MA in Bioethics and Science Policy Student at Duke University in Durham, North Carolina USA. flora.sheppard@duke.edu.

13

Co-Director of the Cleveland Fellowship in Advanced Bioethics and a Regional Bioethicist in the Center for Bioethics ath the Cleveland Clinic in Cleveland, Ohio USA. critesj@ccf.org.

Abstract

Scholars and professional organizations in bioethics describe various approaches to "quality assessment" in clinical ethics. Although much of this work represents significant contributions to the literature, it is not clear that there is a robust and shared understanding of what constitutes "quality" in clinical ethics, what activities should be measured when tracking clinical ethics work, and what metrics should be used when measuring those activities. Further, even the most robust quality assessment efforts to date are idiosyncratic, in that they represent evaluation of single activities or domains of clinical ethics activities, or a range of activities at a single hospital or healthcare system. Countering this trend, iin this article we propose a framework for moving beyond our current ways of understanding clinical ethics quality, toward comprehensive quality assessment. We first describe a way to conceptualize quality assessment as a process of measuring disparate, isolated work activities; then, we describe quality assessment in terms of tracking interconnected work activities holistically, across different levels of assessment. We conclude by inviting future efforts in quality improvement to adopt a comprehensive approach to quality assessment into their improvement practices, and offer recommendations for how the field might move in this direction.