The effect of the organization of work on moral values of health professionals and their considerations related to prioritizations in health care
Format
Completed research project
Key words
Work organization, work environment, ethics, moral stress, health care prioritization.
Time table
The project started in January 2001 and was completed in March 2004.
Financial support
The Swedish Council for Work Life Research, now FAS.
Objectives
- To study the relationships between work organization, stress and ethical deliberations in connection with prioritization in health care.
- To evaluate if a learning programme will have any effect on ethical deliberations and the work environment.
Brief description
During the last decade, the Swedish health-care system has undergone radical changes. New evidence-based medical programs and quality certification health-care programs have been implemented parallel with the development of advanced biomedical techniques. Organizational reforms have been carried out in order to make health care more efficient, often including elements of competitive incentives between health-care providers. A more educated population and changes in values have increased consumer demands on health-care services.
The changes have made health care more complex, and ethics has increasingly become a required component of clinical practice. In particular, the demand on first-line professionals to make decisions concerning priority setting has become greater. In light of this, it is not surprising that stress related to ethical decision-making among health care professionals has been reported. Stress arises when the health-care provider believes he/she knows the morally desirable course of action to take, but is not able to implement the decision due to institutional, organizational or economic constraints.
Moral distress raises complex questions about the organization and management of work in health care. Different support structures could increase both collective and individual moral competence at the workplace. Examples of such support structures are education in ethics and organized dialogues concerning ethical dilemmas in the day-to-day work of health care.
The present study investigates what kind of situations health-care professionals themselves think involve ethical dilemmas. It also measures to what extent these ethical dilemmas create moral distress. The investigation includes both hospital clinics and pharmacies, thus covering health care in a broad perspective. An intervention in the form of structure training in ethics - consisting of lectures and ethical rounds - is performed on some of the clinics and pharmacies. The level of moral distress is then measured again, in order to see if increased moral competence reduces the prevalence of moral distress and whether the outcome of the intervention is related to the organization of work at the different clinics/pharmacies.
Scientific publications
Kälvemark Sporrong S, Ethical competence and moral distress in the health care sector. Prospective evaluation of ethics rounds. Dissertation, Uppsala University 2007
Kälvemark Sporrong S, Höglund AT, Arnetz B, Measuring Moral Distress in Pharmacy and Clinical Practice, Nursing Ethics, 2006;13(4): 416-427.
Kälvemark Sporrong S, Arnetz B, Hansson MG, Westerholm, P, Höglund AT, Developing Ethical Competence in Health Care Organizations, Nursing Ethics, 2007:14(6):825-837.
Kälvemark S, Höglund AT, Hansson MG, Westerholm P, Arnetz B, Living with Conflicts. Ethical Dilemmas and Moral Distress in the Health Care System, Social Science and Medicine, 2004;58:1075-1084.
Kälvemark Sporrong S, Höglund AT, Hansson MG, Westerholm P, Arnetz B, ”We are White Coats Whirling Round”. Moral Distress in Swedish Pharmacies, Pharmacy World and Science 2005;27: 223-229.
Miscellaneous
Planning (Höglund) and participation (Arnetz, Hansson, Höglund & Kälvemark) in two courses arranged by Kurssekretariatet at Uppsala University on Moral Stress and Ethics Rounds.
Anna T. Höglund & Sofia Kälvemark presented their research and participated in the seminar "Etik och ansvar i hälsoarbete", arranged at Örebro University, November 14, 2002.
Oral presentation (Kälvemark) at the 1st Nordic Social Pharmacy and Health Services Research Conference, October 14th 2004.
Contact and more information
Project Group
Bengt Arnetz, Professor
Department of Public Health and Caring Sciences
Peter Westerholm, Professor
Arbetslivsinstitutet
Mats G. Hansson, Professor of Biomedical Ethics
Anna Höglund, Associate Professor
Sofia Kälvemark, PhD
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