The IntegratedEthicsTM Facility Workbook: An Evaluation Tool to Support Health Care Ethics Program Implementation and Quality Management

Background: IntegratedEthicsTM (IE) establishes a new model for ethics programs, with the goal of continuously improving “ethics quality” in health care. This article describes the IntegratedEthics Facility Workbook (IEFW), an evaluation tool developed by the National Center for Ethics in Health Care (NCEHC) to help health care facilities improve ethics quality in their organization. The workbook helps facilities to evaluate their local ethics programs relative to specific quality standards established for the IE model. This article describes the origins of the quality standards established for the IE model, explains IEFW conceptual underpinnings and tool development, illustrates how ethics programs use the tool to drive local program quality improvement, and provides longitudinal IEFW national results (2008–2011) for Department of Veterans Affairs (VA) IE programs. Methods: The project uses descriptive analysis of IEFW data submitted by VA facilities from 2008 through 2011. Results: In VA, longitudinal IEFW data demonstrate that facilities have made great strides in improving their ethics programs relative to quality standards defined for IntegratedEthics. Improvements in ethics consultation and preventive ethics practices—particularly related to accountability structures, consistent use of standardized processes, and evaluation of program quality—have been impressive and generally consistent over time. In the area of ethical leadership, facilities have had some success in improving structures and processes (e.g., the top corporate decision making body includes a member with recognized expertise in ethics), but less success in improving behaviors by individual leaders (e.g., involving clinical staff members in major organizational decisions that have ethical implications). Conclusions: The IEFW is a useful tool for monitoring progress in building a high-quality ethics program. [Supplemental materials are available for this article. Go to the publisher's online edition of AJOB Primary Research for the following free supplemental resource: IntegratedEthicsTM Facility Workbook.]