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

Background: Clinical ethics is fundamental to the quality of health care and is a concern facing all health care systems. This study examined clinicians’ perceptions of ethical practices in shared decision making with patients, end-of-life care, professionalism in patient care, and patient privacy and confidentiality in order to identify strengths in ethical practices and opportunities for improvement. Methods: We analyzed data from the 48,857 clinician respondents to the 2010 IntegratedEthics™ Staff Survey (IESS). The IESS was developed to provide a broad snapshot of a health care organization's ethical practices for quality improvement purposes. We used descriptive statistics to evaluate clinicians’ perceptions of clinical ethics practices and multivariate logistic regression analyses to evaluate associations between clinician- and organization-level characteristics and positive ethical practices. Results: Survey results suggest opportunities for improvement in ethical practices, including giving patients sufficient time to discuss treatment recommendations, giving better guidance to clinicians on how to maintain professional boundaries, disclosing medical errors to patients and surrogates, and providing clinicians with better education about ethical issues in end-of-life care. The majority of respondents were familiar with the ethics consultation service (ECS). Familiarity with the ECS was significantly associated with length of time working at VA, physician status, and manager/supervisory level of responsibility. If confronted with an ethical concern, approximately three-quarters of respondents reported that they would be very or moderately likely to use the ECS. Conclusions: The results from this study support quality improvement activities by allowing health care organizations to compare clinical ethics practices across staff groups, settings, and time. After a facility obtains its results, the next steps should include seeking greater understanding through qualitative interviews, and then selecting topics for quality improvement initiatives. These activities will reinforce the importance of ethics as a component of health care quality and promote a positive ethics environment.