Dr. Firn’s research focuses on interprofessional education and collaboration, clinical ethics, and clinician moral distress, burnout, and resilience. Here, she discusses her work to address ethical dilemmas in healthcare proactively, with the goal of promoting provider wellbeing and making the overall healthcare environment safer, more equitable, and more compassionate.
What are you thinking about?
As a clinical ethicist and a researcher who studies how ethical dilemmas can affect the quality of healthcare, I’m thinking about how we can better anticipate and address ethical conflicts when they arise.
In my role as the Clinical Ethicist for the Center for Bioethics and Social Sciences in Medicine (CBSSM), I’m the point of contact for all ethics consults at Michigan Medicine. Anyone involved in the healthcare system, including patients and families, can request an ethics consult. We get involved when people may be struggling to figure out the right course of action because of ambiguity or difference of opinion or perception. We try to help come to a systematic way of talking about the different values that may be informing different perspectives to find a process for resolving ethical dilemmas.
My team of ethicists and I think about how we can recognize risk factors on the patient level, on the provider level, and on the system level that could lead to ethical conflicts – this focus on preventive and proactive ethics is something unique to U-M’s program. Preventive ethics work tries to provide real-time, interprofessional education around different ethical concepts so that we can have a shared language to talk about the different types of challenges we might be facing in patient care, while also ensuring that we’re honoring different types of values, and recognizing that there might be more than one approach.
We round weekly through all of our intensive care units (ICUs) to provide an opportunity for the many healthcare professionals who are members of those care teams to reflect on and discuss any ethical concerns, a concept known as “creating moral space.” Having that space really improves communication, which is one of the most important components of good patient care.
How are ethical dilemmas connected to healthcare provider burnout?
As providers, we are continually exposed to ongoing ethical dilemmas, which can hinder our communication, creativity, and problem-solving capacity. This can also contribute to burnout, which can limit providers’ ability to embrace complexity and divergent viewpoints, as well as their sensitivity to the emotional needs of others. Provider burnout is a significant barrier to patient safety, as well as to a diverse, equitable, inclusive, and compassionate healthcare environment.
My work focuses on finding strategies to break this cycle between ongoing ethical dilemmas contributing to stress and burnout and the overall negative impact on patient outcomes and provider satisfaction. This is why trying to anticipate and identify ethical issues early, when they’re more amenable to being resolved, is so important. Ultimately, the goal is to create a more ethical work environment by establishing early, team-based ethics dialogue as a standard of care, and supporting patients, families, healthcare teams, and healthcare systems to respond to risk factors (including moral distress and burnout) and early indicators of moral disagreement.
How are ethical considerations implemented to improve quality at the health system level?
Ideally, ethics is embedded at all levels of an institution, and it’s a team sport – having diverse viewpoints on these complex problems helps us improve the quality of the services we provide. My quality improvement/quality assurance work involves evaluating the nature of our consults for patterns over time that could lead to policy or guideline changes across the institution to better ensure fairness and equitable access for patients across the system. We also get involved with policy consultation and development at the health system level in areas such as guidelines around medication distribution during shortages, revamping advance directive policy, and revising the Patients’ Rights and Responsibilities statement.