Choosing Issues for PE Worksheet*

PARTICIPANT HANDOUTS

Determining Whether an Issue Is MODULE 1 Right for the ISSUES Approach

Handout 1.1: Choosing Issues for PE—Worksheet Handout 1.2: Choosing Issues for PE: Tracking Tool (Appropriateness) Handout 1.3: IntegratedEthics Health Care Ethics Domains and Topics Handout 1.4: Advance Directives Issue—Worksheet Handout 1.5: Instructions for the Activity Handout 1.6: Identification of Surrogate Decision Makers Issue—Worksheet Handout 1.7: Dating of Subordinates Issue—Worksheet Handout 1.8: Long Waits for Appointments Issue—Worksheet Handout 1.9: Disclosure of Reportable Adverse Events Issue—Worksheet Handout 1.10: Service Dog Policy at Clinic Issue—Worksheet Handout 1.11: Choosing Issues for PE: Tracking Tool (Appropriateness)— Answer Key PARTICIPANT HANDOUTS

Handout 1.1 Choosing Issues for PE—Worksheet* This worksheet should be completed for each issue referred for PE. Answers should then be transferred to the Choosing Issues for PE: Tracking Tool. Together, the worksheet and tracking tool provide a record of issues considered by the PE team, and can be used to explain decisions about “appropriateness” in a rational and organized manner to leadership. *A copy of this worksheet is available online at http://vaww.ethics.va.gov/integratedethics/PECtools.asp.

Appropriateness for an ISSUES Approach

1. Date that the issue came to the attention of the PE team?

2. What is the source of the issue?

3. Describe the possible ethics issue. Provide a brief description of the issue: who, what, where, when, how much, or how often?

4. Does this issue require immediate attention or urgent action by leadership? Does the issue involve a situation that includes, for example, possible legal violations, wilful disregard of institutional policy, or intentionally unsafe acts?

Resp. () Next step Yes STOP Refer to leadership. No Proceed to the next question for assessing appropriateness for PE. Explain:

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.1 Preventive Ethics: Beyond the Basics (Page 2 of 6) PARTICIPANT HANDOUTS

5. Does this issue represent a simple problem with an obvious solution? For example, if you have an ethics policy that hasn’t been updated or the ethics program hasn’t offered necessary education to staff.

Resp. () Next step STOP This issue does not require an ISSUES approach to improve. Yes Just Do It! No Proceed to the next question for assessing appropriateness for PE. Explain:

6. Is another program or service responsible for this issue? Does another program or service have oversight responsibilities for the issue? Does this issue involve a clinical, business, or research process that another office “owns” or is directly responsible for?

Resp. () Next step

Contact the program or service that has oversight responsibility Yes or that “owns” the process.

No Proceed to the next question for assessing appropriateness for PE. Explain:

7. Is there an ethics domain related to this issue? (Select from Handout 1.3: IntegratedEthics Health Care Ethics Domains and Topics.)

Yes  No 

If yes, Domain: If the PE team cannot, at a minimum, identify an ethics domain, then If no: the issue probably does not suggest an ethics quality gap but, rather, a technical or service quality gap. Comment:

8. Is there an ethics topic related to this issue? (Select from Handout 1.3.) Yes  No 

NOTE: If your issue does not appear to fit any of the ethics topics listed under an ethics domain, designate “Other,” which is the last sub-category under each ethics domain, and briefly describe the topic in the space provided.

If yes, Topic: If no, fill in “Other” Comment:

9. Is the practice inconsistent with ethical standards, norms, or expectations?

Yes  No 

If Yes, which standard(s) support your response? Select the standards below that are related to this issue, and cite their sources, if known. (Choose all that apply.)

Source of Ethical Standard Common Sources of Ethical Standards Check () (e.g., VHA Handbook 1004.01 Informed Consent Treatments and Procedure) Accreditation standards Consensus statements or white papers from professional societies Executive directives or other senior management guidance Organizational policies Precedents from case law Professional codes of ethics Statutes Other

NOTE: If the PE team can identify an ethics domain and ethics topic, then the issue, at least on its face, suggests an ethics quality gap. If the team is able to identify an ethical standard that relates to the issue, the case for appropriateness is even more persuasive.

10. Is there measurable data (i.e., something you can count and express as a number and/or percentage) about current practice?

Resp. () Next step Yes Proceed to Question 12. No Proceed to Question 11. Explain:

11. If you don’t have measurable data about current practice, is it easily collected?

Resp. () Next step Yes Proceed to Question 12. No This issue may be outside the scope of what the PE team can address. Explain:

12. Describe the preliminary improvement goal (i.e., the desired outcome of the improvement process, including the direction of change).

13. Is this issue appropriate for PE?

Resp. () Next step Yes Proceed to prioritization of ethics issue. Close feedback loop, communicate rationale to source of issue, and help No the program or service think through where else they might turn for assistance.

Handout 1.2 Choosing Issues for PE: Tracking Tool (Appropriateness) (See reverse side for brief column descriptions.)

Appropriateness for PE 1 2 3 4 5 6 7 8 9 10 11 12 13 Ethics Quality Gap App ropr Si Oth Current iate mp er Best Ethics Ethics Im for le Pro Practice Practice Preliminary Improvement Goal me PE Pro gra Date dia ble m Practic Issue te m/ Res e Came to Source of Act Et Inconsi Ob pon Et Attention Issue (1–2 ion hi stent vio sibl hi of PE words) Re cs with If Data us e for cs (mm/dd/y q’d D Ethical Data Unavailable Sol This T Standar Available , Easily y) (Y/ o uti Issu o ds, (Y/N) Collected N/U m on e pi Norms, (Y/N) ) ai (Y/ (Y/N c or Possible Ethics Issue N) ) n Expect (who, what, where, when, how much or how ations often) (Y/N) A recent accreditation review of primary care health 9/15/ records found that only a few patient requests for TJC N N N 20XX assistance with completing an advance directive were followed up on by clinic staff.

Y= Yes; N=No; U=Unsure *A complete version of this tracking tool is available online at http://vaww.ethics.va.gov/integratedethics/PECtools.asp.

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.2 Preventive Ethics: Beyond the Basics (Page 9 of 2) Column Descriptions

1. Date Issue Came to Attention of PE: 6. Other Program or Service Responsible: 10. Data Available: Do you have measurable Enter the appropriate month, day, and Does another program or service have data about current or baseline practice year that you learned about the issue. oversight responsibilities for the issue? If (i.e., qualitative or quantitative information (mm/dd/yy) Yes, contact the appropriate program or you can count or express as a number or service to determine if collaboration would percentage)? (Yes/No) 2. Source of Issue: Answers could include a be the best approach to address this member of the ethics team, as well as a 11. If Data Unavailable, Easily Collected: issue. If unsure, determine whether service line or department leader. (1 or 2 Could you easily gather measurable data another program has oversight words) about current or baseline practice? If No, responsibilities or “owns” the process. the issue may be outside the scope of 3. Possible Ethics Issue: Provide a (Yes/No) what the PE team can address. (Yes/No) description of details relating to the issue, 7. Ethics Domain: Refer to IntegratedEthics including who, what, where, when, how 12. Preliminary Improvement Goal: Website for listing of domains and topics much, or how often. (3–5 sentences) Describe the desired outcome of the at http://www.ethics.va.gov or improvement process, including the 4. Immediate Action Required?: Does the http://vaww.ethics.va.gov direction of change (e.g., increase issue require immediate attention or 8. Ethics Topic: Refer to IntegratedEthics disclosure of adverse events that cause urgent action by leadership? If Yes, STOP Website for listing of domains and topics harm to patients or personal this assessment process and refer the at http://www.ethics.va.gov or representative). issue to line management or leadership. If http://vaww.ethics.va.gov unsure, discuss with leadership before 13. Appropriate for PE: If you can develop a proceeding to the next question. (Yes/No) 9. Practice Is Inconsistent with Widely preliminary improvement goal based on Accepted Ethical Standards, Norms, or 5. Simple Problem/Obvious Solution: answers to questions 7–11, then answer Expectations: Does this issue represent a simple yes to 13 and proceed to prioritization. If Is the PE team certain that the practice problem whose solution is apparent? If Unsure, bring the issue to leadership. described in the ethics issue is Yes, STOP the assessment. The issue (Yes/No) inconsistent with prevailing ethical does not require an ISSUES approach to standards, norms, or expectations? Can Handout 1.3 improve. (Yes/No) you identify specific and widely accepted IntegratedEthics Health Care ethical standards (e.g., policy, professional codes of ethics, accreditation Ethics Domains and Topics standards), norms, or expectations for the practice? Without a clear practice NOTE: Numbered items are ethics domains; standard, an ISSUES approach may not indented letter items are ethics topics. be appropriate. If unsure, consult with the When applicable, transfer these numbers ethics leadership team. (Yes/No) and letters to their respective columns on the tracking tool (Handout 1.2).

1. Shared Decision Making with Patients (how well the organization promotes

collaborative decision making between near the end of life). clinicians and patients). a. Cardiopulmonary resuscitation a. Decision-making capacity (ability (CPR) (withholding or stopping of the patient to make his/her own resuscitation in the event of health care decisions) cardiopulmonary arrest, including b. Informed consent process DNAR or DNR orders) (providing information to the patient b. Life-sustaining treatments or surrogate, ensuring that the (questions relating to the initiation or decision is voluntary, and discontinuation of artificially documenting the decision. NOTE: administered fluid or nutrition, Informed consent for research mechanical ventilation, dialysis, should be coded under Ethical surgery, antibiotics, etc.) Practices in Research) c. Medical futility (a clinician’s c. Surrogate decision making judgment that a therapy will be of no (selection, role, and responsibilities benefit to a patient and that it should of the person authorized to make not be offered or should be health care decisions for the patient) withdrawn) d. Advance care planning d. Hastening death (intentionally or (statements made by a patient with unintentionally, e.g., questions decision-making capacity regarding relating to euthanasia, assisted health care decisions in the event suicide, or the doctrine of double they lose capacity in the future) effect) e. Limits to patient choice e. Death and post-mortem issues (questions relating to choice of care (determination of death, organ setting, choice of provider, demands donation, autopsy, disposition of for unconventional treatment, etc.) body or tissue, etc.) f. Other (topics about shared f. Other (topics about ethical decision making with patients that do practices in end-of-life care that do not fit in the categories listed above) not fit in the categories listed above)

2. Ethical Practices in End-of-Life Care (how well the organization addresses ethical aspects of caring for patients

4. Patient Privacy and Confidentiality including disclosing bad news, 3. Ethical Practices at the Beginning of (how well the organization protects adverse events, etc. Truth Life (how well the organization NOTE: patient privacy and confidentiality). promotes ethical practices with respects telling related to informed consent should be coded under Shared to preconception, conception, a. Privacy (protecting individuals’ Decision Making with Patients; truth pregnancy, and in the perinatal period). interests in maintaining personal telling relating to leadership, human space free of unwanted intrusions a. Preconception and conception resources, or business integrity and in controlling data about should be coded under Ethical (questions relating to assessment of themselves) reproductive capacity, cryobanking Practices in Business and of sperm, ova, and embryos, fertility b. Confidentiality (nondisclosure of Management; truth telling relating to information obtained as part of the communications with the public medications, assisted reproductive clinician-patient relationship) should be coded under Government technologies, preconception sex Service; truth telling among staff Other (topics about patient selection, gestational surrogacy, c. should be coded under Ethical privacy and confidentiality that do etc.) Practices in the Everyday not fit in the categories listed above) Workplace. b. Pregnancy (questions relating to c. Challenging clinical relationships genetic testing and diagnosis, the 5. Professionalism in Patient Care (how (staff management of relationships balance between the health of the well the organization fosters behavior with patients and/or their family and appropriate for health care mother and the fetus, forced loved ones who present with professionals). interventions during pregnancy, etc.) challenging or disruptive behaviors, a. Conflicts of interest (situations Perinatal period (questions requests, or demands. NOTE: c. that may compromise the clinician’s relating to labor-inducing drugs, challenging requests, demands, and fiduciary duty to patients, including choices related to treatments and elective cesareans, extraordinary inappropriate business or personal procedures should be coded under medical interventions for premature relationships. NOTE: Financial Shared Decision Making with infants, perinatal care at the conflicts of interest relating to the patients) threshold of viability. government employee’s duty to the public should be coded under Ethical d. Other (topics about ethical Practices in Government Service; d. Respect for diverse practices at the beginning of life that conflicts of interest relating to the cultural/religious sensitivity do not fit in the categories listed researcher’s duty to research (clinician interactions with above) subjects should be coded under patients and/or family and loved Ethical Practices in Research) ones of different ethnicity, b. Truth telling (open and honest religion, sexual orientation, communication with patients, gender, age, etc.)

e. Other (topics about 7. Ethical Practices in Business and c. Risks and benefits for human professionalism in patient care Management (how well the organization subjects research (questions about that do not fit in the categories promotes high ethical standards in its adequate protections of human listed above) business and management practices). subjects and the appropriate balance of risks and benefits) 6. Ethical Practices in Resource a. Leadership (behaviors of leaders Allocation (how well the organization in support of an ethical environment d. Selection of human subjects demonstrates fairness in allocating and culture) (questions about equitable resources across programs, services, recruitment and selection, including b. Human resources (questions and patients). for vulnerable populations, etc.) relating to the fairness of supervisory a. Systems level/macroallocation management for employees) e. Informed consent for human (questions relating to fairness in subjects (questions about providing c. Business integrity (questions allocating resources across information to research relating to the support for the programs and services) participants/others, ensuring that the oversight of business processes, decision is voluntary, participation b. Individual level/microallocation compliance with legal and ethical incentives, approach to (questions relating to fairness in standards, and promotion of documentation, etc. informed allocating resources to individual business quality and integrity) NOTE: patients or staff) consent for clinical care should be d. Other (topics about ethical coded under Shared Decision c. Other (topics about ethical practices in business and Making) practices in resource allocation that management that do not fit in the Privacy and confidentiality for do not fit in the categories listed categories listed above) f. above) human subjects (questions about the protection and disclosure of personal 8. Ethical Practices in Research (how information of research subjects) well the organization ensures that its employees follow ethical standards that g. Other (topics about ethical apply to research practices) practices in research that do not fit in the categories listed above) a. Research Integrity (questions about the conduct of research and Ethical Practices in the Everyday reporting of results) 9. Workplace (how well the organization b. Societal value (questions about supports ethical behavior in everyday the value of research to the interactions in the workplace) advancement of science and to Respect and dignity (employee society at large) a. privacy, personal safety, respect for

diversity, respectful behavior toward others, etc.) b. Ethical climate (openness to ethics discussion, perceived pressure to engage in unethical conduct, etc.) c. Other (topics about ethical practices in the everyday workplace that do not fit in the categories listed above)

10. Ethical Practices in Government Service (how well the organization fosters behavior appropriate for government employees) a. Government ethics rules and laws (ethics rules, regulations, policies or standards of conduct that apply to federal government employees, e.g., bribery, nepotism, gift and travel rules) b. Other (topics about ethical practices in government service that do not fit in the category listed above)

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.2 Preventive Ethics: Beyond the Basics (Page 2 of 2) PARTICIPANT HANDOUTS Handout 1.4 Advance Directives Issue—Worksheet

This worksheet should be completed for each issue referred for PE. Answers should then be transferred to Handout 1.2: Choosing Issues for PE: Tracking Tool (Appropriateness). Together, the worksheet and tracking tool provide a record of issues considered by the PE team, and can be used to explain decisions about “appropriateness” in a rational and organized manner to leadership.

Appropriateness for an ISSUES Approach 1. Date that the issue came to the attention of the PE team? Sept. 20XX

2. What is the source of the issue? The Joint Commission survey findings

A recent accreditation review of primary care health records found that only a few patient requests for assistance with completing an advance directive were followed up on by clinic staff.

Resp. () Next step Yes STOP Refer to leadership.  Proceed to the next question No for assessing appropriateness for PE. Explain:

5. Does this issue represent a simple problem with an obvious solution? For example, if you have an ethics policy that hasn’t been updated or the ethics program hasn’t offered necessary education to staff.

Resp. () Next step STOP This issue does not require an ISSUES approach to improve. Yes Just Do It! No  Proceed to the next question for assessing appropriateness for PE. Explain:

No  Proceed to the next question for assessing appropriateness for PE. Explain:

Yes  No 

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.4 Preventive Ethics: Beyond the Basics (Page 18 of 6) PARTICIPANT HANDOUTS 9. Is the practice inconsistent with ethical standards, norms, or expectations?

Yes  No 

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.4 Preventive Ethics: Beyond the Basics (Page 19 of 6) PARTICIPANT HANDOUTS 10. Is there measurable data (i.e., something you can count and express as a number and/or percentage) about current practice?

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.4 Preventive Ethics: Beyond the Basics (Page 20 of 6) PARTICIPANT HANDOUTS 12. Describe the preliminary improvement goal (i.e., the desired outcome of the improvement process, including the direction of change).

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.4 Preventive Ethics: Beyond the Basics (Page 21 of 6) PARTICIPANT HANDOUTS Handout 1.5 Instructions for the Activity

Imagine that your group represents a PE team, and you are meeting to discuss 5 issues for appropriateness. The following handouts include 5 worksheets, each containing a different issue. As you discuss each issue, record your answers to the guiding questions on the worksheet, and then enter your Yes/No answers on Handout 1.2, the tracking tool. You have 20 minutes to complete the 5 issues. Some will take more time than others. Once you have made a decision about an issue, stop answering the questions on the worksheet and proceed to the next issue.

Be Prepared: In the large group debrief that follows, you may be asked to report your decision about an issue―and to explain why it is or isn’t appropriate for an ISSUES cycle. The debrief will cover these questions:  Is the issue appropriate for an ISSUES approach? Why (or why not)?  If you are uncertain after applying the criteria, what other information might help you decide?  What will you do if you decide the issue is not appropriate for an ISSUES approach?

Notes: See Handout 1.3: IntegratedEthics Health Care Ethics Domains and Topics when answering questions 7–8 on the worksheets.

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.5 Preventive Ethics: Beyond the Basics (Page 22 of 1) PARTICIPANT HANDOUTS Handout 1.6 Identification of Surrogate Decision Makers Issue—Worksheet

Appropriateness for an ISSUES Approach 1. Date that the issue came to the attention of the PE team? Sept. 25, 20XX

2. What is the source of the issue? Ethics Consult Service

Ethics consult service reports a 50% increase in cases in the ICU where there is a lack of timely identification of surrogate decision makers causing delay in treatment planning and decision making for patients with life-limiting diseases.

Resp. () Next step Yes STOP Refer to leadership. Proceed to the next question No for assessing appropriateness for PE. Explain:

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.6 Preventive Ethics: Beyond the Basics (Page 23 of 6) PARTICIPANT HANDOUTS 5. Does this issue represent a simple problem with an obvious solution? For example, if you have an ethics policy that hasn’t been updated or the ethics program hasn’t offered necessary education to staff.

Yes  No 

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.6 Preventive Ethics: Beyond the Basics (Page 29 of 6) PARTICIPANT HANDOUTS Handout 1.7 Dating of Subordinates Issue—Worksheet

2. What is the source of the issue? Business Office Staff

Staff have reported that there are three supervisors in the business office openly dating their subordinates.

Yes  No 

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.7 Preventive Ethics: Beyond the Basics (Page 35 of 6) PARTICIPANT HANDOUTS Handout 1.8 Long Waits for Appointments Issue—Worksheet

2. What is the source of the issue? Primary Care Manager

60% of patients seeking primary care services for non-urgent issues are accommodated within the requested time frame. 40% of the patients wait an average of 3 weeks beyond the requested time for an appointment.

Yes  No 

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.8 Preventive Ethics: Beyond the Basics (Page 41 of 6) PARTICIPANT HANDOUTS Handout 1.9 Disclosure of Reportable Adverse Events Issue—Worksheet

2. What is the source of the issue? Nurse Manager of Surgical Services

The nurse manager for surgical services reported that there have been instances where adverse events that caused harm that should have been disclosed to patients or their personal representative were not disclosed.

Yes  No 

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.9 Preventive Ethics: Beyond the Basics (Page 47 of 6) PARTICIPANT HANDOUTS Handout 1.10 Service Dog Policy at Clinic Issue— Worksheet

Appropriateness for an ISSUES Approach 1. Date that the issue came to the attention of the PE team? Aug. 30, 20XX

2. What is the source of the issue? Patient Advocate Report

A review of the patient advocate report shows an increased number of complaints this quarter by patients who have a designated service dog being denied entry to the clinic by the clerk. Policy indicates service dogs are allowed in the clinic.

Yes  No 

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.10 Preventive Ethics: Beyond the Basics (Page 53 of 6) PARTICIPANT HANDOUTS Handout 1.11 Choosing Issues for PE: Tracking Tool (Appropriateness)—Answer Key

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.11 Preventive Ethics: Beyond the Basics (Page 54 of 2) PARTICIPANT HANDOUTS Appropriateness for PE 1 2 3 4 6 7 8 9 10 11 12 13 O Ethics t Quality h Gap e r Best Ethics P Practice Current Ethics Practice r o g r a m

I A R m p e m p s e r p di o o Date at p n Pract Issue e ri s ice Came Source A at i Incon to of ct e b siste Attenti Issue io nt f l with on of (1–2 n If Data o e Ethic PE words) R Unavaila r al Data (mm/dd e Ethics Ethics ble, P f Stan Available /yy) q’ Easily E o Domain Topic dards (Y/N) d Collecte ( r , ( d (Y/N) Y Norm Y/ / T s, or N Expe N h ) ctatio ) i ns s (Y/N)

I s s u e

( Y Possible Ethics Issue / (who, what, where, when, how much or N how often) ) Preliminary Improvement Goal Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.11 Preventive Ethics: Beyond the Basics (Page 55 of 2) PARTICIPANT HANDOUTS Appropriateness for PE 1 2 3 4 6 7 8 9 10 11 12 13 O Ethics t Quality I h Gap A m e p m r Best p e Ethics r di P Practice Current Ethics Practice o Date at p r Pract Issue e o ice ri Came Source A g Incon at to of ct r siste e Attenti Issue io a nt f with on of (1–2 n If Data o m Ethic PE words) R Unavaila r al Data (mm/dd e Ethics Ethics ble, P R Stan Available /yy) q’ Easily E e Domain Topic dards (Y/N) Collecte d , ( s Preliminary Improvementd (Y/N) Goal ( p Norm Y Y/ o s, or / N n Expe N Possible Ethics Issue ) ctatio ) (who, what, where, when, how much or s ns how often) i (Y/N) b Ethics consult service reports a 50% Increase early increase in cases in the ICU where there is identification of a lack of timely identification of surrogate Surr. Dec. 9/25/XX ECC N N SDM Y N Y surrogate Y decision makers causing delay in treatment Mkg decision makers planning and decision making for patients in the ICU with life-limiting diseases. Business Three supervisors in the business office 9/30/XX Y N Office Staff are openly dating their subordinates. 60% of patients seeking primary care services for non-urgent issues are not Primary 9/30/XX accommodated within the requested time N Y N Care Mgr. frame. 40% of patients wait an average of 3 weeks for an appointment. 9/15/XX Nurse Mgr. The nurse manager for surgical services N y Prof. Truth Tell Y Y Increase Y Surg. reported that there have been instances disclosure of Svcs. where adverse events that caused harm adverse events that should have been disclosed to patients that caused or their personal representatives were not harm to patients disclosed. or their personal representative on surgical Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.11 Preventive Ethics: Beyond the Basics (Page 56 of 2) PARTICIPANT HANDOUTS Appropriateness for PE 1 2 3 4 6 7 8 9 10 11 12 13 O Ethics t Quality I h Gap A m e p m r Best p e Ethics r di P Practice Current Ethics Practice o Date at p r Pract Issue e o ice ri Came Source A g Incon at to of ct r siste e Attenti Issue io a nt f with on of (1–2 n If Data o m Ethic PE words) R Unavaila r al Data (mm/dd e Ethics Ethics ble, P R Stan Available /yy) q’ Easily E e Domain Topic dards (Y/N) Collecte d , ( s Preliminary Improvementd (Y/N) Goal ( p Norm Y Y/ o s, or / N n Expe N Possible Ethics Issue ) ctatio ) (who, what, where, when, how much or s ns how often) i (Y/N) b services

The patient advocate reports an increased number of complaints this qtr by patients who have a designated service dog being 8/30/XX Pt Adv N N denied entry to the clinic by the clerk. Policy indicates service dogs are allowed in the clinic.

Module 1—Determining Whether an Issue Is Right for the ISSUES Approach HANDOUT 1.11 Preventive Ethics: Beyond the Basics (Page 57 of 2)