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By Sasha Milam, Gustavson Content Curator. Photo: by Online Marketing on Unsplash.

Dr. Cheryl Mitchell, Gustavson Academic Director for UVic’s MBA in Sustainable Innovation, has spent 20-plus years consulting with the public service and healthcare organizations, on topics such as collaboration and ethics. Predictably, understanding ethics in healthcare has become more urgent than ever during a pandemic.

One question Cheryl has been exploring through research and practitioner engagement is that of moral distress: when it shows up for workers, how to recognize it, and how organizations can prevent or mitigate its effects.

The conversation starts with “morals” and “ethics,” concepts most readers are generally familiar with. For the purpose of her work, Cheryl defines morals as reflecting the values by which we determine what is right or wrong, acceptable or unacceptable. Ethics, she says, reflect our willingness to act on our moral values, even when it is difficult.

What these terms mean for workplaces, and the tensions they can create under certain circumstances can easily be imagined. What might be less intuitive is how leaders responsible for organizing those workplaces can take steps to mitigate their impact.

“Moral distress comes into play when you know the right action based on your morals, but you are constrained from taking that action because of circumstances,” says Cheryl. “And often that happens because we’re under-resourced or stretched for time. It’s certainly a dynamic that has been diagnosed in healthcare.”

In healthcare, moral distress can crop up because of the challenges in the environment. These challenges are likely to be exacerbated when we move into what Cheryl and other experts call crisis standards of care (CSC), such as can happen in care facilities during a pandemic.

“All of a sudden – if there’s a surge, you may not be able to treat everybody,” she says. “Failing to enact CSC policy measures, proactively, can have a major psychological effect for clinicians working on the frontlines during a pandemic.”

Cheryl and several co-authors recently published a paper on this topic1, and are continuing to explore the topic of moral distress at the leadership level, specifically. “Leaders need to think about what they are going to do in those circumstances, to make those kinds of difficult ethical decisions to minimize the moral distress of care providers.”

Outside of the extreme healthcare situation at hand, the studies have implications for leaders across industries. That’s because there are many phenomena we face that qualify as moral dilemmas, the scenarios that frequently lead to moral distress. But these are not unavoidable situations. We can do something about moral dilemmas and moral distress.

“When the work environment limits a person’s ability to meet their professional standards, then as leaders we must consider our ethical obligations to create work environments in which individuals aren’t in moral distress,” Cheryl says.

In her recent work applying these concepts with practitioners, she recommends healthcare leaders consider the following points:

  1. Focus on the system and creating priorities that allow people to enact their professional (and personal) values.
  2. Cross organizational structures to have multi-disciplinary dialogue and sense-making on the most challenging topics of healthcare (end of life, critical issues, frail elderly, etc.).
  3. Create measurements that support business outcomes and that ensure a high quality of care.
  4. Recognize the impact of ‘not having enough time’.
  5. Cultivate a culture of learning rather than blaming.
  6. Champion a patient-centered and clinician-centered culture.

But she also encourages leaders to consider: are there other questions we should be asking to mitigate moral distress in our organizations?

Questions, comments? Cheryl Mitchell can be reached at: clmitch@uvic.ca

1Hertelendy, A., Ciottone, G., Mitchell, C., Gutberg, J., & Burkle, F. (Forthcoming) Crisis Standards of Care in a Pandemic: Navigating the Ethical, Clinical, Psychological, and Policy-making Maelstrom. International Journal for Quality in Health Care, https://doi.org/10.1093/intqhc/mzaa094