의료조직을 위한 프로페셔널리즘 헌장(Acad Med, 2017)
The Charter on Professionalism for Health Care Organizations
Barry E. Egener, MD, Diana J. Mason, RN, PhD, Walter J. McDonald, MD, Sally Okun, RN, MMHS, Martha E. Gaines, JD, LLM, David A. Fleming, MD, MA, Bernie M. Rosof, MD, David Gullen, MD, and May-Lynn Andresen, RN, BSN
프로페셔널리즘이 헬스케어시스템에 필요한 심오하고 광범위한 변화를 일으키기에 충분하지 않을 수도 있지만, 만약 프로페셔널리즘이 없으면 헬스케어 산업이 사라질 것이다. - Lesser et al1
Professionalism may not be sufficient to drive the profound and far-reaching changes needed in the health care system, but without it, the health care enterprise is lost. — Lesser et al1
헬스케어 제공자 및 조직을 위한 프로페셔널리즘의 개념은 경제적으로 어렵고 급변하며 윤리적으로 어려운 환경에서 의사 결정을위한 지침을 제공 할 수 있습니다.
The concept of professionalism for health care providers and organizations can offer guidance for decision making in a fiscally difficult, rapidly changing, and ethically challenging environment.
의사를 위한 이러한 원칙은 13 년 전 의-프로페셔널리즘에 관한 의사 헌장에서 강조되었습니다. 이 헌장은 의사들에 의해 널리 받아 들여졌지만, 점차 건강 관리의 질과 환자 경험에 미치는 영향은 보건 의료 조직의 프로페셔널리즘과 얽혀있는 것으로 점차 인식되고 있습니다.
These principles for physicians were enunciated in the Physician Charter on Medical Professionalism 13 years ago.2 That charter has been widely accepted by physicians, but its impact on the quality of health care and patient experience is increasingly recognized as intertwined with the professionalism of health care organizations.1,3
실제로, 건강 관리 시스템의 구조적 요소가 의사가 헌장을 준수하는 것을 방해 할 수 있습니다.
Indeed, structural factors in the health care system may impede physicians from living up to the charter.4
좋건 나쁘건 점점 더 많은 수의 의사가 병원 및 병원 시스템에 고용되고 있기 때문에, 점점 더 헬스케어 시스템이 헬스케어 전문직의 행동을 지배하게 된다.7 이와 같이 건강 관리 조직은 그들이 고용한 직원 및 affiliated 의사들의 행동에 긍정적 및 부정적 영향을 미치게 된다. 대부분의 의료 팀 구성원은 올바른 일을하도록 동기 부여됩니다. 그러나 보건 의료 제공자 및 조직에게는 의료 프로페셔널리즘의 원칙과 일치하지 않는 활동에 참여할 수있는 많은 기회가 있습니다.
Health care systems increasingly dictate the practices of health care professionals, for better or worse, as an increasing number of physicians are employed by hospitals and hospital systems.7 As such, health care organizations have an opportunity to positively and negatively influence the behavior of their employees and affiliated physicians. Most members of the health care team are motivated to do the right thing. There are, however, many opportunities for health care providers and organizations to engage in activities that are not in concordance with the principles of medical professionalism.
건강 관리 지도자, 보건 전문가, 정책 이해 관계자 및 사회가 그들의 현재 및 선호하는 운영 방법을 평가하도록 자극하는 목적으로 헬스케어 조직을 위한 프로페셔널리즘에 관한 헌장 ( "헌장"; 부록 1 참조)을 다루고 있으며, 이는 건강 관리를 제공하고 건강을 향상시키는 데있어서 best practice를 담보하기 위한 것이다.
This Perspective includes a Charter on Professionalism for Health Care Organizations (referred to as the “Charter”; see Appendix 1) with the aim of stimulating health care leaders, health professionals, policy stakeholders, and society to evaluate their current and preferred ways of operating, to ensure best practices in providing health care and improving health.
왜 조직을 위한 프로페셔널리즘 헌장인가?
Why a Charter on Organizational Professionalism?
헌장은 가치관을 반영하며 대상 고객에게 긍정적 인 변화를 가져 오는 데 효과적 일 수 있습니다. 그간의 근거를 살펴보면 그러한 유형의 문서, 즉 헌장은 기술된 가치에 관한 담론과 확인을 자극할 수 있음을 나타냅니다. 예를 들어, 2002 년에 발행 된 이래, 의료 전문직에 관한 의사 헌장은 130 개 이상의 기관에서 승인되었으며, 관련 전문성 기사의 수는 600 개 이상으로 4 배 증가했습니다.
A charter is a reflection of values and can be effective in bringing about positive changes in a target audience. Evidence indicates that such a document can stimulate conversation and affirmation of the stated values. For example, since its publication in 2002, the Physician Charter on Medical Professionalism has been endorsed by over 130 organizations,8 and the number of related professionalism articles has quadrupled to over 600 annually.9
Kanter의 재정적으로 성공적인 회사에 대한 연구는 사회적 책임에 대한 표현 된 의지가 불확실성에 대한 완충제를 만들고, 긍정적 인 감정을 불러 일으키며, 직원들 간의 동기를 자극한다고 밝혀졌습니다. 이와 비슷한 맥락에서, Paine11은 자사 프로그램에 지역 사회 참여 및 윤리와 같은 요소가 포함되어있을 때 기업이 재정적 보상을받는다고 주장합니다.
Kanter’s10 research on financially successful companies revealed that an expressed commitment to social responsibility creates a buffer against uncertainty, evokes positive emotions, and stimulates motivation among employees. Along similar lines, Paine11 argues that companies reap financial rewards when their programs feature such elements as community involvement and ethics.
헌장 작업과정
Charter Process
The Steering Committee nominated individuals for the Writing Group who were approved by consensus and created the Charter.
These writers represented a variety of disciplines, points of view, and stakeholders in health care. They included nurses, health system leaders, medical ethicists, and consumer advocates.
특정 조직을 대변하지 않음 Although some participants felt that they were to represent the organization that nominated them, the Charter was not subject to approval by any grantor or organization.
The Writing Group refined the document by conference calls and e-mail. As might be expected from such a diverse group, compromise was important for the final Charter to be approved by consensus. The issues that required the most vigorous discussions were
whether health care is a “right,”
whether to stipulate a specific percentage of margin that a health care organization ought to return to the community, and
the obligation of health care organizations to address the social determinants of health.
헌장의 목적
Charter Goals
모든 헬스케어 조직에 관한 것
The purpose of the Charter is to describe professionalism behaviors to which for- profit and not-for-profit hospitals and hospital systems may aspire. As the work unfolded, the Writing Group recognized that the principles were relevant to any health care organization.
상충하는 행동을 제안하기도 함
At times, different sections of the Charter will suggest competing actions.
For example, touchstones of the Charter are to prioritize the health of individual patients and to improve the health of the community.
However, being a steward of limited resources may conflict with optimizing the health of each individual patient.
미션과 가치에 따라 다른 행동을 취할 수 있음
Organizations may ethically take different actions based on their different missions and cultural values.14
헌장 영역
Charter Domains
환자 파트너십
Patient partnerships
2001 년에 IOM이 발표 한 보고서 인 "Quality Chasm 교차점 : 21 세기를위한 새로운 건강 시스템"은 환자 가족 요구를 충족시키는 데 필수적인 개선을 위한 여섯 가지 목표를 중심으로 구축 된 의료 시스템을 재발 명해야한다는 긴박감을 야기했습니다.
In 2001, the IOM report Crossing the Quality Chasm: A New Health System for the 21st Century created a sense of urgency for reinventing a health care system built around six aims for improvement considered essential for better meeting patient-family needs.15
이 6 가지 목표 중 하나는 "환자 개개인의 기호, 필요 및 가치에 대해 존중하고 반응하는 치료를 제공하고 환자의 가치가 모든 임상 결정을 이끌어 내도록 보장하는"환자 중심의 치료입니다 .15 의료 팀 간의 협력이 필요합니다 환자, 가족 및 기타 간병인과의 효과적인 파트너십을 유지합니다 .16,17 전통적인 "가장 잘 아는 사람은 의사다"모델에서 환자와 가족이 간병과 의사 결정에 참여하도록하는 방식으로 성공적으로 옮겨가려면 조직의 리더십 문화가 중요하다. 다-방향 협업과 커뮤니케이션을 중요하게 여기고 있습니다 .17
Among these six aims is patient- centered care, defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”15 It requires collaboration among health care teams and effective partnerships with patients, families, and other caregivers.16,17 Successful navigation from the traditional “doctor knows best” approach to one that engages patients and families to participate in their care and decision making is contingent on a culture of organizational leadership that values multidirectional collaboration and communication.17
시간이 지남에 따라 사람 중심의 원칙을 통합 한 조직은 환자의 신뢰와 충성도를 향상시키고보다 조율 된 방식으로 기능하는 팀을 경험할 수 있습니다 .18 환자 및 가족과의 효과적인 관계는 조직의 개선에 측정 가능한 영향을 미칠 수 있으며, 장기적인 시스템 차원의 변화를 유지할 잠재력을 가진 것으로 여겨진다.
Over time, organizations that integrate person-centric principles can experience greater patient trust and loyalty and teams that function in a more coordinated manner.18 Effective engagement with patients and families can have a measurable impact on organizational improvement and has been cited as having the greatest potential for sustaining long- term system-wide transformation.19
지난 10 년 동안, 환자와 가족이 건강과 건강 관리에 영향을 미치는 결정에 적극적으로 참여할 것이라는 기대에 영향을 준 여러 요인이 있었고, 이러한 방식이 모든 관계자에게 도움이 됨을 보여주었다.
In the last decade, many factors have influenced the expectation that patients and families take an active role in decisions that impact their health and health care,21 and studies demonstrate that this practice benefits all involved.22–24
이그제큐티브 리더십은 조직 전체의 환자 및 가족과의 진정한 파트너십을 지원하는 데 필요한 문화적 변혁을 달성하는 데 필수적입니다 .25 환자 가족 투입 전략을 유지하는 데 필요한 자원을 제공하며, engaged leadership은 이러한 관행을 성공적으로 채택하는 데 중요합니다.
Executive leadership is essential for achieving the cultural transformation needed to support genuine partnerships with patients and families throughout their organizations.25 Leadership that is engaged and provides the resources needed to sustain strategies for patient-family input is critical for successful adoption of these practices.
조직 문화
Organizational culture
보건 의료 시스템의 성공적인 변화는 금융 자본보다 조직의 사회적 자본에 더 의존하게 될 것이다.
Successful transformation of health care systems will likely depend more on the social capital of organizations than their financial capital.27
조직 문화는 환자, 실업자, 직원 및 리더십이 공동으로 만듭니다. 리더십이 신뢰받으려면 경영 행동이 조직의 사명, 전문적 가치 및 직원의 기대와 일치해야합니다 .28 이러한 신뢰는 개개인의 일치된 행동들이 그들이 일하는 다양한 단위로 전파 할 수 있도록합니다. 따라서 조직 문화는 상호 연관된 미세 문화로 구성된 복잡한 적응 시스템이라 할 수 있다.
organizational culture is cocreated by patients, nonemployed workers, employees, and leadership. Trust in leadership requires that management behavior be consistent with the organizational mission, professional values, and expectations of employees.28 That trust in turn empowers individuals to propagate consonant behaviors into the various units where they work. Organizational culture is thus viewed as a complex adaptive system composed of interrelated microcultures.
조직의 리더십 스타일은 의사와 간호사 만족도 및 소진에 모두 영향을 미칩니다. 의사의 소진은 치료의 질에 달려 있지 않지만, 간호사의 소진은 관련이 있다.34 의사의 휄빙은 회전율의 감소와 관련이 있으며 특정한 조직적 개입을 통해 개선 될 수 있습니다. 의사의 복지에 관한 랜드 (Rand)의 한 연구는 "의학 외 분야에서 적용되는 것과 동일한 고려 사항 - 예를 들어 공평한 대우; 반응이 빠른 리더십; 작업량, 내용 및 속도에 대한 관심은 의사의 전문성 향상을 추구하는 정책 입안자 및 건강 전달 시스템의 목표로 사용될 수 있습니다. "36
Organizational leadership style influences both physician31 and nurse satisfaction and burnout.32 Although physician burnout has not been consistently tied to the quality of care,33 nurse burnout has.34 Physician well-being is correlated with lower rates of turnover and can be improved through focused organizational interventions.35 A Rand study on physician well-being concluded that “the same considerations that apply outside medicine—for example, fair treatment; responsive leadership; attention to work quantity, content, and pace—can serve as targets for policymakers and health delivery systems that seek to improve physician professional satisfaction.”36
"삼중 목표"를 달성하기 위해서는 참으로 "의료진에 대한 돌봄"을 포함해서 "quadruple aim"으로 통합해야 할 수도 있습니다. 치유 환경은 조직의 모든 사람들이 임상의가 제공하고자하는 동일한 가치와 존경을받을 때 가장 잘 성취 될 수 있습니다. 환자. 이를 위해서는 직원의 관점을 구하고, 존중하고, 통합해야합니다.
Achieving the “triple aim” may indeed require incorporating “care of the provider” into a “quadruple aim.”37 A healing environment can best be achieved when all those in the organization are afforded the same value and respect that clinicians aspire to give to patients. This requires soliciting, respecting, and incorporating the perspectives of employees.
High-value, cost-conscious 의료는 interprofessional collaboration에 달려 있습니다 .38 팀워크가 향상되면 환자 결과, 환자 만족도, 조직 효율성, 환자 참여 및 근로자 만족도와 관련이 있습니다 .40
High-value, cost-conscious practice also depends on interprofessional collaboration.38 better teamwork is correlated with better patient outcomes, patient satisfaction, organizational efficiency, patient engagement, and worker satisfaction.40
커뮤니티 파트너십
Community partnerships
전통적 임상 서비스는 인구 건강의 10 ~ 20 %만을 차지하고 유전학은 20 % ~ 30 %를 차지한다. 43,44 건강한 지역 사회를 만들기 위해 잘 명료화 된 미션에 힘 입어, 헬스케어 기관은 그들이 봉사하는 지역 사회와의 풍부한 전략적 동반자 관계를 통해 남은 50 % ~ 70 %를 결정할 수 있으며, 소위 이를 건강결정요인이라고 한다.
Traditional clinical services account for only 10% to 20% of a population’s health, and genetics account for 20% to 30%.43,44 Spurred by well-articulated missions to create healthy communities, model health care organizations have sought to address the remaining 50% to 70%—the so-called social determinants of health—in rich strategic partnerships with the communities they serve.45
인구의 건강을 증진시키기 위해서는 건강을 보호하거나 약화시킬 수있는 사회적, 환경 적 요소를 이해하고 해결하기위한 시스템 접근법이 필요하다는 인식이 커지고있다.
There is growing recognition that promoting the health of populations requires a systems approach to understanding and addressing the social and environmental factors that can protect or undermine health.46
"건강"을보다 광범위한 구성으로 다루는 것의 중요성에 대한 인식이 커짐에 따라, 다른 헬스케어 조직 및 지역사회와의 파트너십을 갖춘 헬스케어 조직의 중요성도 점차 커지고 있다. 이를 통해 건강과 헬스케어의 장애요인을 정의하고, 개입법을 설계하고, 투자의 효율을 최대화하고, 새로운 전략을 도입한다.
As awareness of the importance of addressing “health” as a broader construct has grown, so too has awareness of the importance of health care organizations joining together—in full partnership with each other and the communities they serve—to define barriers to health and health care, design interventions, maximize the value of investments, and implement new strategies together to improve a community’s health.47
건강한 지역 사회를 만들기위한 사명과 함께, 좋은 건강 관리 기관은 공공 정책을 [인구 및 결과 기반 보상]으로 전환함하는 것이야말로 post-fee-for-service의 미래에 재정적으로 지속가능한 건강의 사회적 결정 요인의 효과적 해결방안임을 인식합니다 .51,52
In tandem with the mission to create healthy communities, model health care organizations recognize that shifts in public policy toward population and outcomes-based reimbursement make effectively addressing the social determinants of health mission critical to fiscal sustainability in a post-fee- for-service future.51,52
운영과 비지니스
Operations and business practices
보건 의료 조직에서 윤리적 행동을 강화하려는 노력은 최상의 운영 및 비즈니스 관행을 가져오고 환자에게 실질적인 혜택을줍니다.
Efforts to enhance ethical behavior in health care organizations result in best operational and business practices and in real benefits for patients.55
Paine57은 점점 더 많은 기업들이 윤리 프로그램, 가치 이니셔티브 및 지역 사회 참여 활동을 시작하고 있으며 경영진의 "윤리는 돈이 된다"라는 믿음을 전제로하고 있다고 주장합니다.
Paine57 argues that increasingly, companies are launching ethics programs, values initiatives, and community involvement activities premised on management’s belief that “ethics pays.”
사명 선언문의 표현에서 뚜렷한 중요성은 봉사의 질, 환자 복지 및 만족에 대한 헌신이다. 일반적으로 임무에 포함되지 않는 구성 요소는 재정적 목표와 경쟁 전략입니다. 사명 선언문의 형태로 된 윤리적 지침은 의료 시스템이 조직의 성과를 높이고 직원의 동기를 향상시키는 데 유용한 도구입니다.
in the wording of mission statements, Of distinct importance is a commitment to service quality, patient welfare, and satisfaction. Components typically not included in the mission are financial goals and competitive strategies. Ethical guidance in the form of mission statements are valuable tools for health systems to use to improve organizational performance and increase employee motivation.59
윤리 강령 및 조직 사명 선언문에 공식화 된 윤리 지침은 제도적 청렴성과 책임에 관한 윤리적 담론과 심의를 촉진하고 이러한 목표를 달성하는 데있어 조직의 행동에 영향을 미칩니다.
Ethics guidance that is formalized in codes and organizational mission statements promotes ethical discourse and deliberation around institutional integrity and responsibility, and influences organizational behavior in meeting those goals.
헌장의 장애물
Charter Obstacles
헌장은 염원을 다룬 것이다; 그것은 "모델 조직"의 행동을 묘사하기위한 것입니다. 많은 도전 과제는 문화적입니다. 조직의 리더와 직원 모두가 조직의 역사적인 견해와 그 내부에서의 역할을 변경해야합니다. 전통적으로 보건 의료 기관은 위계적이고 의사 중심적이었습니다. 최근 재정, 구조 및 운영상의 변화에도 불구하고 의료기관은 리더십과 직원 간의 관계를 근본적으로 바꾸지 않았습니다. 일부 개인은 지도력과 전문직 종사자, 고용 된 비 전문인 및 헌장에 명시된 환자 간의보다 역동적이고 공개적인 대화로 인해 불편할 수 있습니다.
The Charter is aspirational; it is meant to describe the behavior of a “model organization.” Many of its challenges are cultural, requiring both organizational leaders and employees to alter their historical views of their organizations and their roles within them. Traditionally, health care institutions have been hierarchical and physician focused. And despite recent financial, structural, and operational changes, health care institutions have not fundamentally altered the relationship between leadership and employees. Some individuals may be challenged by the more dynamic, open dialogue between leadership and the full spectrum of professions, employed nonprofessionals, and patients as described in the Charter.
또 다른 과제는 건강의 사회적 결정 요인을 변화시키는 것입니다. 이러한 결정 요인의 생태학은 복잡하고 완전히 이해되지 않습니다. 이러한 결정 요인들에 대한 모든 영향들에 영향을 미칠 수있는 위치에있는 어떤 사회적 구조도 없다. 이 헌장은 건강 관리 단체가 건강의 사회적 결정 요인을 개선하는 것에 전적으로 책임이 있다고 말하지 않습니다. 오히려 지역 사회의 건강을 향상시키기 위해 그들의 수단과 고유 한 임무와 일치하는 다른 조직, 정부 및 지역 사회와의 전략적 파트너십을 추구 할 것을 제안합니다.
Another challenge is altering the social determinants of health. The ecology of these determinants is complex and not fully understood. Nor is any social structure in a position to affect all the influences on these determinants. The Charter does not suggest that health care organizations are solely responsible for improving the social determinants of health but, rather, suggests that they seek strategic partnerships with other organizations, government, and local communities, consistent with their means and their unique missions, in order to improve the health of the community.
우리가 원하는 것
What We Want to Accomplish
이 헌장은 프로페셔널리즘에 관한 기존의 논문을 보완하여 개인 집단이 아닌 보건기구 및 시스템을 대상으로 한 문서를 작성합니다. 헌장은 조직이 조직 전체에서 전문적인 행동을 촉진하는 환경을 조성하기 위해 활용할 수있는 전문 역량 및 행동을 정의합니다.
This Charter complements existing treatises on professionalism, creating a document directed at health organizations and systems rather than a group of individuals. The Charter defines the professional competencies and behaviors that organizations can leverage to create an environment that promotes professional behavior throughout the organization.
우리는 이것이 의료 전문직에 관한 의사 헌장과 유사한 살아있는 문서임을 확인하고 그 헌장에 사용 된 과정에서 배운 교훈을 얻을 것입니다.
We wish to ensure that this is a living document similar to the Physician Charter on Medical Professionalism and will take lessons learned from the process employed with that charter.
Charter on Professionalism for Health Care Organizations
Preamble
This document is intended to articulate a set of principles and behaviors for health care organizations that aspire to nurture professionalism, to encourage the pursuit of excellence by all employees, and to achieve outstanding health care with the broader community. The document is structured as a set of expectations as to how model health care organizations should be led and managed. It is aspirational and supports a health system that is dynamic and constantly trying to improve.
A key tenet of this document is that health care organizations have been gradually evolving so that the activities of model health care organizations should go beyond trying to treat disease and restore health. The work of model health care organizations should include health promotion, disease prevention, value-driven care, interdisciplinary collaboration, and community involvement, all within a fiscally responsible environment.
This evolution of the health care environment has and will continue to create challenges for all of the traditional professions that operate within health care organizations. As increasing numbers of the members of these professions are employed by and function within these organizations, the organizations will have further opportunities to profoundly affect the professional behaviors of those individuals in both positive and negative ways. Organizational behaviors do more than create an environment that influences the professionalism of those within it. They have a powerful influence on the environment beyond their walls: They interact with other organizations that affect health and can directly impact the social determinants of health in ways that individual professionals or health care professional membership organizations cannot.
This Charter was created to help meet these challenges. There are four themes or concepts that apply to all health care organizations’ activities. First, model health care organizations need to emphasize the primacy of obligations to patients and ensure that all members of the organization reflect this priority in their day-to-day work. Second, model health care organizations promote the goal of broad access to health care. Third, model health care organizations are good stewards of resources invested in health care. Finally, model health care organizations are learning organizations. The organization continually transforms itself to perform its core mission better and to take on new roles as the health system evolves.
Patient Partnerships
The primary focus of health care organizations is the care and well-being of patients. Model organizations partner with patients to ensure a patient-centered approach that supports the health of the whole person, not just the treatment of disease.
Commitment to engagement
Model organizations invite active participation of patients and their formal and informal care partners in all relevant aspects of care. These partnerships support care that is respectful of and responsive to an individual’s priorities, goals, needs, and values. Utilizing communication strategies that engender trust, model organizations foster an outcomes-based approach to health that goes beyond delivery and receipt of health care.
Commitment to shared decision making
Together, patients and their care partners clarify and evaluate all care options and the best available evidence to choose a course of care consistent with the patient’s personal values and preferences. Organizational professionalism ensures that the culture, environment, and infrastructure support the communication and literacy needs of all involved in the decision-making process.
Commitment to collaboration, continuity, and coordination
Model organizations foster effective team-based care and support the role of patients as members of teams. In collaboration with patients and their formal and informal care partners, model organizations ensure safe and effective team transitions across settings and time to support a “one patient, one team” model of care.
Commitment to measure what matters to patients
In partnership with patients, model organizations identify outcomes of interest to patients and use patient-reported and -generated data to monitor progress and performance on those outcomes. Model organizations establish methods to support their continuous learning from these data. They provide meaningful feedback to patients and their care partners related to these data and the learning from it.
Organizational Culture
Organizational culture is the set of beliefs and practices that creates the expectations, norms, and operational behaviors within an organization. Organizational culture is reflected in the well-being of patients and employees, employee retention, quality of care, health outcomes, and elimination of medical error.
Commitment to the well-being of individuals
Model organizations promote the well-being of all those who are cared for or work within them. Encouraging and modeling self-reflection and humility ensures that all interactions are respectful and that employees are valued and empowered.
Commitment to teamwork
Best care happens when all members of the team, including patients, share information and decision-making responsibility. Ensuring teamwork requires organizational structures and processes that support communication across staff and with patients.
Commitment to a healthy workplace
Model organizations create work environments that are physically and psychologically safe and provide tools and incentives for employees to achieve healthy lifestyles.
Commitment to inclusion and diversity
Model organizations incorporate the voices of employees and patients in organizational initiatives, including clinical domains. They encourage respectful attention to alternative viewpoints. Communication training for all staff emphasizes teamwork, respect, inclusiveness, and cultural sensitivity. The workforce, including leadership, reflects the diversity of patients and the community.
Commitment to accountability
Model organizations create a culture of trust and empowerment by articulating the mission and values of the organization, aligning policies, creating an infrastructure to promote those values, and eliminating activities that undermine professionalism. They align employee incentives with organizational values, reward success, provide supportive remediation for those who struggle to meet expectations, promote job satisfaction, and provide opportunities to learn. Model organizations encourage feedback to leadership regarding any experience and observation of activities that compromise the organization’s values. Model organizations create an environment that encourages disclosure of events or suspect processes using knowledge gained to prevent harm and improve safety for patients and staff.
Community Partnerships
Model organizations collaborate with other health care organizations and the communities they serve to reduce health disparities related to factors such as education, income, and the environment. They focus particularly on preventable root causes of illness and access to appropriate, effective, culturally sensitive health care.
Commitment to address the social determinants of health
Clinicians frequently encounter root causes of preventable illnesses, such as environmental toxins, nutritional deficits, unhealthy behaviors, and other preventable social factors. Treating these in a clinical vacuum diminishes the organization’s full potential to improve health. Therefore, it is a model organization’s ethical obligation to help identify, understand, and address social determinants of health, and to incorporate this understanding into its work.
Commitment to partner with communities
Model organizations engage in strategic partnerships with governmental entities, community organizations, and other organizations serving the community to identify and mitigate root causes of illness as well as to ensure effective, culturally appropriate care. Model health care organizations include the community in organizational activities and governance, and their employees participate in community activities and governance.
Commitment to advocate for access and high-value care
Model organizations partner with others to promote universal access and rational allocation of health care resources and to moderate incentive structures that do not directly lead to high-value care and healthier communities. They advocate with communities for regulatory reforms to improve environmental conditions, mitigate barriers to health care access, and improve social services.
Commitment to community benefit
Model organizations and their leaders engage generously with community organizations and civic leaders to make innovative, strategic investments that leverage improved community health.
Operations and Business Practices
Model organizations ensure patient safety, clinical excellence, transparency, evidence-based practices, high-value care, and professional competence. They provide sensitive, respectful, compassionate, prompt, and courteous patient care.
Commitment to safeguard the privacy of patients and their health information
Model organizations must safeguard the privacy of patients and their health information. This is particularly important in the use of electronic health records, which pose continually evolving challenges to the privacy and security of patient information.
Commitment to ethical operations
Ethics and compliance programs in model organizations articulate mission and values, guidelines for observing legal requirements, and standards for the highest ethical focus in addressing the health care needs of diverse populations. These programs require qualified senior-level executive leadership, mechanisms to set standards, evidence-based policies, comprehensive training and education, mechanisms to report violations without fear of retaliation, and approaches to monitor compliance and audit performance. Model organizations adhere to credentialing and regulatory standards in their operations, recruitment, training, education, and privileging.
Commitment to transparent management of conflicts of interest
Model organizations have systems to identify and address potential conflicts of interest. When patients may be affected, patient welfare is given priority.
Commitment to align incentives with values
Model organizations routinely review their incentive systems to ensure that they are in alignment with articulated organizational values.
Commitment to fair treatment, education, and development
Model organizations compensate employees fairly; provide appropriate benefit packages; avoid staff shortages; and promote employee education, training, and growth.
Commitment to high-value care
The policies and practices of model organizations engender evidence-based care and treatment that are provided to every patient. Model organizations always strive for high-value, optimal clinical outcomes, aligned with the three aims of better care, healthy populations, and reduced costs. They ensure that ordering practices for testing and treatment are evidence based and supported by standards of care.
Commitment to innovation
Model organizations strive to improve current models of care. Creating opportunities to assist other organizations to achieve similar success is a form of public service. The search for and implementation of innovative approaches to management, leadership, and patient care are important indicia of organizational professionalism.
Commitment to accounting and financial reporting standards
Model organizations ensure that their financial statements accurately reflect the performance of the organization. They create financial control systems and internal auditing mechanisms that ensure financial integrity.
Commitment to ensure fair and equitable access to health care
Model organizations display price transparency. They make adjustments to bills for uninsured patients, so that they are not expected to pay substantially more than insured patients. They act fairly in granting “charity status” to patients who have no plausible means of paying the cost of treatment. They show flexibility in settling patient balances that exceed the patient’s financial capabilities.
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