Satisfaction, Managed Ethics, and the Duty to Design

Abstract

Healthcare ethics committee (HEC) members and healthcare professionals at all levels are facing a crisis in ethics as a result of the pervasive organizational, economic, scientific, and technological changes in medicine and healthcare. Our current approach to medical ethics does not effectively address the fundamental challenge this crisis poses: to provide ethically principled care to the satisfaction of all stakeholders. In this paper we present a new approach that extends the scope and understanding of ethics by building links between the disciplines of ethics, management, and design. We call such an approach "Managed Ethics and Design." After outlining the main tenets of this approach, we illustrate its application with a design-based quality improvement project at the Kaiser-Permanente Medical Center at Santa Clara, California, that successfully enhanced delivery of thrombolytic drugs to treat patients arriving with acute MI. We conclude that in order to provide and ensure ethically principled care to the satisfaction of all stakeholders, we have a "duty to design," a duty to improve, create and innovate new practices, processes, standards, and understandings of healthcare. Good design can lead to new possibilities that will enable us to achieve higher, rather than lower, ethical standards. In the current era of organizational medicine and managed care, the duty to design is an inescapable moral imperative.