From corridor to boardroom: An upstream-focused model of clinical ethics for organisational impact

Abstract

In this paper, we present a model of clinical ethics support that is focused on addressing clinicians’ ethical concerns in practical and meaningful ways, including at a systems level within the hospital by engaging institutional leadership. Our work highlights the importance of this approach as a focus in nascent service establishment. The ‘corridor-to-boardroom’ model that we put forward aims to amplify clinicians’ voices in order to motivate organisational change. The model evolved in our clinical ethics service (CES) in a public hospital in Melbourne, Australia, and reflects the specific context including changes in our state's healthcare landscape that created organisation-wide ethical challenges enabling the establishment of our service. Key features of the corridor-to-boardroom model include: 1) identifying patterns of clinician concern and articulating them as ethical issues; 2) amplifying clinicians’ concerns through organisation-level discussions and engagement with leadership; and 3) partnering with clinicians and organisational leaders to develop pragmatic and ethically robust responses at a systems level. To elucidate the key features of the model, we use the example of our recent clinical ethics work responding to occupational violence and aggression in the emergency department. Sharing features of an ‘Integrative Clinical Ethics Support’ model, our model applies similar principles at an institutional level. This approach also contributes to answering the call for CESs to more effectively link the clinical workforce with institutional leadership to address ethical issues in clinical practice at an organisational level.