Clinicians and administrators have a professional obligation to contribute (OTC) to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution’s sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework (EF) for learning healthcare systems (LHSs) does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we analyse the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider’s legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: the self-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers’ interests and interests of a health system; and the mediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers’ interests and the regulatory model for weighing opposite interests in LHSs.
- interests of health personnel/institutions
- public health ethics
- quality of healthcare
- research ethics
- applied and professional ethics
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Twitter @JJPiasecki, @viliusdranseika
Contributors Both authors contributed to this article and both approved the final version.
Funding This project was funded by the National Science Centre, Poland, 2015/19/D/HS1/00991. We thank Thomas Foley for comments on the first version of the manuscript and Phyllis Zych Budka for linguistic edits.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Read the full text or download the PDF:
Other content recommended for you
- LAGOS: learning health systems and how they can integrate with patient care
- Identifying positively deviant elderly medical wards using routinely collected NHS Safety Thermometer data: an observational study
- A qualitative positive deviance study to explore exceptionally safe care on medical wards for older people
- Lessons learnt from quality improvement collaboratives in Cambodia
- Positive deviance: a different approach to achieving patient safety
- Remote monitoring of medication adherence and patient and industry responsibilities in a learning health system
- What methods are used to apply positive deviance within healthcare organisations? A systematic review
- Conscientious commitment, professional obligations and abortion provision after the reversal of Roe v Wade
- Identifying requisite learning health system competencies: a scoping review
- Enabling individualised health in learning healthcare systems