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Towards organisational quality in ethics through patterns and process
  1. Bryan D Siegel1,2,
  2. Lisa S Taylor3,
  3. Katie M Moynihan1,2,4
  1. 1 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
  3. 3 Office of Ethics, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4 Children's Hospital of Westmead, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  1. Correspondence to Dr Katie M Moynihan, Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; katie.moynihan{at}

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Measuring outcomes using quantitative analytic methods is the hallmark of scientific research in healthcare. For clinical ethics support services (CESS), tangible outcome metrics are lacking and literature examining CESS quality is limited to evaluation of single cases or the influence on individual healthcare professional’s perceptions or behaviour. This represents an enormous barrier to implementing and evaluating ethics initiatives to improve quality. In this context, Kok et al propose a theoretical framework for how moral case deliberation (MCD) can drive quality at an organisational-level, termed morisprudence 1 . By offering mechanistic insights into how MCD can lead to organisational learning and quality improvement (QI), they provide a roadmap for actionable items to measure quality.

As conceptualised, morisprudence follows accumulation of organisational practical wisdom from a repertoire of ‘paradigmatic’ MCDs, aiding identification of patterns of morally important features. Here, there are parallels between healthcare professionals’ clinical judgement, where past experience linked to patient outcomes leads to exercising good medical practice. Practical wisdom evolves by recognising recurring thematic ‘content’ in MCD and using this to develop good ethical practice. The ‘morisprudence hypothesis’ contends that creating organisational memory increases the likelihood that novel cases will provoke reference to established cases, growing capacity for formulating ‘quality’ moral responses, thus better satisfying traditionally considered features of organisational QI.

Patterns and process: complimentary approaches

The authors acknowledge that success of the ‘morisprudence hypothesis’ relies on specific organisational characteristics. They cite explicitness, need for active engagement …

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  • Contributors BDS - Conceptualised and wrote the first manuscript draft. KMM - Conceptualised and wrote the first draft. LST - reviewed and critically revised for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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