Dificultades éticas en las organizaciones sanitarias asistenciales públicas / Ethical dilemmas in public health care organizations

Hoy en día cabe preguntarse por una ética de las organizaciones, dado que gran parte de las decisiones de mayor impacto global no se toman desde la perspectiva particular, sino a nivel organizacional. Lo que legitima a cualquier organización es la necesidad social que satisface, y dicha legitimación depende, a su vez, de la calidad del servicio prestado. Y para ofertar un buen servicio las organizaciones deberían tener presente que es necesario hacer bien las cosas, aunque este «hacer bien» no debería limitarse a lo instrumental, sino también a lo ético, lo cual no parece que esté tan presente. Las organizaciones sanitarias asistenciales públicas mantienen un discurso en el que manifiestan promover actitudes y actuaciones éticas, tanto en su funcionamiento interno como en la consecución de sus fines. Pero un mayor conocimiento y análisis de su funcionamiento interno permite poner en cuestión lo anterior. Estas organizaciones, por su estructuración y procedimientos, pueden dificultar que los criterios éticos sean principios rectores en su funcionamiento interno, al tiempo que pueden tener consecuencias éticamente cuestionables a nivel poblacional. Una organización sanitaria no debiera organizarse ni estructural ni funcionalmente como una organización cualquiera que ofrezca servicios, al tiempo que los miembros de la organización no pueden limitarse a ser actores pasivos. Se hace necesario que tanto los profesionales de la organización como los usuarios tengan más conductas pro-éticas, los miembros de la organización desde el profesionalismo y los usuarios desde la responsabilidad (AU)

Today you can ask if you can apply ethics to organizations because much of the greater overall impact decisions are not made by private individuals, are decided by organizations. Any organization is legitimate because it satisfies a need of society and this legitimacy depends if the organization does with quality. To offer a good service, quality service, organizations know they need to do well, but seem to forget that should do well not only instrumental level, must also make good on the ethical level. Public health care organizations claim to promote attitudes and actions based on ethics, level of their internal functioning and level of achievement of its goals, but increased awareness and analysis of its inner workings can question it. Such entities, for its structure and procedures, may make it difficult for ethical standards actually govern its operation, also can have negative ethical consequences at the population level. A healthcare organization must not be organized, either structurally or functionally, like any other organization that offers services. In addition, members of the organization can not simply be passive actors. It is necessary that operators and users have more pro-ethical behaviors. Operators from the professionalism and users from liability (AU)

Tratamiento metodológico de la observación indirecta en la gestión de organizaciones deportivas / Indirect observational methodology in managing sports services

Contemplar al usuario/a como elemento clave de la gestión, es una de las tendencias que actualmente ha recibido mucha atención científica. Sin embargo, la evaluación de la calidad de los programas deportivos orientados a la población infantil, es escasa, queda evidenciado en los pocos estudios realizados. Por ello, consideramos necesario realizar un estudio dirigido a la población infantil, como usuarios directos, ya que se trata del grupo social más numeroso a la hora de realizar actividades físicas y, la necesidad de crear y consolidar hábitos deportivos que pueden repercutir en estilos de vida saludables. El objetivo de nuestro trabajo es plantear un desarrollo metodológico de observación indirecta con el fin de profundizar en la evaluación de la calidad en los servicios municipales deportivos orientados a la población infantil. En la actualidad, el desarrollo metodológico ha beneficiado de manera muy notoria a la observación indirecta. Se trata de documentos de los cuales hemos aprendido a extraer información válida y consistente; documentos que pueden tener un alto valor informativo, pero que formalmente requieren de una preparación que los adecúen para alcanzar la necesaria sistematización. Para ello contrastamos las percepciones de los usuarios/as más pequeños/as (de 8 a 12 años) con la de los/as padres/madres y el personal experto de las instalaciones municipales deportivas, para adecuar y mejorar los servicios deportivos orientados a la población infantil. Para la recogida de información se realizaron entrevistas en profundidad y para el tratamiento de los datos, se utilizó el programa Atlas Ti. Los datos aquí presentados forman parte de un trabajo de mayor envergadura

Researchers are paying increasing attention to users as a key component in service management. However, very few studies have sought to examine the quality of sports services for children. This is perhaps surprising when one considers that physical activity is engaged in more by children than by any other social group, not to mention the importance of developing and consolidating children’s interest in sport so as to help promote healthy lifestyles. With this in mind the present study uses indirect observation as a means of assessing the quality of municipal sports services for children. In recent years the indirect observational approach has made a notable contribution to the development of research methodologies. Indeed, it has been shown that valid, reliable information can be extracted from documents of various kinds. However, in order to ensure that such information is of high value, these documents need to be prepared in such a way that systematic analyses are possible. This study focuses on the quality of sports services for children and compares the views of children (8-12 years old) with those of parents and of the staff of municipal sports facilities. The aim was to gather information that could help improve such services and tailor them more to children’s needs. The information was gathered by means of in-depth interviews, the contents of which were then analysed using Atlas.ti software. The data presented here forms part of a broader research project

Building an ethical organizational culture.

The success of a health care institution-as defined by delivering high-quality, high-value care, positive patient outcomes, and financial solvency-is inextricably tied to the culture within that organization. The ability to achieve and sustain alignment between its mission, values, and everyday practices defines a positive organizational culture. An institution that has a diminished organizational culture, reflected in the failure to consistently align management and clinical decisions and practices with its mission and values, will struggle. The presence of misalignment or of ethics gaps affects the quality of care being delivered, the morale of the staff, and the organization's image in the community. Transforming an organizational culture will provide a foundation for success and a framework for daily ethics-grounded operations in any organization. However, building an ethics-grounded organization is a challenging process requiring strong organization leadership and planning. Using a case study, the authors provide a multiyear, continuous step-by-step strategy consisting of identifying ethics culture gaps, establishing an ethics taskforce, clarifying and prioritizing the problems, developing strategy for change, implementing the strategy, and evaluating outcomes. This process will assist organizations in aligning its actions with its mission and values, to find success on all fronts.

La ética en la salud pública, Provincia Granma / Ethics in public health. Granma Province

Lo que caracteriza al hombre y lo diferencia del resto de los seres biológicos es su condición de ser social, su capacidad de relacionarse con sus semejantes en el propio proceso de producción, reproducción y distribución de sus bienes materiales y espirituales. Este tipo de relaciones lo enfrenta a disímiles situaciones que llevan en sí mismas la necesidad de adoptar conductas que se consideran las más apropiadas o más dignas de ser cumplidas. En todos los casos se trata de problemas de orden práctico que se presentan en las relaciones efectivas reales y que demandan acciones o decisiones propias acerca de acciones o decisiones de otros hombres que no solo afectan a la persona particular, sino también a otras personas, quienes sufrirán las consecuencias de dicha acción, decisión o juicio moral. Cuando el hombre trasciende el hecho mismo de su particular comportamiento práctico para tomarlo como objeto de reflexión y de su pensamiento y examina razones, argumentos para demostrar la validez del acto, decisión o juicio moral que se ha realizado, entonces ha establecido la relación entre los problemas morales, la práctica y los problemas éticos, la teoría de esta reflexión teórica para un comportamiento práctico responsable, trata este trabajo(AU)

Corporative social responsibility (CSR) activities in the workplace: a comment on Aguinis and Glavas (2013) / Actividades de responsabilidad social corporativa en el trabajo: comentario a Aguinis y Glavas (2013)

Recent research has indicated that Corporate Social Responsibility (CSR) is beneficial to organizations: CSR enhances employee attitudes, behaviors, and productivity in the workplace and thus contributes to companies’ profitability. Recently, Aguinis and Glavas (2013) advanced the innovative distinction between embedded vs. peripheral CSR and compellingly demonstrated how this distinction could help straighten out the inconsistencies in the associated academic literature regarding the relationship of CSR to its antecedents and outcomes. Within this vast array of literature, however, relatively little is known about the psychological underpinnings that might define the manner in which CSR actually affects these work attitudes and behaviors, both directly and indirectly. The purpose of this note is to cast light on this issue (AU)

La investigación reciente ha indicado que la Responsabilidad Social Corporativa (RSC) es beneficiosa para las organizaciones: la CSR facilita las actitudes, las conductas y la productividad de los empleados en el trabajo y también contribuye a la rentabilidad de las compañías. Recientemente, Aguinis y Glavas (2013) avanzaron una distinción innovadora entre la RSC periférica y la incorporada y convincentemente demostraron cómo esta distinción podría ayudar a clarificar la incoherencia en la literatura académica asociada a la relación de la RSC con sus antecedentes y resultados. Sin embargo, en esta amplio conjunto de literatura se conoce muy poco sobre las bases psicológicas que pueden definir la manera en que la RSC realmente afecta a estas conductas y actitudes laborales, tanto directa como indirectamente. El propósito de esta nota a aportar luz sobre esta cuestión (AU)

[Continuing education in ethics: from clinical ethics to institutional ethics]. / La formation éthique continue: de l'éthique clinique à l'éthique institutionnelle.

UNLABELLED: The mandate of the Ethics Committee of the Conseil de médecins, dentistes et pharmaciens (CMDP) at the Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec is three-fold: to guide the clinical decision; to address the institutional ethical function; to create the program for continuing education in ethics (Formation éthique continue or FEC). Might FEC be the means of bridging from individual ethics to institutional ethics at a hospital? AIM: To take the FEC perspectives considered appropriate for doctors and consider them for validation or disproving in the context of those of other professionals. PROPOSED METHOD: Situate the proposed FEC mandate in a reference framework to evaluate (or triangulate) the clinical decision and the institutional ethic. CONVICTION: Sustainable professional development for doctors (DPD) includes ethics; it cannot be ignored. Without constant attention to upgrading one's abilities in professional ethics, these suffer the same fate as other professional aptitudes and competences (for example, techniques and scientific knowledge): decay.

Exploración del clima ético en estudiantes escuela de terapia ocupacional / Exploring the ethical climate in occupational therapy students / Exploração do clima ético em alunos escola de terapia ocupacional

El trabajo que presentamos consta de dos partes. La primera expone una reflexión acerca de la situación intervinculada que se presenta, a nivel ético, entre el desarrollo de las relaciones interpersonales y la incursión de éstas en el escenario de la vida académica. Además, las funciones que se le atribuyen a la Universidad, en torno al tema y en especial la misión de la Escuela de Terapia Ocupacional en la formación, en valores, del futuro profesional. En la segunda parte, usando el método de análisis cualitativo, expondremos el diagnóstico del clima ético percibido por los estudiantes de primer nivel de la Escuela. Esto, respondiendo a la necesidad de elaborar una propuesta formativa en valores éticos, orientada a la creación de una ciudadanía interesada en profundizar los estilos de vida protectores de la salud. En la disciplina (Terapia Ocupacional) que abordamos en nuestra formación, son principios fundamentales los valores democráticos e inclusivos de las personas en situación de desventaja. Para ello, es prioritario desarrollar competencias valorativas desde un modelo formativo ético que, tanto en su dimensión teórica como práctica se den en el clima universitario...

The work presented in two parts. The first presents a reflection on the situation presented interlinked, on an ethical level, between the development of interpersonal relationships and the incursion of these on the stage of academic life. Moreover, the functions that are attributed to the University, around the issue, and especially the mission of the School of Occupational Therapy in training, in values, of the future professional. In the second part, using the method of qualitative analysis, we discuss the diagnosis of ethical climate perceived by students in the first level at the school. This response to the need to develop a training proposal on ethical values, oriented towards the creation of a citizenship deeply interested in the lifestyles of health protective. In the discipline (Occupational Therapy) which we address in our training are fundamental principles of democratic values and inclusive of people at a disadvantage. This is a priority to develop skills training model values from an ethical dimension in both theory and practice are given in the university environment...

O trabalho que apresentamos consta de duas partes. A primeira expõe a reflexão sobre a situação intervinculada que ocorre em nível ético entre o desenvolvimento das relações interpessoais e a incursão destas no cenário da vida acadêmica. Além disso, as funções atribuídas à Universidade quanto ao tema e, em especial, a missão da Escola de Terapia Ocupacional na formação, em valores, do futuro profissional. Na segunda parte, utilizando o método de análise qualitativa, expomos o diagnóstico do clima ético percebido pelos alunos do primeiro ano da Escola, isto em resposta à necessidade de ser elaborada uma proposta de formação em valores éticos, orientada à criação de uma cidadania interessada em aprofundar-se nos estilos de vida protetores da saúde. Na disciplina (Terapia Ocupacional) que abordamos em nossa formação, são princípios fundamentais os valores democráticos e inclusivos das pessoas em situação de desvantagem. Para isso é prioritário desenvolver competências de valor a partir de um modelo formativo ético, que tanto em sua dimensão teórica como prática ocorram no clima universitário...

Mapping out structural features in clinical care calling for ethical sensitivity: a theoretical approach to promote ethical competence in healthcare personnel and clinical ethical support services (CESS).

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the 'favourite' ethical issues of the day. In this paper we attempt to capture a comprehensive overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS.

Need for ethics support in healthcare institutions: views of Dutch board members and ethics support staff.

OBJECTIVE: The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. METHODS: This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. FINDINGS: Most respondents see a need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. CONCLUSION: There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice.

Understanding the stigma of hyperemesis gravidarum: qualitative findings from an action research study.

BACKGROUND: Severe nausea and vomiting in pregnancy (hyperemesis gravidarum) can be a distressing and debilitating condition when it is uncontrolled. For all concerned, hyperemesis gravidarum can be difficult to treat satisfactorily, and women tend to be admitted to a hospital several times during early pregnancy. Our research objectives were to describe the experience of hyperemesis gravidarum from the perspective of affected women and to explore with health care professionals the barriers and facilitators to caring for women with the condition. METHODS: A qualitative research design was used. A total of 18 women were interviewed, of whom 8 had two or more interviews. Seven focus groups were conducted with health care professionals. Thematic data analysis was undertaken. RESULTS: The main themes emerging from the women's data were the effect and burden of the symptoms of the condition and feeling unpopular with staff. From the practitioner data, the main themes were the validity (or invalidity) of hospitalization for women, skepticism of the severity of symptoms, the psychological and social dimensions of the condition, and inadequate primary care services. CONCLUSIONS: The main findings revealed that hyperemesis gravidarum is a debilitating condition and that the unhelpful attitudes of practitioners may affect whether women access timely and appropriate care. Many women appear to be unsupported by primary care services and are distressed when perceived either as "time wasters" or someone else's responsibility. We propose that a tailored assessment and care plan for each woman is needed to help them control their symptoms, which ideally should be delivered in the community.

La cultura ética de la investigación biomédica en Venezuela / the ethical culture of the biomedical research in Venezuela

La investigación biomédica en seres humanos requiere principios bioéticos, de los cuales la autonomía es fundamental para proteger la dignidad de las personas objeto de estudio. Con la finalidad de analizar si existe cultura ética de investigación en Venezuela y si se respecta la autonomía de sujetos participantes en investigaciones biomédicas, independientemente de su competencia o incompetencia legal para otorgar su consentimiento, se realizó el presente trabajo. En él se analizan críticamente estos aspectos, de acuerdo con la cultura ética planteada por Lavery y el modelo de libertades preconizado por Sen. Asimismo, se realizó un análisis del ejercicio de la autonomía de niños y niñas y adolescentes establecido en la doctrina del menor maduro y en los instrumentos legales disponibles en el país. Se concluye que existe vulnerabilidad de la autonomía de las personas, particularmente de niños, niñas y adolescentes debido a factores que afectan el contexto humano, político y económico-social del país

The biomedical research in human beings requires of bioethics principles from which the autonomy is essential to proyect the dignity of prople which are the subject of study. The present study was carried out with the aim of analyzing if there is an ethical culture of reseach in Venezuela and if the subjects' autonomy that take part in biomedical research is respected, independently of its legal or illegal competency in order to give its consent. In this study these aspects are critically analyzed in accordance with the ethical culture expressed by Lavery and the model of liberties recommended by Sen. Likewise, an analysis of the practice of children and adolescents autonomy was carried out, established in the doctrine of the mature minor as well as in the legal instruments available in the country. It is concluded that there is a clear vulnerability of people's autonomy, especially the children and adolescents' autonomy, due to several factors that affect the human, political and socio-economical context of the country

Analysis and comparison of competitive balance in the spanish ACB basketball league: a preliminary study

Regardless its relevance in sports economics, competitive balance has not been studied neither in Spanish nor inEuropean professional basketball. In this preliminary study we measured the competitive balance in the Spanish ACB Leaguefrom seasons 1983/1984 to 2003/2004 using the well-known winning percentage standard deviation index. Results showed greatdifference between seasons and a general low competitive balance index. In addition, tournament designing did not seem toaffect the competitive balance in ACB(AU)

El profesor docente y la ética institucional / The educational teacher and the institutional ethics

Organizations develop codes of ethics to give orientations to their members on how to recognize, understand and handle ethical dilemmas in their daily work. In year 2005 a group of faculty members of the Universidad de Chile Faculty of Medicine started an institutional ethics project, acknowledging that all institutional decisions have moral contents. The purpose of this project is to promote an ethical environment in the institution. The first step was to establish a diagnosis by means of the organization of focal groups that collected the perceptions of students, faculty members and non-academic personnel. With a diagnosis in hand, a preliminary document was prepared, the “Universidad de Chile Faculty of Medicine declaration of principles and values”. Members of all groups that participated in the diagnostic phase had the opportunity to discuss this preliminary document and check if their agreement with its contents. Given the relevance of the ethical aspects of the learning and teaching process for the positive modeling of students from all health-related professions, special emphasis is given to its discussion.

Healthcare provider moral distress as a leadership challenge.

Healthcare leaders are responsible for using strategies to promote an organizational ethical climate. However, these strategies are limited in that they do not directly address healthcare provider moral distress. Since healthcare provider moral distress and the establishment of a positive ethical climate are both linked to an organization's ability to retain healthcare professionals and increase their level of job satisfaction, leaders have a corollary responsibility to address moral distress. We recommend that leaders should provide access to ethics education and resources, offer interventions such as ethics debriefings, establish ethics committees, and/or hire a bioethicist to develop ethics capacity and to assist with addressing healthcare provider moral distress.

Integrar la enseñanza pregrado en el hospital / Integrating undergraduate education within hospitals

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