The ethical void: a critical analysis of commissioned expert reports on Swedish healthcare governance

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Abstract

Purpose

The purpose of this paper is to contribute knowledge on ethical issues and reasoning in expert reports concerning healthcare governance, commissioned by the Swedish healthcare system.

Design/methodology/approach

An in-depth analysis of ethical issues and reasoning in 36 commissioned expert reports was performed. Twenty-seven interviews with commissioners and producers of the reports were also carried out and analysed.

Findings

Some ethical issues were identified in the reports. But ethical reasoning was rarely evident. The meaning of ethical concepts could be devalued and changed over time and thereby deviate from statutory ethical goals and values. Several ethical issues of great concern for the Swedish public healthcare were also absent.

Practical implications

The commissioner of expert reports needs to ensure that comprehensive ethical considerations and ethical analysis are integrated in the expert reports.

Originality/value

Based on an extensive data material this paper reveals an ethical void in expert reports on healthcare governance. By avoiding ethical issues there is a risk that the expert reports could bring about reforms and control models that have ethically undesirable consequences for people and society.

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Most cited references 31

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Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

U.H. Graneheim, B Lundman (2004)

Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.

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A PUBLIC MANAGEMENT FOR ALL SEASONS?

Christopher John Hood (1991)

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Is Open Access

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States

Linda Aiken, Walter Sermeus, Koen Van den Heede … (2012)

Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.

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Author and article information

Contributors

Falkenström Erica :

ORCID: https://orcid.org/0000-0003-1158-9140

Bio :

Erica Falkenström is a senior researcher at the Institute for Futures Studies, Stockholm, Sweden, and associated researcher at the Centre for Research Ethics and Bioethics, Uppsala University. Her current research concerns organizational ethics in public sector governance. Her latest book is På spaning efter etik. Etisk kompetens och ansvarstagande för ledning och styrning av hälso- och sjukvården [ In Search of Ethics: Ethical Competence and Responsibility in Health Care Governance] (Appell, 2018).

Höglund Anna T. :

Bio :

Anna T. Höglund is a professor of care ethics and gender studies at the Centre for Research Ethics and Bioethics, Uppsala University, Sweden. She has worked and published extensively on the question of ethical competence for health care practitioners. Related research areas are moral distress in clinical settings and prioritization in health care.

Journal

Journal ID (publisher-id): JHOM

Journal ID (doi): 10.1108/JHOM

Title: Journal of Health Organization and Management

Abbreviated Title: JHOM

Publisher: Emerald Publishing

ISSN: 1477-7266

Publication date (Electronic, pub): 22 November 2023

Publication date (Print, pub): 24 January 2024

Volume: 38

Issue: 1

Pages: 32-48

Affiliations

[1] Institute for Future Studies; , Stockholm, Sweden

[2] Centre for Research Ethics and Bioethics; , Uppsala University; , Uppsala, Sweden

Author notes

Erica Falkenström is the corresponding author and can be contacted at: erica.falkenstrom@iffs.se

Article

Publisher ID: 712243 Original-pdf ID: JHOM-09-2022-0261.pdf Filename ID: JHOM-09-2022-0261

DOI: 10.1108/JHOM-09-2022-0261

SO-VID: 37308d03-265d-44b2-a339-8e1d63457145

History

Date received : 20 September 2022

Date: 15 September 2023

Date accepted : 13 October 2023

Page count

Figures: 0, Tables: 1, Equations: 0, References: 49, Pages: 17, Words: 9941

Custom metadata

peer-reviewed Yes

academic-content Yes

EContentType Journal

rightslink included

ScienceOpen disciplines: Health & Social care

Keywords: Sweden,Ethics,Health policy,Organizational ethics,Commissioned expert reports,Healthcare governance

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: Sweden, Ethics, Health policy, Organizational ethics, Commissioned expert reports, Healthcare governance

The ethical void: a critical analysis of commissioned expert reports on Swedish healthcare governance

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Emerald: Healthier Lives

Most cited references 31

Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

A PUBLIC MANAGEMENT FOR ALL SEASONS?

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States

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