Institute for Future Studies, Stockholm, Sweden.
Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
J Health Organ Manag. 2019 Nov 19;34(1):53-70. doi: 10.1108/JHOM-05-2019-0130.
The purpose of this paper is to analyse ethical competence related to healthcare governance and management tasks at the county/regional level in Sweden. The paper also discusses conditions that support or constrain the development and application of such competence.
DESIGN/METHODOLOGY/APPROACH: The study is based on original qualitative data from 13 interviews and 6 meeting observations. Three key groups of actors were included: politicians, civil servants and CEOs in publicly financed health-provider organizations. An abductive analysis was carried out by a stepwise method guided by thematic research questions.
The informants viewed themselves as having a high degree of ethical responsibility for healthcare practice. However, they did not integrate ethical reflection and dialogue into their work decisions (e.g. regarding budgets, reforms and care agreements). The current organization, control systems and underlying business principles, along with the individuals' understanding of their own and others' roles, tended to constrain the development and use of ethical competence.
Qualities of an appropriate ethical competence related to healthcare governance and management, and conditions to develop and use such competence, are suggested.
ORIGINALITY/VALUE: Hardly any empirical research has examined ethical competence related to healthcare governance and management tasks. The paper integrates ethics and theories on learning in organizations and contributes knowledge about ethical competence and the conditions necessary to develop and practise ethical competence in an organizational and inter-organizational context.
本文旨在分析瑞典县级/地区医疗保健治理和管理任务相关的伦理能力。本文还讨论了支持或限制这种能力发展和应用的条件。
设计/方法/途径：本研究基于来自 13 次访谈和 6 次会议观察的原始定性数据。包括了三个主要的利益相关者群体：政治家、公务员和公共资助医疗机构的首席执行官。通过主题研究问题的逐步方法进行了归纳分析。
受访者认为自己对医疗保健实践负有高度的道德责任。然而，他们并没有将伦理反思和对话纳入工作决策（例如关于预算、改革和护理协议）。当前的组织、控制系统和基本业务原则，以及个人对自己和他人角色的理解，往往会限制伦理能力的发展和运用。
提出了与医疗保健治理和管理任务相关的适当伦理能力的素质，以及发展和运用这种能力的条件。
原创性/价值：几乎没有任何实证研究考察过与医疗保健治理和管理任务相关的伦理能力。本文将伦理学和组织学习理论相结合，为在组织和组织间背景下发展和实践伦理能力所需的伦理能力和条件提供了知识。
