The document summarizes the development of an Ethics Framework by Alberta Health Services (AHS) to support ethical decision-making. AHS formed a working group to develop the framework over 4 months, soliciting input from various stakeholders. The framework provides information on ethics resources available at AHS and outlines a process for addressing ethics issues. It is intended to clarify resources for staff and patients and support critical thinking on ethical issues that arise in healthcare. AHS will track awareness and use of ethics resources to evaluate the framework.

1. The Alberta Health Services
Ethics Framework
A Guide for
AHS Staff,
Physicians and
Volunteers
Al-Noor Nenshi Nathoo and Kimberley Stever

2. Opportunity
Alberta Health Services (AHS) is committed to building an ethical culture and promoting
public trust. Patient and family centered care is enhanced when clinicians, patients and
their families are supported in the presence of challenging ethical issues.
• Accreditation Canada requires health organizations to have an Ethics
Framework that identifies processes and tools within the organization to
manage ethical issues, dilemmas, and concerns.
• Given AHS’ commitment to supporting ethical decision-making, the need for an
Ethics Framework provided an opportunity to launch a cross-portfolio initiative
to develop a consistent, easily understandable and resourced approach to
addressing ethics issues.
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3. Build Understanding
• Over a 4-month period, an Ethics Framework Working Group solicited input
from a cross-section of representatives across the organization, including
front-line clinicians, patients and families, leaders, physicians, and clinical
ethics committee members.
• The result of those efforts is the AHS Ethics Framework (Framework). The
Framework provides a summary of the resources available to staff and
patients within AHS to support ethical behaviour and decision-making, and
to build the collective ‘ethics IQ’ of the organization.
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Ethics Framework - Section I
“Section I - Ethics Resources” describes
AHS support available in four different
areas of ethics
Quality
Improvement &
Evaluation
Ethics
Screening Tool
Research Ethics
Boards
AHS Ethics &
Compliance
Office
AHS Clinical
Ethics Service

5. Ethics Framework – Section II
“Section II - Ethics Decision-
Making Process” outlines a
step-by-step decision-making
guide to be used by staff to
help identify and address
ethics issues.
The Framework is available at
www.albertahealthservices.ca/9879.asp
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6. Patient Safety/Quality Improvement
Contribution & Measurement
Central to patient safety & quality improvement is a just and trusting culture. The
Framework plays a central role in:
(1) Clarifying for staff and patients the significant resources that exist within the
organization to help them address ethics issues and build their ethical
healthcare practices; and
(2) Supporting their own efforts in critical thinking to identify, analyze and act on
ethical issues that arise everyday in delivery of healthcare.
AHS will track levels of awareness of ethics resources, requests for ethics support
and consultation, requests for ethics education and capacity building, as well as
quality of ethics services provided through the applicable departments beginning
in 2015-16.
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7. Partnership
In an organization of over 110,000 personnel, partnership
amongst key stakeholders and divisions is a priority if initiatives
are to effect change. A variety of groups were involved or
consulted in the development of the Framework.
Representatives from
AHS Clinical Ethics,
Research Ethics,
Organizational/Ethics
Compliance, and
Quality Improvement
Ethics
Inclusion of patient
voices as well as the
concerns of front-line
clinicians through the
AHS Patient and
Family Advisory
Council and the
Alberta Clinician
Council
Final review and
support from senior
leaders: the Quality
and Safety Executive
Committee (QSEC),
Co-CEOs, and the
Official Administrator
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Sustain Results
Content
Key lessons learned from Phase I (Development) include:
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Attention to Process
• The initial goal was to develop
and publish a consistent
organizational approach to
building an ethical culture within
AHS. Ultimately, the process of
development was just as
valuable as the end product:
• In stakeholder consultations,
a variety of issues and
concerns were raised about
how the organization can
better support ethical
decision-making.
•This input was both
instrumental to the initiative
and enlightening for those
leading it.
Awareness
• This process uncovered gaps
within AHS regarding the presence
and availability of existing
resources to support staff and
patients in their ethical decision-making:
• The majority of staff and
patients consulted were not
aware of the various ethics
departments or services within
AHS.
•This underscores the need to
ensure that the Framework is
widely communicated, and that
the initiative is properly
resourced, in order for it to be
effective.
Time
•Developing a consistent
framework of this kind takes
time, due to:
•The number and wide range
of stakeholders relevant to
the process.
•The nature and complexity of
values-based decision-making.
• The difficulty in
communicating information
about such a complex subject
to a broad audience.