Guidance for Creating Morally Healthy Organizations That Remediate the Experience of Moral Injury in Health Care: Findings From an International e-Delphi Study.

Abstract

Objective: To date, research and policy directives have focused on identifying individual risk factors for moral injury, with less attention to solutions for establishing nonmorally injurious cultures and practices.

Methods: Experts with academic or clinical knowledge of moral injury were recruited to a three-round e-Delphi survey exploring descriptors and characteristics of nonmorally injurious organizations.

Results: Forty-nine, 41, and 39 experts responded at each round. Morally "healthy," "congruent," and "centered" were endorsed as descriptors for nonmorally injurious organizations. Consensus was also obtained on 111 characteristics and behaviors relating to organizational identity (eg, just culture), behaviors and practices (eg, transparency in decision-making), and self-awareness (eg, monitoring of moral injury in workforce).

Conclusions: The findings implicate the need for a strengths-oriented, solution-focused approach to addressing moral injury. The recommendations proposed warrant evaluation and operationalization within formal guidance.