Perspectives in Biology and Medicine最新文献

Health-care organizations traditionally view accountability through punitive and performance-metric lenses, failing to address their responsibility to communities most impacted by health inequities. While research exists on organizational accountability in health care, little explores how Black, Indigenous, and People of Color (BIPOC) frameworks might transform health-care delivery toward justice and equity. This article examines how four BIPOC philosophical frameworks-right relations, Seven Generations, calling in versus calling out, and Emergent Strategy-can reimagine organizational accountability to advance health equity. The authors' findings reveal that combining BIPOC accountability frameworks with structural reforms in payment and care delivery systems enables health-care organizations to center relationship-building and long-term community impact. Concrete organizational examples demonstrate successful implementation of these principles through initiatives like the Robert Wood Johnson Foundation Advancing Health Equity program, while personal narratives illustrate their transformative potential in patient care. This work provides practical pathways for health-care organizations to move beyond punishment toward accountability models that prioritize immediate holistic care needs, health equity, and generational community well-being, fostering healing and justice.

How to improve the delivery of health care within hospitals is a central question for policymakers, managers, clinicians, and the public. Conventional approaches to improvement have largely focused on either systems or individual behaviors. But social practice theory provides an alternative way of understanding how modern hospitals work, going beyond conventional explanations and pointing to new modes of intervention. The authors examine two cases to demonstrate how practice theory offers a way to move beyond binary understandings and explore such issues as what practices are at play, how those practices are helpful and to whom, what types of competence, meaning, and infrastructure support those practices, and how the linkages that support those practices can be strengthened or weakened to change outcomes.

As health-care systems increase in complexity, how do they ensure ethical practices, with a specific focus on addressing persistent health disparities and advancing justice? This essay contemplates the role of a system-level ethics committee in supporting organizational efforts toward justice, drawing on the author's experiences leading ethics efforts at Beth Israel Medical Deaconess Medical Center and now developing a system-level ethics committee for the broader Beth Israel Lahey Health system. Although the author's experiences largely demonstrate the rich potential for a grassroots, bottom-up approach centered around individual employee initiative to create a justice-oriented organizational ethic, there is also a benefit to top-down support from the organization's leadership to formalize and articulate the mission and values that should drive the actions of the organization and its individual employees. Arguing that neither a bottom-up nor top-down approach is independently sufficient, the essay suggests a combined approach to further the organization's mission and, in particular, health-care justice. Insights from this analysis are translated into five recommendations for the role and contributions of a system-level ethics committee to ethics- and justice-oriented practice within a complex health system.

The idea that people should have a voice in decisions that affect them is now widely accepted in the US health sector. Practices such as patient and family advisory boards, community-based participatory research, patient-centered research, and public deliberation are becoming commonplace. The appeal of public participation turns on a number of purported benefits, including the potential for more inclusive and transparent decision-making, equitable interventions and outcomes, and public trust in institutions. Considerable conceptual work has refined definitions and frameworks of participatory processes, and ample experimentation is underway. Yet participation remains an ambiguous concept and highly variable in practice. Drawing on the authors' collective experiences in life and work, this article clarifies what participatory processes are, describes how they might support varied goals of justice, and identifies opportunities and considerations for their use in health-care organizations. Although participatory processes alone cannot solve the erosion of trust in American health care or remedy marked US health inequities, they can be an important tool for health-care leaders who wish to work toward building fairer health systems, services, and outcomes.

The Chicago Maternity Center provided obstetrical services for the medically underserved on Chicago's Near West Side for nearly eight decades (1895-1974). While its founder's vision, its outreach to underserved communities, the reasons for its decline, and the perceived abandonment of the community when it closed have been well documented, less attention has been paid to the role of trainees in providing obstetrical care. Medical students and residents routinely delivered babies in patients' homes, often without adequate supervision. This aspect of the center's history can help illustrate the evolution of experiential education in clinical medicine, along with emerging concepts of equitable access and quality of care. This work explores the center's role in medical education in light of contemporary perceptions of some participants-trainees, faculty, and institutional leadership-and through analysis of scholarly and popular publications, institutional archives, and communications with alumni and retired faculty. The popularity of the experience with trainees and its constituents, segregation of the center's activities from those of the sponsoring medical center, and its well-respected history led to the persistence of a model for clinical medical education that was an anachronistic remnant of earlier approaches to education and to care for the poor and disenfranchised.

In the US, there has historically been strong public opposition to health-care reform involving "socialized medicine." This resistance, at least in part, is influenced by a deeply entrenched individualistic ethos. It is becoming increasingly clear, however, that the current US health-care system is broken, and that existing systems around the world achieve better outcomes while costing less. This article argues that learning from these systems should be possible. The authors describe roadblocks to health-care reform in the US, including social fragmentation, resistance to global models, and the prioritization of profit over well-being; argue that a value system that prioritizes the individual over the collective precludes successful health-care reform; highlight shortcomings of the US model; and propose that reimagining health care through a socially oriented lens, emphasizing collective and reciprocal moral obligations, may offer a path forward.

Hospitals and health systems have become prime movers in US health care, employing more than 77% of the physician workforce and growing in scale through persistent market consolidation (Muoio 2024). These entities' business practices have recently come under sharp scrutiny for appearing to run contrary to some of the more idealistic norms of medicine. While the law is a valuable tool in discouraging and punishing bad organizational behavior, it frequently struggles to keep pace with a changing marketplace. What ethical concepts, if any, can provide a check or constraint on their behavior? Sociologist Fred Hafferty, one of the leading scholars of professionalism in medicine, explores these and other questions in conversation with ethicist and management scholar Lauren Taylor.

To many participants in today's US health-care system, it can seem as if health care has lost its way. Complex, fragmented systems. Difficulty accessing care. Strain on physicians. Financial burdens for patients. Yet there are also many opportunities to improve care, patient and provider experience, and-ultimately- health. It won't be easy, according to SCAN Group and Health Plan President and CEO, Dr. Sachin Jain, MD, MBA. It requires nothing less than examining the paradigms of thought and practice that tend to maintain "business as usual" in the health-care industry. It will require reenvisioning mission, moral leadership, and what patient-centeredness means in health care.

Medical education, while a process of deep moral formation, lacks any account of how students and trainees are to morally approach the process of learning. The classical understanding of the vice curiositas and the virtue studiositas, as described by the theologian Paul Griffiths, provides a framework to help understand the better and worse ways that students and trainees can engage in the learning experience. While medical school may powerfully inculcate the vice of curiositas, such a posture to learning fails when one is faced with the novel challenges of clinical care. Given the challenges inherent to moral formation in medicine, students and trainees might find communities that catechize the virtue of studiositas outside of the boundaries of the medical school and hospital.

This article discusses tensions related to expectations about the health-care sector's investment in the social drivers of health. As social-care roles and responsibilities are defined, the health-care sector needs a clearer set of ethical principles to guide policy and practice. Norman Daniels's accountability for reasonableness (A4R) approach offers a framework for the development of more formal approaches, by structuring organization-wide conversations about the relevant values and providing a vocabulary for talking about the ethical dilemmas involved in questions of justice and organizational responsibility.