Of medicine and ethics

Changes in the business of medicine are creating opportunities to better integrate ethics and social justice concerns into health care decision-making, a shift that benefits all concerned, a speaker at Harvard Medical School (HMS) said Thursday.

Delivering the keynote speech at HMS’ fifth annual Bioethics Conference, James Corbett said that the shift from the traditional medical payment model provides an incentive for health care corporations to address broader issues, such as poverty, in their patient care.

A high turnover rate among CEOs of those institutions also makes this a favorable moment for change, argued Corbett, senior vice president for community health improvement and values integration for Centura Health, a health care system serving Colorado and Kansas.

“The time is now. We are in the arena where those on the outside and the inside can help reshape the system,” he said.

The annual conference, organized by the HMS Center for Bioethics, offers participants, notably members of the various ethics committees and programs throughout the medical school and its affiliated teaching hospitals, a chance to network and discuss common issues of concern.

“It’s a great opportunity for us to be able to leverage the resources we have in order to offer something meaningful to that broader community,” said Robert Truog, the center’s director and a professor of medical ethics, anesthesiology, and pediatrics.

This year’s event, which drew about 400 participants, focused on the role of social justice and ethics committees in health care. Sessions touched on issues from addressing race in health care delivery to caring for refugees and undocumented patients.

The conference, previously held at the Tosteson Medical Education Center, was moved to the more spacious Martin Conference Center this year “to attract a more diverse and larger audience,” said Christine Mitchell, executive director of the Center for Bioethics.

Corbett, who holds both a law degree and a master’s degree in divinity, said his inspiration to bridge the gap between the high ideals of the law and actual practice mirrors his work now in health care.

“I think there are some social justice themes in the mission and values of all of our organizations that we can lift up as a burning platform of sorts to inspire action,” he said.

Corbett challenged the assumption that concern for social justice is contrary to the bottom line for health care corporations, summed up in the expression “Our margin is our mission.” In fact, he said, the two can go hand in hand.

“It is that mission that allows you to achieve your margin,” he said, citing studies showing a link between patient happiness and hospitals’ bottom lines. “Happier employees and a more just environment leads to happier patients, which leads to an increased margin.”

Moving the system in a more mission-oriented direction can be challenging in an era of mega-health care systems, Corbett said, noting that large-scale corporations can overlook the needs of individual communities.

But he said the high rate of turnover of health care CEOs, which is one result of the competitive environment — 18 percent in both 2014 and 2015 — offers a chance to focus more attention on ethics.

Noting that a desire to “do something bigger than myself” is part and parcel of millennial culture, he said, “I think we have a tremendous opportunity to leverage that and to bring the right leadership into health care in these changing times.”

Also making this a ripe time to elevate ethics as a corporate concern, Corbett said, is the gradual shift away from the fee-for-service model of payment to value-oriented models such as bundled payment systems and accountable care organizations in which provider groups are required or given incentives to deliver care in a more efficient and comprehensive way.

He said social justice concerns could fare well in that changing environment, since health care organizations will need “to think outside the hospital wall and to think about social structures and social issues as part and parcel of the care.”

Corbett cautioned that “an ethics committee alone will not make it an ethical organization.” He said champions of those issues must be seated in the boardrooms where decisions are made.

“We need to force health care executives and systems to live up to their greatest aspirations,” he said.