Recommendations for the ethical conduct of quality improvement.

(VHA) is an interdisciplinary group authorized by the Under Secretary for Health through the National Center for Ethics in Health Care. The NEC produces reports on timely topics that are of significant concern to practicing health care professionals. Each report describes an ethical issue, summarizes its historical context, discusses its relevance to VHA, reviews current controversies, and outlines practical recommendations. Previous reports have been useful to VHA professionals as resources for educational programs, guides for patient care practices, and catalysts for health policy reform. Scholarly yet practical, these reports are intended to heighten awareness of ethical issues and to improve the quality of health care, both within and beyond VHA. Executive Summary The Veterans Health Administration (VHA) is a national leader in quality improvement (QI). QI activity is essential and has brought tremendous benefits for patients. Yet, while widely accepted ethical standards exist for other activities in the clinical arena, including medical treatment and research, no analogous ethical standards currently exist for QI. This report by VHA's National Ethics Committee (NEC) is a preliminary attempt to fill this gap by providing practical recommendations for the responsible conduct of QI. The following guidelines are intended to balance the ethical imperative to adequately protect patients and the ethical imperative to continuously improve patient care: 1) Health care organizations should recognize that QI cannot always be meaningfully differentiated from other activities that occur in the clinical arena, notably treatment and research. 2) Health care organizations should ensure that the rights and interests of patients involved in all health care activities – including QI – are adequately protected. 3) Health care organizations should take care that efforts designed to protect patients do not unnecessarily encumber the QI process. 4) Health care organizations should clearly define the locus of responsibility for the ethical conduct of QI. 5) Health care organizations should proactively promote the ethical conduct of QI. 6) QI activities should produce benefits that outweigh their potential burdens or risks. 7) QI activities should respect each patient's right to self-determination. 8) QI activities should preserve patients' privacy and confidentiality. 9) QI activities should be distributed fairly across patient groups. 10) Health care organizations should develop specific policies and procedures that fit their unique circumstances and needs. These recommendations are intended as a starting point for discussion and elaboration of standards for the ethical conduct of QI. Further discussion will be needed within health care …