The purpose of the South Western Ontario Maternal, Newborn, Child and Youth Network (MNCYN) is to enable the consistent delivery of safe, quality maternal, newborn, child and youth care across Southwestern Ontario.
Conflicting expectations, privacy and confidentiality concerns and availability of human and financial resources are only some of the factors that have the potential to impact the Network’s decision making process. Their existence means that, from time to time, difficult choices will have to be made. This ethical framework aims to support and guide transparent decision making across Network partner organizations by clearly identifying foundational ethical principles.
MNCYN Mission and Vision
To enable the consistent delivery of safe, quality maternal, newborn, child and youth care across our region.
- Improved health outcomes through systematic improvements in health promotion, illness and injury prevention, acute and follow-up care and patient safety.
- Better operational management through improved asset management within the organization and across the region resulting in greater return on investment.
- Seamless systems integration through improved communication, program planning, and support resulting in greater coordination across the region.
- Enhanced learning and growth by promoting and advocating for a consistent standard of care throughout the region.
PURPOSE OF ETHICAL FRAMEWORK
The purpose of the Ethical Framework is to outline core ethical principles that support and guide the decision making processes of the Network and its member organizations by:
- Promoting a cohesive and transparent structure for discussions, thereby ensuring that all important aspects of each issue are considered;
- Fostering fairness, transparency and consistency in decision making, thus reducing the potential for inequity;
- Supporting an ethically informed process that ensures decisions are rooted in the network’s mission, vision and core values, evidenced-based, cost effective and fair and
- Ensuring integration and sustainability across the network.
Formulating policy recommendations regarding Network activities and priorities involves the exercise of judgment and there will be room for disagreement both within and among partner organizations. Although there is no objective or infallible measure by which such decisions can be based, the Ethical Framework will provide an approach to decision making that is consistent, respects the needs of individuals, organizations and the community and is grounded in accepted ethical principles.
The committee charged with developing this framework recognizes that individual and organizational decision making may be affected by a range of other constraints, including professional Colleges, laws, regulations, agreements, etc.
The ethical framework policy will outline the factors to be considered when deciding whether a particular project, intervention, quality improvement or educational activity will be developed and/or approved by the Network and constituent organizations.
The Ethical Framework policy will not apply in the following situations:
- Where professional practice codes, organizational policies, accountability agreements or legal requirements already govern activities;
- Where organizations are not Network members.
This framework is based on the principles that Maternal, Newborn, Child and Youth Network initiatives will be evidence-informed, based on need and equitably accessible. Furthermore, when planning for future activity, the MNCYN must ensure that financial balance is achieved at the end of the year as specified in the Memorandum of Understanding.
The Network will consider the exceptionality of the case when considering planning or implementing interventions. For the purposes of the policy, exceptionality is taken to mean that an organization is different in its structure, capacities and needs compared to other organizations of similar size and with similar mandate (e.g. in the case of order sets, certain variations are expected).
2. MNCYN ETHICAL FRAMEWORK – A POLICY FOR INTERDISCIPLINARY PLANNING, IMPLEMENTATION and EVALUATION
The Maternal, Newborn, Child and Youth Network has convened a panel to address initial and ongoing ethical issues related to governance. When making decisions to move forward with planning, implementing and evaluating future initiatives, the decision making process must be appropriately informed, transparent, equitably applied and open to discussion.
- There will be open, honest and respectful communication among the parties;
- Any conflicts of interest must be clearly disclosed;
- The Network may operate as a decentralized model of service delivery. That is, there may be offices and staff located in designated communities across the Southwest region. Appropriate regional or expert representation and input will be sought;
- The parties will work together to develop and support the implementation of the Network and work to ensure the on-going sustainability, development and delivery of services through the Southwest region;
- The parties will work together to develop collaborative working relationships with other Maternal, Newborn, Child and Youth Networks in Ontario, Provincial Council for Maternal and Child Health, the South West and Erie St. Clair LHINs and the Ontario Ministry of Health;
- Partner organizations will participate in setting and achieving Network-endorsed standards and mandates as outlined by the Regional Steering Committee.
In preparation for developing a framework to facilitate decision making, the panel discussed and agreed upon the factors that should be considered. The following list indicates the factors to be considered when making decisions:
- Health care need and the probability and magnitude of the expected benefit and the potential side effects and complications;
- Scientific evidence of clinical effectiveness;
- Cost effectiveness;
- Specialist Advice: The views of independent experts in the relevant field and / or the views of the specialist clinical networks;
- Equity: Ensure that Network decisions promote equity in the availability of treatment to individuals within the Perinatal and Paediatric populations of Southwestern Ontario;
- The Network will not discriminate on grounds of personal characteristics, such as age, gender, sexual orientation, gender identity, race, religion, lifestyle, social position, family or financial status, intelligence, disability, physical or cognitive functioning;
- The Law: Decisions taken by the Network will remain within the law;
- Opportunity costs of funding a particular project or initiative. When funding a project, if money will be diverted from the commissioning of other services the final decision needs to be considered within the context of the overall Network strategy and other identified provincial, regional and local priorities.
In considering the factors listed above we will ensure that in, the absence of evidence of need, a project will not generally be given “the green light” solely because a partner organization, group, or individual requests it
Dispute Resolution Process
The following dispute resolution process shall be used to address and resolve conflicts:
As a first step, the parties directly involved will work to resolve the conflict using a non-mediated approach. If this does not resolve the conflict, the parties involved are required to provide written notice to the Regional Leader. The Regional Leader will request that the Executive Committee help resolve the conflict no later than within 30 days of the written request. If the conflict involves the Executive Committee or the Regional Steering Committee, a mutually agreeable third party will, as required, be asked to mediate the dispute. The third party shall be acceptable to both parties. The cost of a mediator will be divided equally among the parties involved. Any dispute not resolved through mediation shall be settled through arbitration in accordance with the Arbitrations Act (Ontario) by a single arbitrator. If the parties are not able to agree upon an arbitrator, the selection of the arbitrator will be governed by the Arbitrations Act (Ontario). The award of the arbitrator shall be final and conclusive upon the parties and judgment upon such award may be entered in any court having jurisdiction. Unless the parties otherwise agree, the place of arbitration shall be London, Ontario.
The Ethical Framework outlined in this policy has been consulted upon with the MNCYN Executive Committee and with the Network’s Regional Steering Committee.
Regional Steering Committee members – in their capacity as official Partner representatives – will ensure that all staff involved in planning, implementing and evaluating Network activities are aware of and will follow the policy.
This policy will be provided to all those involved in the said activities and will underpin all subsequent policies relating to the Network and individual Partners. The policy will be available to all stakeholders, including the general public on the Network’s website.
Any breaches to this policy will be monitored through the Executive Committee and reported to the Regional Steering Committee.
4. REFERENCE DOCUMENTS
Memorandum of Understanding, South Western Ontario Maternal, Newborn, Child and Youth Network, April 2009
Organizational ethics, Jennifer L. Gibson, Robert Sibbald, Eoin Connolly, and Peter A. Singer
Setting Limits Fairly, Norman Daniels, James E. Sabin (pp. 43-65)
South Central Ethical Framework, South Central Priorities Support Unit,
Dr. Kevin Coughlin
Lucia St. Aubin
March 20, 2010