Moral Distress Among Health System Managers: Exploratory Research in Two British Columbia Health Authorities

• Published in: Health care analysis Vol. 19; no. 2; pp. 107 - 121
• Main Authors: Mitton, Craig, Peacock, Stuart, Storch, Jan, Smith, Neale, Cornelissen, Evelyn
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2011; Springer Nature B.V
• Subjects: British Columbia; Canada; Decision Making; Delivery of Health Care - organization & administration; Dissent and Disputes; Ethics; Female; Focus Groups; Health administration; Health authorities; Health care; Health care management; Health Informatics; Health Personnel - psychology; Health Priorities; Health services; Humans; Male; Medical ethics; Medical research; Medicine; Medicine & Public Health; Mental stress; Moral aspects; Morality; Morals; Organizational culture; Original Article; Philosophy of Medicine; Prevalence; Psychological distress; Public Health; Qualitative Research; Resource Allocation; Senior management; British Columbia; Ethics; Canada; Priority setting; Moral distress; Healthcare management; Resource allocation
• ISSN: 1065-3058; 1573-3394
• DOI: 10.1007/s10728-010-0145-9

Moral distress is a concept used to date in clinical literature to describe the experience of staff in circumstances in which they are prevented from delivering the kind of bedside care they believe is expected of them, professionally and ethically. Our research objective was to determine if this concept has relevance in terms of key health care managerial functions, such as priority setting and resource allocation. We conducted interviews and focus groups with mid- and senior-level managers in two British Columbia (Canada) health authorities. Transcripts were analyzed qualitatively using constant comparison to identify key themes related to moral distress. Both mid- and senior-level managers appear to experience moral distress, with both similarities and differences in how their experiences manifest. Several examples of this concept were identified including the obligation to communicate or ‘sell’ organizational decisions or policies with which a manager personally may disagree and situations where scarce resources compel managers to place staff in situations where they meet with predictable and potentially avoidable risks. Given that moral distress appears to be a relevant issue for at least some health care managers, further research is warranted into its exact nature, prevalence, and possible organizational and personal responses.