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

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Abstract

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.

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Author information

Authors and Affiliations

  1. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th Floor, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Craig Mitton & Neale Smith

  2. School of Public and Population Health, University of British Columbia, Vancouver, BC, Canada

    Craig Mitton & Stuart Peacock

  3. National Centre for Health Economics, Services, Policy and Ethics, British Columbia Cancer Agency, Vancouver, BC, Canada

    Stuart Peacock

  4. School of Nursing, University of Victoria, Victoria, BC, Canada

    Jan Storch

  5. Faculty of Health and Social Development, UBC Okanagan, Kelowna, BC, Canada

    Evelyn Cornelissen

Authors
  1. Craig Mitton
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  2. Stuart Peacock
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  3. Jan Storch
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  4. Neale Smith
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  5. Evelyn Cornelissen
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Corresponding author

Correspondence to Craig Mitton.

Appendix: Moral Distress Interview Questions

Appendix: Moral Distress Interview Questions

Moral distress can be defined as the suffering experienced as a result of situations in which individuals feel morally responsible and have determined the ethically right action to take, yet due to constraints (real or perceived) cannot carry out this action, thus committing a moral offence. The suffering can present as feelings of anger, frustration, guilt and/or powerlessness associated with a decreased sense of well-being [read out loud]

  • As defined, would you say that you have experienced moral distress in your current or previous roles in this organization? [NOTE—this is in general; relating to any position/role you have had in the organization.]

    • If so, can you describe the situation(s) or actual moral dilemma(s), i.e. the details/specifics to set the context?

    • What are the morally difficult areas for you?

  • Could you describe what this experience (or these experiences) has been like for you, providing specific examples or illustrations?

    • Consider how it made you feel, and also what the trade-offs were, i.e. consequences like time off work, personal ill health, frustration with self, colleagues, your position, the organization, etc.

  • What characteristics at an individual and/or organizational level do you think are related to and/or contribute to moral distress?

Priority setting (or rationing) is defined as the process in which choices are made about what services to fund (and to what degree) and what services not to fund. Due to limited resources, the implications of setting priorities (and thereby directing resources towards one area at the expense of other areas) can lead to distress at the individual level. [read out loud]

  • Given this definition of priority setting, does your current or past role involve priority setting? What is your perception of what ‘priority setting’ entails in your organization/department?

  • Have you personally experienced moral distress in relation to setting priorities in your organization—first consider your role in priority setting (if you have one); and second, consider how you have been impacted by having to implement priorities set above you (that you had no voice in)?

  • Please describe what this experience was like for you and whether you can recall any specific consequences (e.g., time off from work, personal ill health, frustration with self, co-workers, your position and/or the organization)?

  • What else should we be asking about this topic for future interviews in order to get information that will be useful for helping the organization improve itself in these areas?

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Mitton, C., Peacock, S., Storch, J. et al. Moral Distress Among Health System Managers: Exploratory Research in Two British Columbia Health Authorities. Health Care Anal 19, 107–121 (2011). https://doi.org/10.1007/s10728-010-0145-9

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