Typically, clinical/ organizational consultations are core activities of healthcare Ethicists. Clinical consultations tend to deal with challenges involving a particular patient, while organizational consultations tend to deal with challenges faced by the organization that can impact groups of patients. Both clinical and organizational consultations are usually brought to the ethicist (by a patient, family member, staff member or physician), rather than being uncovered or discovered by the ethicist directly. At Osler we average about 1,200 consults a year across acute care, long-term care and community care.

The Ethics Quality Improvement Lab (EQI Lab) at William Osler Health System (Osler) is putting forward a leading practice to address recurring clinical and organizational ethics challenges and the themes that arise from them called Ethics Quality Improvement Projects (EQIPs). EQIPs are an upstream approach to address ethical issues towards reducing harms to patients and system inefficiencies that can occur downstream. EQIPs apply quality improvement methods and tools in order to bring about measurable, sustainable changes in organizational thinking and behaviour. The EQI Lab identifies patterns in the consultation service and then designs EQIPs that address the root-causes and prevent repeat ethics-related issues and downstream burden to the health system. EQIPs support healthcare providers, patients, and their families to think differently and to act differently. The EQI Lab at Osler has demonstrated success with its EQIPs, and has received local, provincial, and national recognition for these projects and approach to ethical issues.

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