Bringing an Organizational Ethics Lens to Perioperative Pain Care: Insights from a Recent Pragmatic Trial

Abstract: Both individual and societal norms shape the ethics of pain care and the concurrent opioid epidemic in the U.S. Policymakers have attempted to mitigate the crisis by regulating opioid manufacturing and advertising, expanding substance use treatment centers, and approving naloxone for over-the-counter use, representing a macro-level commitment to non-maleficence. On a micro level, clinicians have refined their individual practices, placing an increased emphasis on responsible prescribing and patient education. Despite these trends, comparatively little attention has been given to the organizational moral obligations and practices at the meso-institutional level. Organizational ethics locates moral agency within organizations and can help elucidate how the culture and structures of healthcare organizations shape the lived normative ethos in which policies are implemented and individual moral agents work. The NIH-funded Non-pharmacological Options in Postoperative Hospital-Based and Rehabilitation Pain Management (NOHARM) pragmatic trial is testing how to educate and prepare patients for discharge, highlighting evidence-based non-pharmacological options. Ongoing interviews as part of that study presented an opportunity to analyze the cultural and structural dimensions of the work surrounding perioperative pain care within a multi-site academic medical center. Using interviews and summarizing emerging themes from ongoing qualitative analysis with bedside and leadership staff, this paper will highlight the implicit and explicit features of the organizational normative ethics that appear to influence pain management. In so doing, we hope to illuminate gaps and opportunities to identify and foster robust organizational norms and cultures that mitigate harm and create an environment that allows for good pain care.

Jon Tilburt – Mayo Clinic