The Ethical Imperative to Move to a Seven-Day Care Model
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Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery.
KeywordsHealthcare reform Delivery of healthcare Healthcare ethics Ethics, institutional
We thank Associate Professor Christy Simpson for her helpful comments on this paper.
Compliance with ethical standards
The authors have none to declare.
- Academy of Medical Royal Colleges. 2012. Seven day consultant present care. London: Academy of Medical Royal Colleges.Google Scholar
- Australian Medical Association. 2010. Doctors’ engagement in the management of hospitals. https://ama.com.au/position-statement/doctors%E2%80%99-engagement-management-hospitals-2010. Accessed February 6, 2016.
- Braithwaite, J., J. Healy, and K. Dwan. 2005. The governance of health safety and quality: A discussion paper. Canberra: Commonwealth of Australia.Google Scholar
- British Medical Association. 2013. BMA position paper: 7-day services. http://bma.org.uk/-/media/files/pdfs/working%20for%20change/shaping%20healthcare/bma%20position%20paper%20seven%20day%20services.pdf. Accessed December 15, 2015.
- Dahlgren, G., and M. Whitehead. 1992. Policies and strategies to promote equity in health. Copenhagen: WHO Regional Office for Europe.Google Scholar
- Daniels, N. 1998. Is there a right to healthcare, and if so, what does it encompass? In A companion to bioethics, edited by H. Kuhse and P. Singer, 316–325. Oxford: Blackwell.Google Scholar
- Daniels, N., B. Kennedy, and I. Kawachi. 2000. Justice is good for our health. In Is inequality bad for our health?, edited by J. Cohen and J. Rogers, 3–33. Boston: Beacon Press.Google Scholar
- Duckett, S., and S. Willcox. 2011. The Australian health care system, 4th ed. South Melbourne, VIC: Oxford University Press.Google Scholar
- Dugdale, P. 2012. Governance challenges for primary healthcare. In Health workforce governance, edited by S. Short and F. McDonald, 183–201. Surrey: Ashgate Publishing Limited.Google Scholar
- General Medical Council. 2012. Leadership and management for all doctors. http://www.gmc-uk.org/guidance/ethical_guidance/management_for_doctors.asp. Accessed December 15, 2015.
- Guttmann, A., M.J. Schull, M.J. Vermeulen, and T.A. Stukel. 2011. Association between waiting times and short term mortality and hospital admission after departure from emergency department: Population based cohort study from Ontario, Canada. British Medical Journal 342: d2983. doi: 10.1136/bmj.d2983.
- Institute for Patient- and Family-Centered Care. 2015. Frequently asked questions. http://www.ipfcc.org/faq.html. Accessed December 15, 2015.
- Kerridge, I., M. Lowe, and C. Stewart. 2013. Ethics and law for the health professions, 4th ed. Annandale, NSW: Federation Press.Google Scholar
- Medical Council of New Zealand. 2008. Statement of safe practice in an environment of resource limitation. https://www.mcnz.org.nz/assets/News-and-Publications/Statements/Safe-practice-in-an-environment-of-resource-limitation.pdf. Accessed December 15, 2015.
- Mohammed, M.A., K.S. Sidhu, G. Rudge, and A.J. Stevens. 2012. Weekend admission to hospital has a higher risk of death in the elective setting than in the emergency setting: A retrospective database study of National Health Service hospitals in England. BMC Health Services Research 12: 87. doi: 10.1186/1472-6963-12-87.CrossRefPubMedPubMedCentralGoogle Scholar
- National Health and Medical Research Centre. 1999. Ethical considerations relating to health care resource allocation decisions. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e24.pdf. Accessed December 15, 2015.
- National Health Service Health Improvement Agency. 2012. Equality for all: Delivering safe care—seven days a week. http://www.nhsiq.nhs.uk/media/2336450/equality_for_all_-_delivering_care_seven_days_a_week_july2013.pdf. Accessed December 15, 2015.
- Norheim, O., and Y. Asada. 2009. The ideal of equal health revisited: Definitions and measures of inequity in health should be better integrated with theories of distributive justice. International Journal for Equity in Health 8: 40. doi: 10.1186/1475-9276-8-40.CrossRefPubMedPubMedCentralGoogle Scholar
- Queensland Government. 2011. Health and Hospitals Network Bill 2011: Explanatory notes. http://www.legislation.qld.gov.au/Bills/53PDF/2011/HealthHospNB11Exp.pdf. Accessed February 6 2016.
- Porter, M., and T. Lee. 2013. The strategy that will fix healthcare. Harvard Business Review 2013(October): 1–19.Google Scholar
- Royal College of Physicians. 2012. An evaluation of consultant led input into medical admissions management in England: Hospital service patterns versus clinical outcomes in England. http://webcache.googleusercontent.com/search?q=cache:VfhEQbSFDx4J:www.aomrc.org.uk/doc_view/9450-the-benefits-of-consultant-delivered-care+&cd=2&hl=en&ct=clnk&gl=au. Accessed December 25, 2015.
- Sharpe, V. 2003. Promoting patient safety: An ethical basis for policy deliberation. The Hastings Center Report 33(5): S1–S20.Google Scholar
- The Regulation and Quality Improvement Authority. 2013. The Regulation and Quality Improvement Authority review of hospitals at nights and weekends. http://www.rqia.org.uk/cms_resources/Report%20on%20the%20Review%20of%20Hospitals%20at%20Nights%20and%20Weekends%20Published%2003%20July%2013.pdf. Accessed December 15, 2015.
- Wolf, S.M. 1994. Shifting paradigms in bioethics and health law: The rise of a new pragmatism. American Journal of Law & Medicine 20(4): 395–415.Google Scholar