Case Study

How Children’s Health uses consult services to mitigate moral distress

10 Minute Read


The challenge

Moral distress can occur when a clinician feels as though they know the ethically appropriate thing to do, but constraints create barriers to pursuing what they believe to be the right course of action. If unaddressed, moral distress can undermine resilience, leading to staff burnout and turnover.

The organization

Children’s Health, a pediatric health system in Dallas, Texas, US, is one of America’s leading organizations in addressing moral distress. In 2016, Children’s Health created their RISE framework—which stands for Resilience, Integrated Ethics, and Staff Support and Engagement—to guide their system’s approach.

The approach

The RISE team created forums with expertly trained facilitators in which team members share their concerns about the ethical dimensions of moral distress, clinical conflict, and caregiver grief. The goal is to reduce frontline moral distress by helping staff clarify information, identify the root causes of moral distress, and appreciate differing perspectives.

The result

By providing spaces for team members to discuss their moral distress, the RISE team helps staff gain insight and feel empowered to identify and address moral distress.



How Children’s Health used a consult service to mitigate moral distress

There are many strategies used by the RISE team. This document focuses specifically on the three elements of the moral distress consult service. The RISE team credits this tactic with increased engagement and empowerment of its team members.


The three initiatives

The Children’s Health RISE team created three distinct programs to give its team members a safe space to process ethical dilemmas and mitigate moral distress, to support team members after adverse events, and to address individual and organizational resilience. The moral distress consult services is part of the Integrated Ethics branch of RISE. The primary work of the Integrated Ethics program focuses on three initiatives:

  • Initiative

    Establish expert-led forums to discuss moral distress

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  • Initiative

    Train team members to be expert facilitators

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  • Initiative

    Create spaces for engagement, reflection, and connection

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After implementing their moral distress consults in 2016, the Children’s Health RISE team has experienced success, including:

  • Expansion of Integrated Ethics offerings: While the team was originally formed to mitigate moral distress, it grew to encompass support for clinical conflict and caregiver grief in response to demonstrated need.

  • Doubling of number of trained facilitators: Starting with 15 core team members, the RISE team now has 40 trained members and an additional 30 individuals in training.

  • Revitalization of the RISE program: In 2019 the Resilience and Staff Support branches of RISE grew into independent programs.

Our team is committed to help Children’s Health team members
understand the ethical dimensions of care, expand perspectives,
and mitigate the effects of moral distress so they can continue to
provide world-class care for our patients and their families. We
are proud of the work our team members do to support one
another and create an environment to improve the ethical climate
within our industry.

Stacy Smith, Sr. Director, Integrated Ethics and Conflict Transformation

Children’s Health

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