BACKGROUND Various forms of Clinical Ethics Support (CES) have been developed in health care organizations. Over the past years, increasing attention has been paid to the question of how to foster the quality of ethics support. In the Netherlands, a CES quality assessment project based on a responsive evaluation design has been implemented. CES practitioners themselves reflected upon the quality of ethics support within each other's health care organizations. This study presents a qualitative evaluation of this Responsive Quality Assessment (RQA) project. METHODS CES practitioners' experiences with and perspectives on the RQA project were collected by means of ten semi-structured interviews. Both the data collection and the qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of the decisions. RESULTS The main findings illustrate the relevance of the RQA with regard to fostering the quality of CES by connecting to context specific issues, such as gaining support from upper management and to solidify CES services within health care organizations. Based on their participation in the RQA, CES practitioners perceived a number of changes regarding CES in Dutch health care organizations after the RQA: acknowledgement of the relevance of CES for the quality of care; CES practices being more formalized; inspiration for developing new CES-related activities and more self-reflection on existing CES practices. CONCLUSIONS The evaluation of the RQA shows that this method facilitates an open learning process by actively involving CES practitioners and their concrete practices. Lessons learned include that "servant leadership" and more intensive guidance of RQA participants may help to further enhance both the critical dimension and the learning process within RQA.

中文翻译：

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从实施临床伦理支持的响应式质量评估中学到的经验教训。

背景技术在医疗保健组织中已经开发了各种形式的临床伦理支持（CES）。在过去的几年中，人们越来越关注如何提高道德支持的质量。在荷兰，基于响应式评估设计的CES质量评估项目已经实施。CES从业者自己对彼此的卫生保健组织内部的道德支持质量进行了反思。这项研究提出了对此响应质量评估（RQA）项目的定性评估。方法通过十次半结构化访谈，收集了CES从业人员对RQA项目的经验和看法。数据收集和定性数据分析都遵循逐步方法，包括持续的同行评审以及对决策的认真记录。结果主要研究结果表明，RQA通过与具体背景相关的问题（例如获得高层管理人员的支持并巩固卫生保健组织内部的CES服务），与提高CES的质量有关。基于参与RQA，CES从业人员在RQA之后意识到荷兰医疗保健组织在CES方面的许多变化：认识到CES与护理质量的相关性；CES做法更加正规化；开发新的与CES相关的活动的灵感，以及对现有CES做法的更多自我反思。结论对RQA的评估表明，该方法通过积极地吸引CES从业人员及其具体实践来促进开放学习过程。获得的经验教训包括，RQA参与者的“仆人领导”和更深入的指导可能有助于进一步增强RQA内的关键维度和学习过程。