A dialogue on stewardship. A multiunit organization commits to improving utilization of scarce resources

To initiate a dialogue and begin addressing the issues of appropriateness of patient care and resource utilization, since 1988 leaders within the East Central Region of the Daughters of Charity National Health System (DCNHS-EC) have conducted a series of workshops involving managers, physicians, ethicists, attorneys, and others. The dialogue initiated in these workshops, along with the results of a 1991 survey of the region's local health ministries, has provided DCNHS-EC with baseline information on how each of the region's institutions supports care givers in making ethical decisions at the bedside level. The first workshop focused on the ethical dimensions of providing high-quality care with reduced reimbursement, local initiatives for ensuring quality while containing costs, and steps DCNHS-EC hospitals could take to promote effective use of scarce medical resources. Subsequent workshops provided opportunities for further exploration of these issues. Another workshop is being planned for late 1993 or early 1994. DCNHS-EC health ministries are taking a number of concrete steps to improve appropriateness of care and resource utilization. The support of local management, governance, and physician leaders is critical to these efforts.