From structures to systems: towards a model of ethical healthcare

“Hurt people hurt people” is a phrase which summarises the cyclical nature of painful experiences and harmful actions. Arguably, this cycle of hurt and harm applies to the UK’s National Health Service (NHS), where employees are reporting record low levels of physical and mental wellbeing, while experiencing a climate of hostility, bullying and harassment, and pressures to meet targets. Such working environments carry several risks, not only for the employees themselves but also in terms of clinical outcomes for patients. As a result, a range of systemic and targeted infrastructure interventions have been trialled in several NHS hospitals (managed in the UK by independent Trusts), seeking to promote a culture of compassion, and improve the psychological safety of workers. However, the effectiveness of such measures in achieving ethical working environments and preventing unethical behaviours, has been questioned. We join the ongoing debate by proposing the need to go beyond ethical infrastructures and instead consider ethical environments in their systemic complexity. We conclude, by putting forward a model of a complex and ethical health system, which incorporates workplace networks, policy frameworks, and accounts for regional demographics.