ACORNS - POLICY - ACE

All of the scenarios in the policy suit should be considered from the perspective of a health professional in a staff appointment as the lead officer for medical policy within a Ministry of Defence (rank equivalent of OF4/Commander/Lieutenant Colonel/Wing Commander).

Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: A medical equipment company invites your leadership team to an important overseas medical conference that cannot be funded from your budget. You have just approved a major contract with them to supply equipment to military medical units. Do you accept?
• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers the ethics and law regarding the association of public employees with commercial companies, and potential conflicts of interest. The relationship of health professionals and commercial companies in the ‘Med Tech’ (drugs, devices, information technology etc) is also a risk from both a procurement and a patient care perspective. You will need to find out:

• The actual conference and value to your organisation of attendance.
• The actual contract awarded and background to the company.
• The company’s relationship with the topic and organisation of the conference.
• The policy and regulations for relationships with commercial companies.
• The policy and regulations for supporting national companies in support of their international sales.

You should consider how you might find the answers to these subjects within your own organisation.

Step 2 – ANALYSE

Patient: not applicable

Clinical: not applicable – on the assumption that due diligence was undertaken on the capability, suitability and functionality of the medical equipment for military use as part of the contracting process.

Legal: the WMA STATEMENT ON CONFLICT OF INTEREST is at: https://www.wma.net/policies-post/wma-statement-on-conflict-of-interest/ . This highlights all aspects of conflicts of interest within healthcare, especially in regard to clinical care, research, referrals and organisations. This adds a dimension that will be additional to any associated with organisational policy regarding commercial interests.

Societal/Military: this perspective might also include any policy in regard to supporting national companies with their international exports, which is also a particular aspect of defence sales.

Step 3 – FUSE

• Summarise conclusions
• Insert citations to key reference sources for your analysis
• Determine the exact Decision(s) to be made

This scenario highlights the potential reputational risks associated with conflicts of interest for senior personnel. It also adds the perspectives associated with healthcare ethics that will be additional to those solely applying to non-healthcare military personnel.

Step 4 – DECIDE

• What is your Decision?
• Why (can you justify it)?
• Residual uncertainly, need for review?

It would be easy to decline the invitation and remove all risk. However, there may be benefit from accepting the invitation from a public relations and networking perspective. You might consider: attending and using the reputational aspects of senior attendance to increase international visibility for your organisation and national military medical industry; relatively junior attendance out of uniform to gain insights and information with explicit direction to avoid direct publicity.

Contributor – Air Vice Marshal (Rtd) Alastair Reid CB FFOM, Surgeon General UK Defence Medical Services 2019-2021.