Guidance for creating morally healthy organizations that remediate the experience of moral injury in healthcare: Findings from an international e-Delphi study

Objective: To date, research and policy directives have focused on identifying individual risk factors for moral injury, with less attention to solutions for establishing non-morally injurious cultures and practices.

Methods: Experts with academic or clinical knowledge of moral injury were recruited to a three-round e-Delphi survey exploring descriptors and characteristics of non-morally injurious organisations.

Results: Forty-nine, forty-one and thirty-nine experts responded at each round. Morally 'healthy', 'congruent' and 'centred' were endorsed as descriptors for non-morally injurious organisations. Consensus was also obtained on 111 characteristics and behaviours relating to organisational identity (e.g., just culture), behaviours and practices (e.g., transparency in decision-making), and self-awareness (e.g., monitoring of moral injury in workforce).

Conclusions: The findings implicate the need for a strengths-oriented, solution-focused approach to addressing moral injury. The recommendations proposed warrant evaluation and operationalisation within formal guidance.