Complicity in Moral Injury: A Study of Moral Phenomena in Healthcare Work Settings.

Introduction: Moral injury is characterized by profound, potentially fatal, emotional distress due to perceived violations of moral beliefs. This article addresses calls for improved conceptual clarity about the causes, prevention and treatment of healthcare workers' moral injury. The dominant focus historically in military and psychological studies was on moral injury arising from isolated events. Recent healthcare organization studies have expanded this focus to consider moral injury as a cumulative phenomenon and to emphasize the need to develop greater understanding of causes, prevention and treatment of healthcare workers' moral injury. Extending these themes, this article explores, first, if altering a mode of leadership contributes to moral injury occurring, and second, the need to distinguish cumulative moral injury from "lower-consequence" moral phenomena. The question posed is: "what intervention points exist at which leaders could address lower-consequence types of moral phenomena, thereby preventing moral injury occurring?" This involves consideration of a range of phenomenon, including moral traps, demoralization, moral conflicts, moral dilemma, moral stress, moral distress, and moral suffering. Methods: This qualitative study investigates moral injury and its analysis of interviews focusing on the reported changes in organizational leadership that shaped the experiences of 71 UK National Health Service healthcare workers. Results: The outcomes of the study contribute to the understanding of moral injury in two main ways. One is by opening the black box on moral phenomena, it became possible to theorize that what some workers report as moral injury was one of several less extreme forms of moral phenomena with less severe consequences. The second contribution reveals why during an atypical crisis the change in the mode of leadership, mandated by a healthcare organizational policy, appeared to be complicit in the reports of moral injury occurring. Discussion: The discussion concludes by advocating leaders develop a nuanced understanding of the pathways between moral phenomena, and the intervention points at which lower-consequence types of moral phenomena could be addressed, thereby preventing their transition to the more extreme phenomenon, moral injury.