Healthy World, Healthy Nation, Healthy You

A Consumer’s Guide to Moral Courage: An Essential Ingredient for Patient Safety and Quality Care

Vicki  D. Lachman, PhD, APRN, MBE, FAAN
Clinical Professor emeriti
Director, Innovation and Intra/Entrepreneurship in Advanced Practice Nursing
Drexel University College of Nursing and Health Professions
Philadelphia, PA


VickiVicki D. Lachman is president of V. L. Associates, a consulting, training, and coaching firm specializing in the constantly changing needs of the health care industry. An expert in organizational development she has had extensive experience as a consultant to more than 350 medical centers, community hospitals, long-term care facilities, hospices, and offices of health care practitioners.

In 2002, Dr. Lachman completed a Masters in Bioethics from the University of Pennsylvania. Her focus was on organizational ethics and end-of-life ethical dilemmas. She serves on a hospital ethics committee and acts as a consultant on a variety of ethical problems. Dr. Lachman is a trainer for the EPEC and ELNEC curriculums (end-of-life care). Her books, Applied Ethics in Nursing (2005) and Ethical Challenges in Health Care: Developing Your Moral Compass (2009) provide useful information on managing ethical issues.

Dr. Lachman’s understanding of the dynamics of health care organizations is derived from academic, clinical, and managerial experience gained from more than 35 years of involvement in this field. She is a Masters graduate of the University of Pennsylvania in psychiatric nursing and also holds a PhD in education from Temple University, where her focus was on organizational development. She is also ANNC certified as a nurse executive, advanced and as a psychiatric clinical specialist.

As the author of over 100 articles and book chapters, Dr. Lachman has appeared on radio, television, and satellite conference programs where she has offered expert advice. Dr. Lachman’s skills are a unique blend of first-hand practical experience and academic training, and has produced creative and cost-effective results for clients in today’s demanding health care climate.


Consumers are often faced with situations that require moral integrity and moral courage. There are many circumstances when this is not easy to sort out given all of the competing issues that need to be addressed. Moral distress occurs when one knows what actions to take, but one is unable to act on it. However, this can be a catalyst for change. Dr Lachman has considerable experience in this area and discusses various courses of action that can be considered. Consumers need to know how to address their concerns within the context of a changing health care system.

She has coined the term: CODE is used to identify the key skills to use.

  • Courage
  • Obligations to Honor–What is the right thing to do?
  • Danger to  manage – What do I need to handle my fear and uncertainty?
  • Expression and action. What action is needed to meet my obligations to the patient and to maintain my integrity?

3 Key Points:

  1. Consumers need to use moral courage when necessary to ensure patient safety and quality care.
  2. Communication skills are necessary to display moral courage.
  3. Typical situations where consumers may encounter the need to demonstrate moral courage are discussed.


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