Margaret Freeman is being discharged following surgery at Chicagoland Hospital. When her daughter arrives to take her home, they discover that Mrs. Freeman's coat is missing. The temperature outside is below freezing. The nurse on duty responds, "Which would you rather I do—notify transport to bring a wheelchair, which will take twenty minutes, or call security, which could take two hours?" Mrs. Freeman bites her lip and says, "I just want to go home." While her daughter gets the car, an associate leaves Mrs. Freeman at the front entrance, where she sits in a cold draft. No one apologizes for the loss of her coat, offers a blanket, or tells her how to notify hospital security.

While it is clear that individual associates in this case erred, at an organizational level the case raises concerns about what some writers call "ethical congruence." Ethical congruence involves the extent to which an organization's stated values fall in line with actual knowledge and behaviors of associates, and the tools organizational leadership provides for identifying and resolving difficulties.

Certainly the associates in this case should have behaved differently toward Mrs. Freeman and her daughter. Implementation of Advocate's MVP, including sympathy for her predicament, apology for her loss, and attention to her immediate need for warmth, could have done much to allay Mrs. Freeman's feeling of abandonment.

Unlike Chicagoland Hospital, Advocate's Service Recovery program enables clinical associates to go a step further and rectify the loss. Service Recovery encourages associates to use discretion and creativity in problem solving by covering expenditures up to $250. Responsible use of this organizational tool entails understanding "recovery" as a key concept. The intent is not to reward, or to replace compassionate behavior and quality care. But when untoward events occur, despite the team's best efforts, it is means for timely response. In this case, if a reasonable inquiry into the disappearance of Mrs. Freeman's coat is unsuccessful, a $150 gift certificate from a department store near her home enclosed with a note of regret and best wishes would be in order.

This case illustrates that care involves more than technical competence. Even if Mrs. Freeman's surgery proves successful, she and her family may be reluctant to return to Chicagoland Hospital in the future. At Advocate hospitals, the MVP and Service Recovery provide important tools for ethical action and reparation.