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Background: Employees of the municipal health care systems experience a lot of ethical challenges in their everyday work. The national project «Cooperation on ethical competence (2007–2015)» directed by KS, aimed to increase the ethical expertise in health, social and care services in the municipalities. The ethics project was completed as a project in 2015. In that connection, the Centre for Medical Ethics (CME) carried out an evaluation. The aim of the study was to examine what issues the employees discussed in ethics reflection groups (ERG), whether the ethics initiative has had an impact on the quality of the services and work environment, and if so, what kind of impact, and the extent to which it had contributed to increased competence in ethics. Methods: The study has a qualitative design, where employees in direct patient-related work were interviewed in focus groups. The study is based on ten focus group interviews with a total of 56 people. Results: Employees of the municipal health and care services experience many complex tasks requiring professional skills, but also situations that require expertise in ethics and health law. There was considerable variation between and within the groups regarding what they talked about in reflection groups, ranging from concepts and ethical principles to the specific problems of their own practice. Situations involving conflicting value judgments appear to be particularly demanding, and the informants presented situations that challenged them in several ways. The most common topics were the use of coercion, interaction with relatives, and decisions about treatment intensity. Conclusion: The study shows that employees in municipal health and care services find that the ethics initiative has been an important contribution to quality and competence, handling ethical challenges in a better way. It seems to be important for their professional practice and the work environment.

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