Abstract
BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs.
Highlights
As hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated
Within a given hospital, clinical ethics issues are often handled by an ethics consultation service or ethics committee while business and management issues are handled by compliance officers and human resources staff and research ethics issues are handled by an institutional review board (IRB)
Other ethics models that address a wide range of ethical issues that health care organizations encounter include the Southern California region of Kaiser Permanente, whose bioethics program integrates with many programs including quality management and compliance [7], and the Catholic Health Association (CHA)/ Ascension model [8], which integrates with leadership and numerous institutional committees such as human resources (IRB), and patient relations
Summary
Study hospitals Among the 600 sampled hospitals, one closed before data collection; 462 participated and completed all or part of the study for a response rate of 77.1%. The mean estimate for the total number of FTEs in salary support or equivalent financial compensation provided to these individuals for HCEP work was 0.3 (range 0–15, median = 0). The mean number of individuals who received salary support or equivalent financial compensation such as a consulting fee or a dedicated percentage of their salary for HCEP work was 0.6 (range 0–21, median = 0). The number of individuals receiving financial compensation varied based on bed size, academic affiliation, and urban/rural location as shown, which summarizes the data after implausible answers were removed. Government hospitals were more likely to mention training as a solution than were for-profit hospital (Federal government (0.45), non-federal government (0.62), for-profit (0.18), p < 0.01)
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