Table 6.

The #1 greatest challenges faced by health care ethics programs (HCEPs) (N = 232)

Type of challenge	% of hospitalsa	Illustrative quotes
Resource shortages (time, money, staff, recruitment, and training)	48.5	Lack of time and training of some committee members, especially the physician members As awareness about our services grows the demand grows too, but without additional financial support we are unable to meet the demand. Additionally, while we have targeted known high-need areas, without further financial support we are unable to educate the institution more broadly or assess needs and develop initiatives to target other areas Not enough hours in the day/personnel to be present across the house
Underutilization of HCEP services	34.0	Lack of interest in ethics unless it is to back up a doctor who is making a difficult decision. There is a sense that attendings don't know why an ethics consultant would ever question an attending's decision, even though attendings don't always see how ethically complicated a decision might be
Other	22.1	Relationship building Making ethics a priority alongside issues of improving quality metrics
Lack of clarity about the HCEP’s goals or purpose	4.6	Defining/delineating scope with overlapping services (e.g., social work, palliative care) Clarification between clinical bioethics and “ethics and compliance (ECO)" related issues
Lack of support for the HCEP from organizational leadership	3.8	For me, it is the notion of buy in, whether financially, personnel resourcing, commitment from Senior Leadership. Currently, Healthcare Ethics at our Institution seems to be viewed as “oh it's nice to have, but we're not going to commit the resources to really developing and strengthening it.”

^aPercentages are population estimates determined by weighting the sampling adjustments. Because responses were given multiple codes when they illustrated more than one type of challenge, percentages exceed 100%