Table 7.

Proposed strategies for overcoming challenges of health care ethics programs (HCEPs) (N = 232)

Type of Strategy	% of hospitalsa	Illustrative quotes
Training for existing staff	37.2	Webinars on types of ethical issues in rural facilities Online training Internal training or hire a lead clinical ethicist Perhaps education of medical staff on the real components of an ethics consult and the procedures in place that govern our work
Funds for additional time, staff, or other needs	30.3	More budgetary support for clinical ethics Our efforts to make a case for increased funding include … ongoing conversations with administration; most recently exploring philanthropic means of funding. It really comes down to funding
Other	29.5	Stabilizing a team will require leadership that is willing to make changes that unify the group to a shared sense of purpose Set up triggers for ethics consults It would help if physicians involved in ethics cases took ethics committee recommendations seriously, when the recommendations conflicted with their own inclinations
Increased leadership buy-in	9.4	A strategic plan for Bioethics at (Hospital) presented to the Hospital Board. We should be responsible for an annual report to the board as well
Data demonstrating value of HCEPs	8.0	Refrain from evaluating the quality of ethics services according to patient satisfaction, length of stay, or other ‘traditional’ quality metrics The ability to make a sound business case to get the ethicist position approved
Publicity/marketing	6.0	Having or developing a Marketing tool promotion of awareness of the ethics committee functions
Regional/national support or mandate for HCEPs	5.5	There is a (state) network that we are aware of and somewhat connected to, but we are not “members” of per se Mandates by regulatory and accreditation agencies National norms for adequate support
Quality assurance/quality improvement	5.2	development of quality measures to assess the benefit of clinical ethics consultation quality review of current consult and a formalized process for curbside consults Making demonstration of ethics knowledge a performance standard

^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%