Ethics consultation services may boost patient satisfaction, improve employee morale, lower the risk of litigation, or enhance productivity. However, proving it is challenging.
More funding is needed for ethics-related positions and initiatives, argues Erica K. Salter, PhD, HEC-C, associate professor of healthcare ethics and pediatrics at Saint Louis University. Such funding could go toward ethics rounds, moral distress rounds, ad-hoc team debriefings, and educational events for staff. But securing these resources might mean making a financial or business case, indicating how these services save money.
However, justifying funding an ethics consultation service using cost savings alone could be risky. “The right thing to do isn’t always the cheapest thing to do. If it turns out that ethics consultations result in more spending, this could be used as justification to cut funding,” Salter cautions.
A low volume of ethics consultations at an institution may reflect the fact the service, although needed, is not available consistently. “The value of active and well-compensated clinical ethics services goes far beyond dollars saved,” Salter says.
For example, at many institutions, ethics consults result in fewer ICU days for the patient. However, it is possible ethics consults result in the realization that patients actually would benefit from more time in the ICU, leading to higher costs. “An ethicist should not feel beholden to recommend the cheaper option if the more expensive option turns out to be the most ethically justified,” Salter says.
Aside from citing empirical studies, it may be possible to demonstrate some outcomes via staff surveys. Most ethics services have collected data on consult volume, but this information can be misleading. “Ethics consultation is a supply-sensitive service; its usage is more correlated with availability than need,” Salter says.
Before making a resource “ask,” ethicists should ascertain the organization’s strategic priorities, according to Lindsay Semler, DNP, RN, CCRN, HEC-C, executive director of the ethics service and co-chair of the Ethics Committee at Brigham and Women’s Hospital.
At a previous organization, Semler successfully advocated for an additional full-time equivalent ethicist position by demonstrating the need for such services and the impact of that work.
Semler says these are some important questions to consider: Is the organization trying to shorten length of stay? Is the organization attempting to expand revenue sources? What priorities are the organization expressing to employees?
“Especially in times of financial difficulty, any funding requests must align with organizational priorities and must demonstrate a positive financial impact,” Semler stresses.
Ethicists can learn the organization’s priorities in these ways by carefully reviewing messages from executive leadership, such as town halls or president’s updates. Ethicists also can forge connections with executives, such as the chief medical officer, chief nursing officer, and director of quality.
“These individuals can provide feedback on your proposal and guide you as to when an optimal time would be to request the funding,” Semler says.
Once an ethicist understands more about leadership’s perspective, the next step is to collect and present data that demonstrate how ethics is aligned with organizational goals. For example, many hospitals are attempting to shorten length of stay. Some research suggests ethics consults help medical facilities achieve this goal.1 “But citing evidence is generally insufficient,” Semler says.
Ethicists must prove ethics consults shorten length of stay at their own institutions. At Semler’s previous and current institutions, patients with an “early” ethics consult recorded one-third to one-half the length of stay vs. later ethics intervention. To demonstrate this, Semler recommends this approach: Track consults and categorize them as early (within the first 72 hours of hospitalization) or late (after 72 hours of hospitalization). Over the course of at least one year, compare length of stay of patients who received an early consult vs. a late consult.
“While not causative, leaders being able to see the trends of early ethics consultation and length of stay can be incredibly effective,” Semler offers.
REFERENCE
1. Mayer PA, McElfresh DC, Bracamontes K. Universal ethics evaluation of ICU patients: A model. Journal of Hospital Ethics 2022;8:64-71.
Ethics consultation services may boost patient satisfaction, improve employee morale, lower the risk of litigation, or enhance productivity. However, proving it is challenging.
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