Abstract
While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: (1) train-the-trainer, (2) local capacity-building, (3) circuit-riding, and (4) consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations.
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References
American Society for Bioethics and Humanities. (2011). Core competencies for healthcare ethics consultation (2nd ed.). Glenview, IL: American Society for Bioethics and Humanities.
Belde, D. (2010). Building a lasting and effective health care ethics program: Insights from the field. Catholic Health Association of the United States. http://www.chausa.org/docs/default-source/general-files/building-a-lasting-and-effective-health-care-ethics-program-insights-from-the-field-pdf.pdf?sfvrsn=0.
Bruce, C. R., Smith, M. L., Tawose, O. M., & Sharp, R. R. (2014). Practical guidance for charting ethics consultations. HEC Forum, 26(1), 79–93.
Case, J. R. (2012). An unpredictable gospel: American evangelicals and world Christianity, 1812-1920. New York: Oxford University Press.
Cuellar, A. E., & Gertler, P. J. (2003). Trends in hospital consolidation: The formation of local systems. Health Affairs, 22(6), 77–87.
Cuellar, A. E., & Gertler, P. J. (2005). How the expansion of hospital systems has affected consumers. Health Affairs, 24(1), 213–219.
Fox, E., Bottrell, M., Berkowitz, K. A., Chanko, B. L., Fogia, M. B., & Pearlman, R. A. (2010). Integrated Ethics: An innovative program to improve ethics quality in health care. The Innovation Journal, 15(2, article 8), 1–36 http://www.ethics.va.gov/IEoverview.pdf.
Glick, J. (2003). Comment: On the road: The supreme court and the history of circuit riding. Cardozo Law Review, 24(4), 1753–1820.
Guerin-Calvert, M. E., Davila, E., Keathley, R., & Spulber, B. (2013). How hospital mergers and acquisitions benefit communities: Updated study by the center for healthcare economics and policy. Washington, DC: Center for Healthcare Economics and Policy.
Hamel, R., Slosar, J. P., & Repenshek, M. (2013). Striving for excellence in ethics: Putting it into practice (2nd ed.). Catholic Health Association of the United States. http://www.che.org/members/ethics/docs/2952/Ethics%20Champions10092013%20.pdf.
Ho, V., & Hamilton, B. H. (2000). Hospital mergers and acquisitions: Does market consolidation harm patients? Journal of Health Economics, 19(5), 767–791.
Hoffmann, D., Tarzian, A., & O’Neil, J. A. (2000). Are ethics committee members competent to consult? Journal of Law, Medicine & Ethics, 28(1), 30–40, 2.
MacRae, S., Chidwick, P., Berry, S., Secker, B., Hébert, P., Shaul, R. Z., et al. (2005). Clinical bioethics integration, sustainability, and accountability: The hub and spokes strategy. Journal of Medical Ethics, 31(5), 256–261.
Meredith, E. B., Monroe, S. M., & Phillips, L. (2014). The hospital acquisition report 2014 (5th ed). Norwalk, CT: Irving Levin Associates, Inc. http://www.levinassociates.com/sites/default/files/abstracts/hosp_abstract.pdf.
Volpe, R. L. (2011). Training currently practicing members of the ethics consultation service: one institution’s experience. Journal of Clinical Ethics, 22(3), 217–222.
Acknowledgments
The authors would like to thank Betsy Kusin, BS, for her assistance in preparing the manuscript. The authors would also like to thank Rev. Charles Millikan, D. Min, for his continuous support of us and our development of ethics consultation services within a system.
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Bruce, C.R., Eves, M.M., Allen, N.G. et al. “Systematizing” Ethics Consultation Services. HEC Forum 27, 35–45 (2015). https://doi.org/10.1007/s10730-014-9254-4
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DOI: https://doi.org/10.1007/s10730-014-9254-4