Raising the Profile of the Service
Some clinical ethics services receive numerous referrals from their colleagues, but others have found that referral rates are low. As Slowther and colleagues note, this may in part be due to a lack of awareness of the need for the service and the advice it can offer. Here, we offer some tips for raising awareness of the service.
Provide an Excellent Service
Colleagues should be satisfied that the clinical ethics service is competent and accessible, has clear aims and processes, and delivers quality advice. At a minimum, the Network advises that a clinical ethics service should be alert to:
- Aims and Competencies. Ensure that the service has clear aims and objectives, and that all members have the skills and knowledge needed to deliver on the aims. Members should be appropriately trained. You can read more about training and learning opportunities in Clinical Ethics Resources.
- Composition. Ensure that the service is appropriately composed. For example, a Clinical Ethics Committee (CEC) should have a range of members, including health professionals from different specialties and professions, lay members, legal representation, chaplains, and trained ethicists. Ideally, the membership should be dynamic and diverse. Many recently qualified colleagues will have had some training in ethics during their undergraduate training or as part of an intercalated degree, so consider involving these colleagues in the service (as either observers or full members). You may also wish to co-opt experts to specific meetings, who can contribute to the specific items that are to be discussed.
- Processes. Ensure that the service follows appropriate processes. You should have clear processes (for example) for receiving and advising on referrals to the service. Ideally, the service will have a structured approach to working through referrals, perhaps using an ethical framework.
- Accessibility. Ensure that the service is accessible. Ensure that the service is known to colleagues (see further below) and that there is clear contact information. You should also have processes in place for ensuring that referrals are picked up (including when the usual points of contact are unavailable, when they are on leave, etc.)
- Responsiveness. Ensure that the service suits the local context and is responsive. You may find that you need to tailor the service to suit local needs. For example, it may be appropriate to offer a rapid response service or otherwise be prepared to convene meetings quickly when the need arises. You should also ensure that you seek feedback from those who consult the service and, as appropriate, seek to act on any feedback (including re-configuring the service where this is indicated).
Seek Support from Opinion Leaders
Gaining support from opinion leaders and those in positions of authority in the organisation can help to raise awareness of (and generate referrals to) the clinical ethics service. You may wish to:
- Engage those in the most senior positions, such as the Medical Director or Head of Nursing. You might consider periodically inviting such individuals to a meeting (for example, once a year) or at least periodically providing them with a report. The meeting or report can demonstrate the work – and hopefully the value – of the service. You may wish to ensure that you will engage your senior colleagues by outlining how the service’s activities speak to their interests (for example, a review of ethical issues involving clinical governance, risk, or resource allocation).
- Get managers and board members involved in the work of the service. There are usually colleagues in such positions who have an interest in ethics and who may be able to participate in the service or otherwise help raise awareness of its existence and work.
- Identify and engage vocal and influential colleagues. For example, even if such individuals are not trained in ethics, you may wish to encourage them to attend a specific meeting that is relevant to their work and interests.
- Engage the organisation’s legal team in issues of medico-legal interest. Although the service should focus on ethical matters, there may be legal dimensions to its work that could usefully be discussed (although take care not to allow a focus on legal and procedural issues to stifle open discussions about ethics).
Raise Awareness in the Organisation
- Offer to provide some ethics education. This may be to students or trainees, e.g., during locally organised teaching sessions, or at regional training days. Such training could usefully – and in an appropriately anonymous way – discuss cases and signpost the audience to the clinical ethics service.
- Participate in any policy formulation groups that are convened in the organisation. Offer to take the developing draft to your ethics service for in-depth discussion and invite members of the policy group to attend the discussion.
The service should be accessible and known to colleagues in the organisation. Amongst the strategies for raising awareness, you may wish to:
- Ensure that the service is known to colleagues. For example, advertise the existence of the service – and provide contact information – on notice boards in common staff areas, on the staff intranet, in news bulletins, etc.
- Ask the members of the service (such as CEC members) to speak with their immediate colleagues, in order to identify cases or issues that might usefully be discussed at a meeting. This may result in a (prospective) case referral. However, retrospective case review, perhaps including the colleagues who were involved, can also be helpful, not only to your colleagues, but also to the service itself, as this will help the members to practice and hone their skills.
- Offer to present the work of a service at a suitable meeting of colleagues. Various CECs present their work periodically at a Grand Round (for example, annually). There may be other such opportunities, such as a Journal Club meeting, a departmental Clinical Governance meeting, or an MDT meeting.