1. Impact of Ethical Challenges What do you think is the potential impact of these ethical challenges on rural health care settings? Training materials from Rural Health Care Ethics: A Manual for Trainers. WA Nelson and KE Schifferdecker, Dartmouth Medical School, Hanover, NH

2. Impact of Ethical Challenges Staff – caregiver stress, morale, job turnover, diverted staff time, Patients – patient satisfaction, self-referrals Organizations’ culture – professionalism, quality of care Relationship with community – public image and relations, giving Regulations – Joint Commission standards Organizations’ bottom line – cost of ethics conflicts* Nelson WA, Weeks WB, Campfield JM. The organizational costs of ethical conflicts. Journal of Healthcare Managment 2008;53(1):41-52.

3. Potential Effect on Organizational Performance Ethical Conflicts Marketing Costs Operational Costs Legal Costs Public relations costs Low staff morale Staff work reduction Litigation, settlements, awards Loss of business Higher staff turnover Higher wages required Decreased efficiency Decreased available resources Lower profit margin Decreased charitable giving Nelson WA, Weeks WB, Campfield JM. The organizational costs of ethical conflicts. Journal of Healthcare Management 2008;53(1):41-52.