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How to Approach the Development of a Palliative Care Program

By Kathy Brandt, guest contributor

There are myriad ways to approach the development of a community-based palliative care program. You can begin by partnering with a local hospital, or embed a palliative care clinician in a physician practice. Or you might enter into a pilot with a health plan. And of course, you can always just start making home visits and billing fee-for-service Medicare.

Programs have successfully launched palliative care programs using these and other strategies. However once it’s launched – what’s next? Beyond simply running the program, what’s the plan for evolving and growing the program? How would you respond if:

  • A potential partner approaches you about starting a palliative home health care agency?
  • Your current palliative care program isn’t financially viable?
  • The board wants you to expand to other service areas?
  • Your current partner decides they are going to operate the service without you?

Develop Community Based Palliative Care That will Last

What’s Your Palliative Care Vision?

If you’ve read my blogs over the years or seen me present, you’ll know that I am a strategic planning nerd. I love strategic planning. I love leading strategic planning processes and I also love participating in the planning process. Why? It is an opportunity for a group of smart, committed people to dream about the future direction of an organization.

Don’t get me wrong, I’ve participated in some absolutely dreadful strategic planning sessions, I don’t love those. However, good strategic planning facilitators engage the organization in in-depth, focused discussions resulting in an action-oriented plan. And all good strategic plans are born out of the organization’s vision.

Your organization may or may not already have a vision. And the vision may or may not depend upon the development of a community-based palliative care program. If the vision does – then great! If it doesn’t OR if the vision is so vague that any service line you start would fit within it – then we have some work to do!

“All people living in our county have access to the best possible care.”

Would palliative care fit within this vision? You bet. Does the vision speak to the need for palliative care? Nope.

“Everyone diagnosed with a serious illness or condition in our service area has access to expert palliative care.”

This vision absolutely speaks to the need for palliative care. And while it is very broad, and some might argue too broad, it’s important to remember that a vision statement is a description of the world you are trying to create, not how you will create it. Which brings us to the mission.

What’s Your Palliative Care Program’s Mission?

An organization or program’s mission specifies the types of things your organization will do to help make the vision a reality. It is a statement regarding your approach to palliative care.

In a course I co-wrote with Helen McNeal we discuss the importance of developing an organizational definition of palliative care. That doesn’t mean simply deciding between the National Consensus Project’s definition and the National Hospice and Palliative Care Organization’s definition.

Instead it means that you craft a written description of the palliative care services you will deliver. Not the service you currently offer or will offer within six months. What is the organization’s long-term approach to palliative care?

For example:

Organization A: “Our organization delivers expert palliative care to people with a life-limiting illness in their homes.”

Organization B: “Our organization provides palliative care consultations to individuals from point of diagnosis onward in partnership with their primary and specialist care providers.”

Organization C: “We provide palliative transitional care services to patients discharged home who don’t yet meet the hospice eligibility criteria.”

Organization D: “Our palliative care services will initially focus on serving people with a life-limiting condition. Over time our goal is to broaden the program and provide services to people from point of diagnosis with a serious or chronic condition.”

Organization E: “Our organization will provide palliative care to senior citizens living in the community who are at the highest risk for multiple hospitalizations.”

Each of the above statements fit within the vision statement, applying different strategies to make the vision a reality. Now if you reflect upon the first scenario posed at the beginning of this post, your mission statement provides a framework your response:

A potential partner approaches you about starting a palliative home health care agency. Does this fit within our mission?

Organization A Fits within the mission
Organization B Might fit within the mission, if the partner only wants consults
Organization C Sure, as long as we only admit patients discharged from the hospital.
Organization D Yes, it could.
Organization E Only if we only serve the Medicare population.

Developing the Vision and Mission

Based on attendance at recent educational events and online courses, hundreds, and perhaps more than a thousand programs are either already developing or thinking about launching a community-based palliative care program. If you are one of them, no matter where you are in the process, it’s not too late. Here’s how:

  • Develop a VISION: Gather your leadership team, board members, physicians and other leaders together in one or a series of meetings and lead them through a process of “envisioning the future you are trying to create.” Don’t worry about word-smithing, just get a general agreement regarding answers to these and similar questions:
  • What are the overarching, fundamental, and enduring reasons why palliative care is needed in our community?
  • What are we trying to achieve? Think in the biggest terms, knowing you may never achieve or complete the goal.
  • How will our palliative care program impact the community?
  • Develop a MISSION: Once you have agreement regarding the vision questions, ask the same group of people:
  • What services will we provide?
  • How will we provide them?
  • What people will we serve?
  • In what care setting(s) will your services be offered?
  • What value are we bringing to patients, partners, and the community?

Your goal isn’t to design your palliative care program; rather it is to think about the overarching goal of the program in relation to the change you are trying to bring about (vision). And then to begin thinking about the strategies you’ll employ to achieve the goals. These strategies might change over time as you learn more about your patient population, you partner with new organization, or you evolve your care model.

The vision and mission you create will serve as a strong foundation and framework to guide your program development and implement the policies and procedures needed to deliver the highest quality care.

Tools You Can Use from CSU Shiley Institute for Palliative Care’s Online Course Curriculum:

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