Hospitals and health systems traditionally have offered inpatient palliative care services, but the transition to value-based care models supports a new strategic approach, says Advisory Board expert Tomi Ogundimu.
As hospitals focus on reducing avoidable hospitalizations and ED visits, "it really makes sense for palliative care to start migrating out where patients are"—across the care continuum and into the outpatient setting, Ogundimu says.
Why efforts to scale palliative care tend to fail
But scaling a palliative care strategy can be difficult.
One challenge, Ogundimu says, is that without a targeted strategy, health systems often experience growth that they don't have the capacity to meet. When a health system can't accommodate palliative care referrals, it becomes difficult to maintain provider engagement to refer appropriate patients who can most benefit from these supportive services.
Expansion of palliative care also can create "a huge communication gap." For example, some patients equate palliative care with hospice care at organizations where they’re different, based on the false belief that palliative care is necessarily the same as end-of-life care, Ogundimu says.
Developing an effective strategy
So how can you avoid these pitfalls? Ogundimu outlines four key components to a successful strategy:
1. Start with good governance
Developing an effective strategy starts with convening a system-level, multidisciplinary task force that can define palliative care for your system and determine an organizational structure for leadership, communication, and accountability.
"Organizations really need to start with a targeted focus and clearly defined program goals. Failing to do that will negatively affect patient outcomes and the business of a provider organization," Ogundimu says.
And before implementing any changes, she adds, you need to conduct a needs assessment of your clinical competencies and operational assets to identify gaps that could impede your ability to scale palliative care across the system.
2. Acknowledge that expanding palliative care is a big change, and plan accordingly
When it's time to roll out your program, you must have a plan in place to effectively manage the change.
That starts with developing a timeline for implementation and communicating your plans with the system, Ogundimu says. The rollout itself can follow a phased approach that starts with pilot facilities, or a concurrent approach under which the entire system implements the change.
3. Standardize your operations ... but not too much
An effective palliative care strategy must strike a balance between system-level standards and local-level variation, Ogundimu says.
For example, palliative care programs should:
- Involve multidisciplinary teams across the system, but the ratio of physicians to nurses to social workers can vary at the local level;
- Coordinate care at the same frequency across the system, but methods of communication among providers can vary locally;
- Require regular reporting of operational, clinical, and financial data to track outcomes, but benchmarks can vary locally depending on population, services offered, or team composition.
"Successful organizations come up with some consistent, broad strategy or model, but they allow for local variation based on an individual program's access to resources and patient need," Ogundimu says.
4. Educate your staff—sooner rather than later
Finally, health systems must establish a level of organizational commitment to palliative care. And that happens by educating staff about what palliative care is and why it matters, how to identify appropriate patients, how to manage patients and coordinate their care, and how to share feedback.
"A really effective strategy engages staff early on," Ogundimu says, "because they are really going to champions in providing that hospital-level support and referring patients to the program."
Next steps: Learn how five organizations developed their palliative care strategies
At Trinity Health, an 88-hospital system in 21 states, system leaders expanded from 14 palliative care programs in 2012 to 28 by 2015.
To learn more about how Trinity and four other organizations are leading the way on system-wide palliative care—and how your organization can, too—join Ogundimu for a webconference on Tuesday, Sept. 20.