I'm asked from time to time why I consider palliative care to be two parts accomplishment for three parts potential. I offer many reasons in reply, but none (in my opinion) have a greater impact on the success of palliative medicine programs than role confusion.
The highly collaborative nature of palliative care services (and by extension, advanced palliative care organizations) requires sharp role definition. Ideally, what a person thinks his or her job is, what others expect of that job, and how the job is actually performed are all the same. Role confusion, however, is a common byproduct of the service/program launch process. Role perception “drift” is natural, especially as insufficient resources are strained to meet growing demand for the service.
So that fledgling programs can better identify and eliminate such drift, program sponsors should, up-front, clearly delineate roles and expected results. Most program developers do this through job descriptions, yet, for all of the benefits that accrue from traditional job descriptions, role definition is rarely one of them. I've successfully used a management tool known as Responsibility Charting to systematically identify decisions and activities that must be accomplished and to pinpoint the functions (positions) that will take on roles relevant to those results. Among the benefits that may flow from this process:
-increased productivity through well-defined accountability
-increased capacity through elimination of overlaps and redundancies
-streamlined organizational structure achieved by collapsing unneeded layers and placing accountability closest to the decision
-improved communication and collaboration.
In other words, a strong performance management program for the palliative care service that will guide leadership and palliative care specialists.
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