Sunday, July 27, 2008

Hospice Medical Staff Development Plans

Trained as a hospital administrator, and having worked in hospital executive positions, I've seen the power of careful and timely hospital medical staff planning in furthering a hospital's commitment to its community's health. Effective medical staff development offers other benefits to the hospital, not the least of which, I've found, is that a link will be created between the physician recruitment campaign and the hospital's strategic plan and its growth objectives.

So, I've wondered frequently since my career headed into the palliative care field, would medical staff development plans (MSDPs)for hospices produce similar benefits? My experience suggests that they would. As hospices move beyond their traditional role of serving terminally ill patients who have elected to use the hospice benefit, and toward a leadership role in shaping end-of-life care throughout their communities, the role of the hospice’s physician staff is being redefined. Hospices are evolving into advanced palliative care organizations in which care spans organizational and professional boundaries, while integrating physician services into a traditional nurse-centric organization, and simultaneously adopting a collaborative model. Such a convergence will, unsurprisingly, strain an organization’s resources and its roles.

At their best, MSDPs are an objective quantification of community need on a palliative care basis. The challenge, we've learned, is identifying a standard for staffing of programs. In developing a plan, we consider the following:
-Variability in clinical commitment of current staff
-Presence and clinical role of providers such as NPs and PAs
-Presence of academic practices that may include teaching and research
-Productivity data to analyze MD capacity to absorb additional volumes

So what can a Hospice MSDP offer to the executive leadership of a hospice?
An assessment of community practice around end-of-life care to identify improvement opportunity, and to translate community needs into physician staffing requirements and associated financial commitments. An assessment of the hospice's current capacity, the identification of competencies that are likely to accelerate growth, and the creation of practice opportunities that attract talent and fill competency gaps. Armed with this information, hospice executives are solidly positioned to make a difference in the palliative care practices within their community.

I'm confident that other hospice execs have had related experiences. I'm curious to learn your feedback.

Thursday, July 10, 2008

Role Definition and Advanced Palliative Care Organizations

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.