Performance Management and Palliative Medicine

I hear from palliative medicine physicians whose experiences suggest that their successes often go unrecognized, or at best taken for granted, while their failures are highlighted, particularly during times of program evaluation or subsidy renewal. What prompts these misguided views and feelings? Is it numbers-driven executives who see these palliative medicine practices producing revenue that in best cases meets no more than half of the practitioners' salaries? Or is it underperforming physicians whose practices fail to meet productivity standards? Or is it quite simply a misunderstanding of the value of palliative medicine programs in general, and of palliative medicine physicians specifically?
Our study suggests that another factor is at play here. Call it a misalignment of expectations, a misalignment that manifests itself in role confusion. What is role confusion, and why should palliative medicine be more vulnerable than others to this rather abstract influence? The short answer is that most palliative medicine programs were launched on the proverbial shoestring, and when met with growing demand for their services, turned their attention to their most recent referring sources. These new referring sources, of course, were not the ones behind the launch of the program. Additional MD or NP resources to serve this growing demand are months way from being hired, if at all. And so we find role drift, which inevitably leads to role confusion. This is the time, we find, for the introduction of performance management programs.

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.