Interpersonal Skills Crucial to Nurse Retention and Cultural Competency

The following guest post from Enclara Pharmacia is adapted from their recent ebook, Cultivating Care: Prioritizing Hospice Nurse Learning and Development, which is available as a free download on the Enclara website. 

Two of the top priorities for hospice providers today are improving nurse retention and advancing health equity. While these are both complicated issues that call for a variety of interventions, there is at least one area where they intersect: interpersonal communication.

Perhaps because nursing is a “caring profession,” we tend to assume interpersonal communication comes naturally to nurses. However, research suggests that nurses are more or less in line with the general public when it comes to overall emotional intelligence, including social skills.

Hospice nurses are well aware that they have room for improvement. In a 2019 survey, 70 percent desired more communication training. Self-perceived deficits in navigating difficult topics with patients and caregivers were associated with stress and burnout, which can in turn increase staff turnover.

Interestingly, two of the communication areas palliative nurses find most difficult are directly related to cultural competency: talking with patients or families from different cultures and responding to spiritual concerns. This suggests that incorporating interpersonal communication training alongside diversity and inclusion initiatives can improve the nurse experience while also reducing disparities in care for minority communities with historically lower hospice participation.

For more insights, download Cultivating Care: Prioritizing Hospice Nurse Learning and Development.

• Explore the benefits of nurse education for both quality of care and staff retention
• Prioritize subject matter in technical, operational, interpersonal and clinical domains
• Leverage resources you may already have available to provide maximum value

Using Data to Manage the Hospice Cap

Janice Mitchell, Communications Specialist at Axxess

Hospice leaders are responsible for the health and well-being of both their patients and their organization. From a financial perspective, this includes minimizing risk by managing spending and the hospice cap.

Defining the Hospice Cap

The cap is designed to ensure that hospice care does not exceed the cost of conventional medical care at the end of life. The allowable amounts are limited by two things: an annual limit per beneficiary and the number of beneficiaries served. Any amount paid to a hospice for its claims that exceeds the cap is considered an overpayment and must be repaid to Medicare.

The fiscal year 2023 hospice cap amount increased by 3.8% from the prior year. The recommendation from the June 2023 MedPAC report is for Congress to update the Medicare base payment rates by the amount specified in current law with a wage adjustment, in addition to reducing the hospice aggregate cap by 20%.

Minimize the Risk of Overpayment

“I was thinking specifically about the Medicare payment and cap rate, and [these are] some of my favorite hospice solution features that I wish I would have had as an operator to minimize my risk – outside of spiral bound notebooks,” said Christina Andrews, Senior Director of Professional Services at Axxess.

Reports on the topics outlined below can help organizations minimize their risk of overpayment:

•  Cap Statistics Report: This type of report calculates allowable Medicare payments, estimates how much revenue is under or over the cap, estimates Medicare beneficiaries and provides the total number of Medicare inpatient days and the maximum inpatient days.
• Median and Average Length of Stay Reports: These reports generate the median and average length of stay for the specified date range. This information helps organizations determine if there is an opportunity to create a balanced length of stay.
• Referral Report: This type of report generates a list of all patients and referrals entered into the system, which also helps balance the length of stay.

How to Balance Length of Stay

Andrews encourages hospice organizations to develop a strategy to balance the average length of stay for their patients. Hospices above the cap admit fewer patients per year and have significantly longer stays and higher discharge rates than hospices below the cap. The following activities can be included in the plan.

• Have daily cap calls to report on daily activity toward goals.
• Assess community needs on an ongoing basis to grow market share and penetration.
• Create a brand and identify key messages to convey based on community needs and how your organization solves them.
• Develop marketing and sales strategies based on referral and admission data.
• Establish weekly admission goals by referral partner.
• Use needs-based selling that highlights the value proposition of the services provided.
• Create a diversification strategy to impact the referral mix and stay within national benchmarks.

Using Business Intelligence

Andrews also recommends the use of business intelligence dashboards to create a road map to success. Useful key performance indicators include:

• Medicare Beneficiaries
• Average Length of Stay
• Media Length of Stay
• Referrals by Referral Partner
• Inpatient Days as a Percentage of Total
• Admissions by Benefit Period
• Admissions by Primary Diagnosis
• Live Discharges by Reason
• Benchmark Against Self
• Benchmark Against National

“Be very cautious of information overload,” Andrews said. “This is the excess of information available to a person aiming to complete a task or make a choice. Managing cap risk is a daily task driven by strategy and the metrics that matter.”

Axxess Hospice, a cloud-based hospice software, includes tools such as intuitive medication management and real-time plan of care updates as outlined above to help keep organizations compliant.

Disclaimer: Axxess is a 2023 Strategic Partner of NHPCO. All views expressed in this blog are the author’s own and do not represent the view of NHPCO.

Life, Liberty, and the Pursuit of Equitable Access to Healthcare for All

 

By Ben Marcantonio

COO and interim CEO of the National Hospice and Palliative Care Organization (NHPCO)

The Fourth of July is a time to celebrate the United States’ independence, but it is also an opportunity to reflect on our nation’s founding principles, and how we can live by those ideals today and into the future. The Declaration of Independence tells us: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” The first sentence of the U.S. Constitution sets out the purpose of that founding document and our purpose as a country: “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

As I think about our work in hospice and palliative care, and the broader healthcare community, I see our purpose reflected in these founding documents. Providers certainly are foundational to quality of life and the pursuit of happiness. By supporting patients, families, and the community, we are helping form a more perfect union. Delivering equitable access to healthcare for all is an important part of justice.

Last week, the news was dominated by headlines about recent Supreme Court decisions on affirmative action and LGBTQ+ rights. Regardless of whether you think the court made the right or wrong decisions in these cases, we can all recognize that these rulings will affect the everyday lives of people, particularly Black and Hispanic individuals, and members of the LGBTQ+ community. We also know that these decisions have an influence that is broader and deeper than meets the eye.

These court decisions have multi-directional impact because they are connected to healthcare. Every day, in communities across America, there are people who have inequitable access to healthcare. It’s clear that access to care is impacted by factors such as wealth, where people live, and what insurance they have or are lacking. It may be less obvious on the surface, but it is no less true that race, ethnicity, language, gender, sexual orientation, and religion can impact access to and/or delivery of care as well. If you can’t get care in a language you understand, is that full access to care? If treatment of pain is likely to vary based on a patient’s race, is our health system equitable? If our Hispanic and Latino neighbors know less about hospice than their Black or White counterparts, as shown in a recent report, can we say we are delivering on the promise of equal access? These issues are often compounded by lack of trust and dedicating the time it takes to build rapport and meaningful relationships. The Hospice through the DEI Lens report shows that nearly 1/3 of LGBTQ+ respondents either doubt or are unsure that hospice care providers would respect their sexuality. With that level of doubt, LGBTQ+ people are less likely to access care. Decades of mistreatment of African American/Black and Native American communities by the medical establishment has led to mistrust of doctors and health facilities, creating significant barriers to access for many Americans today. 

As a longtime hospice provider, and now a champion for hospices across the country, I am proud of the many ways in which our members have been at the forefront of making care accessible to more people. One of the most prominent examples is the way that hospices stepped up during the AIDS crisis to care for patients who were largely ignored by the rest of the health system. Today, we have incredible and inspiring examples of hospices reaching people where they are. There are hospices in prisons, with care provided by prisoners. There are hospices delivering care to people who are unhoused. There are hospices established recently with the express goal of reaching underserved communities, in both rural and urban settings, as well as hospices focused on connecting with African American and Black communities. Let’s take that further. Our charge to support equitable and accessible care for ALL at the end of life, includes caring for those who are on the unpredictable and often precarious trajectory of serious illness and co-morbid conditions.

This imperative and unwavering commitment to equity and justice is foundational to our country and to the hospice movement and should be our guide to creating a better future for all. But equity does not exist in a vacuum. It is found through embracing diversity of thought, words, and actions as well as a curiosity for learning with an open mind. As our nation continues to wrestle with inequities that prevent certain groups of people from pursing life, liberty, and happiness, we can strive for an even more perfect union to become a part of the solution. I believe the hospice and palliative care community has an important role to play. It’s our job to meet people where they are, to provide the care they need at the right time and in the right manner. Our job as healthcare providers is to recognize and celebrate the differences that make each person unique, and to deliver care that meets their individual needs. I’m proud to be part of this community; I’m proud of NHPCO’s work to support hospices in advancing equity and providing inclusive care; I’m proud that the hospice movement is helping advance freedom and justice. As we look to the future of our country and of the hospice movement, we must remain committed to freedom, justice, and equality for all.

Note: NHPCO offers a wealth of hospice and palliative care access and inclusion resources at www.nhpco.org/diversity

Hospice Action Week 2023: Advocates Unite on Capitol Hill

On Wednesday, June 7 hospice and palliative care advocates from across the nation made a difference and presented a united voice in Washington, DC.

As a part of the annual Hospice Action Hill Day, over 70 NHPCO and HAN advocates gathered to make legislative visits on Capitol Hill in support of key policy priorities impacting hospices of all shapes and sizes. This was the first completely in-person Hospice Action Hill Day since 2020. Participants were excited to come together and have face-to-face congressional meetings for the first time in years.

Participants included members of the board of directors for both organizations, state leaders, MyHospice Ambassadors, and grassroots advocates. There were representatives from every piece of the hospice and palliative care system, from CEOs to clinicians and nurses, from administrators to volunteers. NHPCO and HAN staff also joined groups of advocates for meetings, including five NHPCO summer interns. Advocates’ previous experience on the Hill ranged from decades of visits to the Capitol to this event being their first-ever opportunity to meet with legislators.

Over 130 Congressional offices in the House and Senate took time to speak with advocates representing providers, patients, and families from more than half the total states in the US.

Advocates spoke with legislative offices about five key policy issues: community-based palliative care, program integrity, payment policy, the future of the hospice workforce, and the results of the recent NORC study on annual hospice cost savings to Medicare. Through a series of trainings and resources, advocates were introduced to recent developments on these issues and key asks for legislators.

One key ask was for legislators to support the Expanding Access to Palliative Cart Act (S. 1845), which was introduced on June 7 during Hospice Action Hill Day. This bill would authorize the Centers for Medicare & Medicaid Services (CMS) to test a demonstration model of providing palliative care to Medicare beneficiaries outside of the hospice benefit and in community settings. On the workforce front, legislative offices were also asked to support the Palliative Care and Hospice Education and Training Act (PCHETA), which is expected to be reintroduced before the end of June.

On program integrity asks, advocates informed legislative offices of NHPCO and partners’ 34 recommendations to CMS, and that a bipartisan sign-on letter to CMS on the issue from Representatives Earl Blumenauer (OR) and Beth Van Duyne (TX) would soon be circulating.

Advocates have shared that legislative offices were engaged with policy issues and asks, expressing enthusiasm for the latest NORC research, interest in exploring paths forward for workforce and program integrity issues, and in expanding access to palliative care. Offices also reportedly expressed interest in being involved in the We Honor Veterans program.

At the pre-Hill Day training on June 6, Hill staffer Sarah Gilbert of Representative Neal Dunn’s office (R-FL) stopped by for a conversation about what advocates could expect when meeting with a Congressional office. 

The training also included recognition for leaders and advocates who made a special difference in the last year for hospice and palliative care.

The 2022 Hospice Angel Awards for members of Congress were shared. Advocates meeting with some offices the following day were able to personally deliver these awards. Honorees who met with advocates during the Hospice Action Hill Day included Senator Shelley Capito (R-WV) and Congressman Joe Morelle (D-NY).

Winners of the 2022 MyHospice Ambassador Awards were also formally announced at the pre-Hill Day event. MyHospice Ambassadors is an advocacy program for those who are particularly committed to advancing hospice and palliative care through their demonstrated passion, dedication, and leadership. These award winners stood out through their efforts in the previous year:

• Rookie of the Year: Angela LaBarca, Business Development Specialist with Caring Circle Hospice, Michigan
• Impactful Voice: Sandy Kuhlman, Executive Director of Hospice Services of Northwest Kansas, Inc., Kansas
• Ambassador of the Year: Demetress Harrell, CEO of Hospice in the Pines, Texas

The event also briefly recognized Mackenzie Daniek, co-director of Providence Hospice in Seattle and first-time Hospice Action Hill Day attendee. Daniek co-wrote an impactful op-ed on hospice care in the Seattle Times this past April, and organizers wanted to recognize the piece as an ideal example of advocates effectively raising the profile of hospice and palliative care issues.

Overall, the Hospice Action Hill Day and the training that preceded it have already proven to be a seminal moment in NHPCO and HAN advocacy for 2023. With the start of a new Congress and the resolution of outstanding issues like the debt ceiling, it was vital for hospice and palliative care advocates to come together and raise a collective voice for the cause. After years of being separate-but-together, an in-person advocacy event provided opportunities for renewed energy among advocates from across the country.

Learn more about how YOU can be part of changing hospice care policy for the better by signing up with the Hospice Action Network today!

 View the full photo library.

  

How Death Doulas Help Those Who Have Decided to Use Medical Aid in Dying

Arlene Radasky | 25-Year Hospice Volunteer and Certified Death Doula/Death Midwife

Disclaimer: All views expressed in this blog are the author’s own and do not represent the view of NHPCO or affiliated organizations.

Virginia grew up on a small farm and was fiercely independent. She worked extremely hard, juggling two jobs to raise her sons after her beloved young husband passed from a heart attack. The youngest of her two sons had an intellectual disability and required much of Virginia’s spare time.

As the boys grew into men, her youngest son, wanting independence for himself, chose to live in a group home. Her eldest son became a dentist and moved across the country.

As Virginia approached 68, she was diagnosed with myositis after several, injury-causing falls. Following two years of treatment, she could not live independently anymore. Additionally, her eldest son had a stroke and was living in a brain injury facility.

Virginia was on Medicaid and was moved to a nursing facility that had a bed available. She eventually declined to the point that she and her doctor decided hospice was the right next step for her wishes. 

She chose a local hospice, was evaluated and accepted, and her care team began caring for her. The hospice death doula volunteer on the team, Mary, made her first visit with Virginia to get to know her. Mary visited once a week for one hour, during which time Virginia became very comfortable with her.

At her visits, Mary helped Virginia fine tune her advance directives, talked about vigils, and planned what Virginia would like to have at hers. Mary also discussed the different options for burials or cremations after Virginia’s death and when Virginia decided on one, Mary made sure it was noted in her advance directives. The hospice team was notified and given copies of the edited advance directives, and Mary made sure a POLST was also completed.

In their many conversations, Mary learned details that Virginia had not felt comfortable talking to the doctor and nurses about. Mary made note of these concerns, such as a suspected bladder infection, in her weekly reports and team meetings. If needed, the subjects were discussed between Mary’s medical team, counselors, and Virginia in more detail.

Virginia continued living in the facility for eight months while she was under hospice care. Her falling risk was high during the last six months of her stay there and she was not let out of bed without supervision. These restrictions cause some toilet accidents that were mortifying to Virginia. Swallowing became more difficult, and the facility tried to compensate by changing her diet, making sure everything was cut into bite-sized pieces and eventually, blending some meals.

At the six month point of Virginia’s hospice care, she began asking about medical aid in dying (MAID). Mary made note of her questions and told Virginia’s team about their conversations. Virginia’s hospice counselor talked to her and together, they made the decision to start the process for Virginia so she would be able to use the option if she wanted to. Virginia asked Mary to transport her and attend the required appointments.

Virginia received the prescription and was told at that time by the facility she was in that she could not be a resident there when she decided to use the option. Virginia became anxious and despondent.

Mary reported this to the hospice team and asked if the hospice facility allowed the option. It did not, and neither did another facility in town. The only option left was to find a bed in a private home.

Mary asked Virginia about her friends with homes who lived nearby. There were very few, but Virginia and Mary contacted one who, after talking to Virginia on the phone, asked to meet with her. Mary picked up her friend, Theresa, and took her to meet with Virginia. They talked for an hour about the past, Virginia’s disease, and her decision. Mary then took Theresa home. One week later, she called Virginia and said she had an extra room where she could come stay for a while.

Mary told the hospice team a bed had been found. Together, Mary and a hospice nurse went to visit Theresa and look at the room. It was found appropriate, and a hospital bed was ordered for Virginia to be able to be in.

Mary was with Virginia during her transport to Theresa’s home and was able to make her comfortable, reporting back to the hospice team that Virginia was laughing with Theresa when she left.

Mary continued her weekly visits with Virginia, who had been on a liquid diet for two weeks when she said she was done and wanted to take the medicine. Mary discussed this decision with Theresa and with her hospice team, and the date Virginia had requested was assigned.

On the day Virginia chose, Mary arrived early so Virginia’s requested vigil space could be set up. A small fountain bubbled in the corner of the room. Virginia was changed into her requested night gown and made comfortable. Large scarves were draped around the windows to create a softer atmosphere, and over Virginia as she lay in the bed. Virginia’s chosen music was playing on Mary’s phone lying next to Virginia. Theresa came in to say goodbye but said she could not stay in the room while Virginia was dying. Mary said she would come tell her when it was over.

The nurse came and helped Virginia mix the medication with her choice of fruit juice. Virginia drank it when it was time. Mary sat next to Virginia, holding her hand at Virginia’s request the entire time.

Virginia continued breathing for longer than expected and the nurse left to attend to other patients while Mary stayed with Virginia during her vigil. After Virginia’s last breath, Mary called the hospice, reported that she needed a nurse to come to declare death, and went to tell Theresa that Virginia had died.

Mary sat with Theresa until Virginia’s body was removed. Mary made one more visit with Theresa a week later to talk about her grief, and to let her know about grief resources in the community.

Mary, the volunteer Death Doula, added many hours of compassionate discussion and attending to personal details for Virginia while she was a hospice patient.

A Conversation with Dr. Aditi Nerurkar, Leading Stress and Resilience Expert

Dr. Aditi Nerurkar, MD, MPH

Dr. Aditi Nerurkar is a Harvard physician, Forbes contributor, and an NBC News medical commentator. Her expertise is in the science of stress, resilience, and burnout. She offers insights in optimizing mental health, wellbeing, and productivity during the Covid-19 pandemic and beyond.

Dr. Nerurkar is on faculty at Harvard Medical School in the Division of Global Health & Social Medicine and serves as the Co-Director of the Harvard Clinical Clerkship in Community Engagement. Prior, she worked in global public health in Geneva, Switzerland with a World Health Organization collaborating center.

NHPCO had the opportunity to sit down with Dr. Nerurkar and ask her a few questions about leading high-quality programs in the healthcare sector, and her lessons learned over the years. NHPCO questions are italicized for clarity.

How will we know when the pandemic is over? Will we know when we have reached the “new normal?”

We are officially in the post-pandemic era from the policy perspective. On May 5, the World Health Organization (WHO) declared the end of the global health emergency but still said that COVID continues to be a global health threat. We are at present entering the new normal. That doesn’t mean that people won’t continue to get COVID or to be hospitalized and potentially die from the infection, it simply means we don’t have the policy guardrails, funding, and coordination we once did when it was considered a global health emergency. There are many downstream implications of this, many of which we cannot understand or begin to perceive now.

Why should hospice and palliative care teams enhance their focus on burnout and mental health? Where should they begin?

Every industry should be focused on mental health at this time because we are seeing unprecedented levels of mental health issues among employees across sectors. We’ve endured a major global event with broad ramifications on mental health, stress, and burnout. Particularly for those in the healthcare sector, this is especially marked. Prior to the pandemic, we were already noticing a rise in burnout among healthcare staff.

However, the pandemic exponentially accelerated this rise. We now have an epidemic of burnout among healthcare workers. We need to heal the healers

There are so many ways to begin to focus on protecting healthcare workers mental health and burnout. The first is to remove the burden of responsibility off the individual healthcare workers. This is a system-wide issue that needs systemic solutions. Broader institutional approaches to protect burnout must be instated. The American Medical Association has a wide array of resources and data on how to do this within an institution.

At the same time, we can support our healthcare workers by normalizing and validating this experience for them. Data shows that 60-72% of healthcare workers have at least one feature of burnout. We must do more to aid in burnout recovery for these individuals, who are now the majority.

You note that the pandemic has created an “occupational health crisis.” What does that mean?

We refer to the pandemic as a public health crisis, which it has been. But it’s also been an occupational health crisis and a mental health crisis. Mental health has been the shadow pandemic. We’ve seen an unprecedented rise in stress and burnout during the pandemic as well as a rise in stress-related conditions like anxiety, depression, and insomnia. The focus on recovery should include both individual and institutional factors. We must help individual healthcare workers recover from their burnout, but we also must focus on systemic solutions to help create more sustainable working conditions and an environment that supports the mental health needs of the individual workers. When an organization’s culture and an employee’s experience can align, that’s when mental health is optimized.

###

If you’re interested in learning more from Dr. Nerurkar, she was a keynote speaker at the NHPCO 2023 Virtual Interdisciplinary Conference. Her session recording, The Reentry Phenomenon: A Blueprint to Navigate the New Normal, is now available in the conference portal for attendees. If you are not yet registered for the conference, register now and access the recording along with an extensive on-demand content library offering 22+ hours of CE/CME-eligible education.

NHPCO members can also find more resources on the end of the PHE through the NHPCO Regulatory and Policy Alerts webpage, under Updates and Alerts and titled “Final CMS Guidance for the Expiration of the COVID-19 Public Health Emergency (5/2/23).”

 

A Conversation with Dr. Ted James of Harvard Healthcare System

NHPCO had the opportunity to sit down with Dr. James and ask him a few questions about leading high-quality programs in the healthcare sector.

Ted James, MD, MHCM, FACS
Medical Director and Vice Chair, Beth Israel Deaconess Medical Center
Associate Professor of Surgery, Harvard Medical School

Dr. Ted James is a medical director and lecturer within the Harvard Healthcare System with extensive experience in efforts to advance healthcare. He leads international programs focused on digital health, clinician engagement, and patient experience, and collaborates with healthcare executives and industry experts from around the world.

He is an author who writes about the trends shaping the future of medicine and strategies for transforming the healthcare ecosystem. Dr. James has received numerous awards for his contributions to teaching, leadership, and quality. One of his greatest professional satisfactions comes from partnering with others to reimagine healthcare in ways that improve organizational performance and the wellbeing of patients, care teams, and communities.

NHPCO had the opportunity to sit down with Dr. James and ask him a few questions about leading high-quality programs in the healthcare sector, and his lessons learned over the years. NHPCO questions are italicized for clarity.

Why should hospice and palliative care teams enhance their focus on quality?

Focusing on quality improves patient outcomes and enhances the patient and family experience, which results in greater confidence in the care team. These have been shown to improve pain and symptom management. Essentially, the quality focus improves the patient's overall quality of life. Quality also leads to more efficient and less costly care, which is critical in the era of value-based care. Lastly, focusing on quality is a source of professional satisfaction

Where should hospice and palliative care teams begin in their quality improvement process? What does an organization focused on quality look like?

Start with a comprehensive assessment of current performance and then identify areas for improvement. This should be a leadership-supported, team-based approach with measurable goals and action plans to address identified gaps in care. Regular monitoring and measurement of outcomes with a constructive, not punitive, focus should be done to track progress and make necessary adjustments. The organization should be focused on continuous quality improvement, always seeking to elevate the next level.

What advice do you have for hospice and palliative care teams focusing on clinical innovation and leadership development?

Embrace change. Foster a culture where change is welcomed and seen as necessary to meet the future needs of patients. Leaders should promote psychological safety where people feel safe to ask questions, admit mistakes, challenge norms, and provide new ideas. Create venues for brainstorming and collaboration. Having opportunities for individual growth and professional development are also critical. Finally, realize that we can all be leaders and take ownership in making things better.

How can hospice and palliative care teams overcome resistance to new ideas?

People are not so much resistant to change as they are resistant to uncertainty. Conveying the "why" behind change, the purpose, can be a powerful way to motivate others. Involving people in the change process is also crucial to getting by in and overcoming resistance to new ideas.

What are some organizational best practices to encourage leadership at every level?

One of the best ways to foster leadership is simply to provide leadership opportunities. Make sure people have opportunities to initiate and lead projects. Seek out people who show potential and give them a chance to shine. Make certain to encourage autonomy and ownership; nothing will stifle leadership development like micromanagement. It also helps to recognize and reward good leadership.

How do you become a high-performing team? How do you know if you are a high-performing team?

High-performing teams need open communication, shared goals, structured processes, and, most importantly, mutual respect and mutual support. Great teams also have high expectations for the team and for individual members. They regularly evaluate their performance, deal with conflicts effectively, and celebrate wins collectively.

What advice can you share on how to enact transformation at different scales (i.e., system/organization-wide versus departmental)?

It requires tailoring the approach to the specific context. Organization-wide transformation needs centralized leadership, extensive strategic planning, and strong communication channels. Departmental transformation needs engaged champions who can spearhead targeted interventions. Well performed departmental initiatives that align to the goals of the organization will often scale to system wide. programs.

What are some steps hospice and palliative care leaders can take to develop leaders at all levels of an organization? What mistakes are healthcare leaders currently making when it comes to leadership development?

Mistakes in leadership development include neglecting to offer adequate resources and support, not recognizing and rewarding leadership behaviors, and not promoting a culture of inclusivity and diversity.

What are some tips that care team members can use to center their focus on the greatest priority of healthcare (and often, the reason for their connection to their work) – the patient?

Prioritize meeting the needs of our patients. We can understand their needs by actively listening to patients and families. Other key approaches are to communicate with empathy, strive to meet patient's physical, emotional, cultural and spiritual needs, convey respect, and empower patients through education and shared decision-making.

What’s the best piece of advice you’ve ever received?

That's a difficult one. I've received good advice from many mentors over the years. I think we should all view patient care as a calling. Also, we should remain curious and never stop learning. Healthcare is constantly evolving and being open to new ideas is essential for quality improvement.

What are some leaders doing that other leaders should be doing?

Leaders should think about how healthcare can innovate to improve the patient experience, including leveraging technology to improve care coordination and patient outcomes. We've seen great advances in other industries that are meeting user needs through technology and innovation. By embracing change and learning lessons from outside healthcare, leaders can drive positive changes.

Are there any other questions that we should have asked you that you’d like to ask and answer yourself?

Clinical teams are under a great deal of stress. Burnout is a serious threat. We should be asking how to use the power of teams and teamwork to support and revitalize the clinical workforce. Leaders and individual team members can take steps to promote mutual support, psychological safety, and a sense of inclusiveness and belonging that helps to address these challenges and allows teams to thrive.

 

###

If you’re interested in hearing more from Dr. James, he was a keynote speaker at the NHPCO 2023 Virtual Interdisciplinary Conference. His session recording, Revitalizing Your Healthcare Teams Through Action-Based Leadership, is available in the conference portal until May 24. Attendees can watch and re-watch the presentation to glean takeaways for them and their teams.

Patient Safety Awareness Week March 2023

Why Safety?

By Aparna Gupta, DNP, FACHE, CPHQ, CRNP

Safety in healthcare is a cure-all – yet how many of us put safety front and center? From wearing seat belts, to washing hands, to crossing the street, the mechanism of safety is (mostly) well entrenched in all of us. Yet when it comes to identifying safety risks, reporting adverse events, or keeping patients and clinicians safe, we are prone to miss the point. The Institute of Medicine has established six domains of healthcare quality – safe, effective, patient centered, timely, efficient, and equitable care .

The first domain is safety. Delivering safe care means that adequate assessments have been done in a consistent, efficient, and equitable manner and that the right patient is receiving care in the right way, at the right time. Which also means that medical waste (unnecessary intervention) is avoided and patient outcomes including the experience of care are optimized. In other words, we accomplish the triple aim – maximize the patient experience of care, quality, reduce cost and enhance outcomes.

But wait, there’s more. What about clinician safety? Our interdisciplinary team members that are in the patients’ homes are exposed to a plethora of risk, the most recent being demonstrated during the COVID pandemic. While these are unsung superheroes, we need to focus on the safety of our staff. Not only physical safety, but psychological safety as well. As much as we need to ensure our staff are protected and feel safe to report any security incidents for their selves, we also need to ensure that the organization nurtures a just culture, whereby staff can “say something” when they “see something”.

It is well known that organizations that focus on a just culture see higher rates of “near miss” reporting – events that could have harmed the patient but didn’t reach the patient just yet. When these organizations make it safe and non-punitive for staff to report near misses, we see better workflows, higher standards of care and better communication between the interdisciplinary team (IDT).

Communication plays a big role in ensuring safety both for  staff and  patients. When the IDT talks to each other and shares important information at the right time and in the right way, the coordination of care reaches a new horizon. Safety tools like SBAR become the language that keeps care focused on the patient and the family.

As we celebrate Patient Safety Awareness Week, I cannot help but think of James Reasons Swiss Cheese Model (BMC Health Serv Res. 2005; 5: 71.) which explains how complex functions like taking care of a human being can be simplified when the whole team gets a say, has input, and works together to put patients’ safety first. Let’s keep our patients, our communities and ourselves safe by working together, trusting each other, and leaning on one another. Happy Patient Safety Awareness Week 2023!

About the author:

Aparna Gupta is the Vice President of Quality with National Hospice and Palliative Care Organization. Aparna is a board-certified adult nurse practitioner and has served in various roles ranging from executive leadership, operations, and clinical care delivery across healthcare. She holds a national certification in healthcare quality and is a Fellow with the American College of Healthcare Executives.

To learn more from NHPCO about improving your organization's quality and safety, register for the upcoming 2023 Virtual Interdisciplinary Conference.