The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Category: Spotlight on MI hospitals (page 1 of 3)

McLaren- Lansing: Using Change as an Opportunity for Optimizing Palliative Care

Kim Hecksel

McLaren- Lansing Palliative Care nurses from left to right: Kim, RN, Paula, CNP and Carol, RN

Although the palliative care program at McLaren- Lansing has been around for about a decade, health care organizations are constantly changing and evolving to meet patient and family needs. The MVC Coordinating Center had the opportunity to speak to the team of case managers and nurses from McLaren- Lansing to hear about the different successes and barriers to palliative care at this facility. One distinct characteristic of this palliative care program is that patients and families are seen by and interact with consistent faces, rather than different clinicians, each time they visit. McLaren uses this consistency as leverage through transitions of care, especially at a time when clinician duties and health organizations are constantly changing.

The palliative care program at McLaren- Lansing also keeps up with the constant changes in health care by utilizing different online resources. One resource available to hospitals interested in palliative care programs is the Center to Advance Palliative Care (CAPC). CAPC offers a platform to help provide different health care organizations across the nation the tools and resources needed to advance palliative care programs in their respective institutions. For example, some CAPC resources help palliative care teams set up and develop a business plan for their respective palliative care programs. CAPC resources are helping guide the McLaren- Lansing team in creating a business model that illustrates the financial impact of a palliative care program on the health system. For more information on CAPC and the resources they can provide, visit www.capc.org.

The palliative care team also looks at the big picture of the care provided to patients and consequently putting together different pieces of information to ultimately develop a course of treatment that best meets the needs of the patients and the family involved. One of the barriers McLaren- Lansing has with their palliative care program is working with patients, family members and other health care providers on understanding the value of palliative care and what it really offers. When met with this resistance, the palliative care team works in different ways on learning about and discussing the care plan and goal setting to find the right format for communication and understanding a diverse patient population. For example, the palliative care team engages with physicians one-on-one and attends presentations on the benefits of palliative care to better understand and work with patients and their families about their diagnosis and individualized care plan. Taking advantage of different resources available, such as CAPC, and instilling a strong support system among the palliative care team and liaising teams are factors that aid in instituting a successful palliative care program.

If you are interested in learning more about the palliative care program at McLaren- Lansing, please feel free to reach out to Deby (debevans@med.umich.edu) or Abeer (abeery@med.umich.edu) for more information and contact.

Hospitals in Michigan: Growing a Palliative Care Program

Melinda Gruber

Melinda Gruber MBA, PhD, is the Chief Executive Officer for Caring Circles.

Palliative care provides a number of benefits for patients of all diagnoses including Congestive Heart Failure (CHF). During the CHF workgroups a topic for discussion was how palliative care programs can reduce readmissions and the MVC Hospital Engagement team found out more about some palliative care programs here in Michigan.

BACKGROUND

Lakeland Hospital started their palliative care program in the outpatient sector through a local independent hospice after recognizing that patients would benefit from improved symptom and pain management along with advanced care planning. By 2008, Lakeland realized they needed to engage a physician champion who was both well-known and accepted throughout the community with a vision for both inpatient and outpatient palliative care. In 2012, the outpatient hospice program joined Lakeland and a business plan was proposed to add an inpatient program. This program has grown and received positive feedback, and Lakeland now has a Hospice and Palliative Medicine Fellowship. Recently they have worked with home care and have started to provide a palliative home care service that is actively growing. As the program evolves, Lakeland continuously assesses the needs of the program to determine where to best allocate resources.

BENEFITS

The benefits of the palliative care program at Lakeland include an added layer of support for both patients and their families. Additionally, examples show reduced readmissions, better pain and symptom management, increased support for the family, and patients meeting their goals in end of life care surrounded by family who have been prepared.

While partnering with other outpatient and inpatient palliative care programs throughout the area, Lakeland is learning the strengths of each to provide for the varying needs of the patients.

CHALLENGES

One of the challenges Lakeland faces is an ongoing lack of understanding about palliative care and its true value to the patient. There is also the challenge to convince the provider that the palliative care team is there to assist with the patient’s needs and not completely take over care of the patient. To address these challenges, the palliative care program at Lakeland takes on the responsibility of educating and coaching staff to provide them with a minimum foundational skill to deliver palliative care and explain how and why the palliative care approach was taken. This helps those involved in patient care understand the different approaches to care given, and how the palliative care program works.

Other challenges being faced by Lakeland are identifying what the optimal approach for palliative care is, staffing needed to provide palliative care and setting expectations to deliver consistent care.

LIAISONS

Lakeland partners with Agency on Aging which includes an interdisciplinary team that goes to a patient’s home and provides dietary and medication advice. Lakeland’s palliative care program also has relationships with primary care for the homebound, nursing homes, hospitalists, hospices, intensivists, and consultation programs for all-inclusive care.

EDUCATION

Lakeland stresses the importance of palliative care education and provides opportunities for growth in learning such as:

  • Huddles with the hospitalists and working more with the residents;
  • Lunch and learns for CME credits; and
  • A patient care summit on the benefits of palliative care

NEXT STEPS

As the palliative care program at Lakeland continues to grow, the palliative care team perform needs assessments to ensure the program is meeting the needs of the patient and the health system. They also utilize data in a simplistic understandable way to demonstrate the value of the program to high level leadership. Moving forward, they have scheduled to attend meetings at provider offices to build relationships and provide educational opportunities to clinicians.

ADVICE

Lakeland advises other hospitals to recognize that there is not one set way to provide palliative care. They recommend setting expectations up front, developing objectives to meet the needs of both the patient and the health system, and finding “champions” and get them engaged in palliative care initiatives.

Lakeland is also seeking advice for how clinicians can be consulted ahead of a patient “crisis”. Team members are currently on call 24/7 but they would like to find ways that the team can be more consistent with providing consults especially in the off shifts.

If you would like to learn more about the palliative care program at Lakeland Hospital, please contact Doris Glowacki at dglowacki@Caring-Circles.org or the MVC Coordinating Center.

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