Palliative Care
 

Palliative Care

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    Palliative Care Palliative Care Document Transcript

    • The  Adoption  Of  Palliative  Care:  The   Engineering  of  Organizational  Change           Endeavor  Management     2700  Post  Oak  Blvd.   Suite  1400   Houston,  Texas  77056   P  +  713.877.8130   F  +  713.877.1823   www.endeavormgmt.com        
    • The  Adoption  of  Palliative  Care:     The  Engineering  of  Organizational  Change       Overview     Imagine  that  you  have  just  been  named  to  the  faculty  of  a  distinguished  medical  institution.  Further   imagine  that  you  have  been  asked  by  the  Director  of  the  institution  to  “help  us  implement   palliative  care  in  our  institution.”  What  would  you  do?  How  would  you  do  it?  With  whom  would   you  work?  Whom  might  you  avoid?  What  missteps  would  you  want  to  avoid?   Hopefully  many  of  the  readers  of  this  case  will  be  asked  exactly  that  question;  “Can  you  help  us   implement  palliative  care?”  The  goal  of  this  white  paper  is  to  offer  a  framework  for  thinking  about   such  an  implementation  as  well  as  some  practical  tools  that  might  be  used  to  make  such  an   implementation  possible  in  a  relatively  short  period  of  time.   Elements  of  the  Framework     While  most  of  us  spend  our  time  inside  a  large  organization,  we  usually  don’t  spend  much  time   thinking  about  the  organization.  What  is  an  organization?  What  is  it  made  of?  What  do  we  mean   when  we  talk  about  “changing  the  organization?”  When  we  say  that  we  want  to  implement   palliative  care  in  an  organization,  what  does  that  mean?     The  following  three  subject  areas  can  form  a  framework  for  envisioning  and  then  changing  an   organization  and  how  it  operates:     1.  The  Organization  as  a  Mechanical  System.  A  large  organization  can  be  thought  of  as  a  mechanical   system  made  up  of  concrete  “moving  parts”  –  parts  that  can  be  “engineered”  (or  altered)  to  cause   the  organization  to  function  in  a  different  way,  like  delivering  a  new  service  such  as  palliative  care   to  the  institution’s  clients.  The  mechanical  parts  of  an  organization  that  must  be  engineered  for   change  are:     • Vision  ...  the  organization’s  understanding  of  its  mission  and  future     • Processes  ...  the  steps  that  allow  the  organization’s  work  to  be  done                (including  the  steps  associated  with  palliative  care)     • Plant/Tools  ...  the  physical  assets  (including  software)  the  organization  uses  in  its  processes     • Performance  management  system  ...  the  organization’s  way  of  attracting  and          retaining  people  to  work  the  organization’s  processes,  including  palliative  care             ©  2011  Endeavor  Management.  All  Rights  Reserved.       Page  2  
    • The  Adoption  of  Palliative  Care:     The  Engineering  of  Organizational  Change       2.  The  Diffusion  of  Innovation  within  a  Social  Organization.  Innovations  –  ideas  that  are   new  to  an  organization  –  diffuse  through  an  institution  in  a  patterned  way  over  time,  with  some   organization  members  far  more  inclined  to  adopt  an  innovation  like  pallia-­‐  tive  care  than  others.   Organization  members  might  be  described  in  “thirds:”     • first  third  ...  those  clearly  eager  to  try  the  new  and  innovative     • third  third  ...  those  clearly  reluctant  to  try  the  new  and  innovative     • second  third  ...  those  “in  the  middle”  who  might  follow  either  the  first  or  third  third     3.  The  Role  of  Leadership  in  Creating  Change  in  an  Organization.  Leaders  cause  things  to  happen  in   an  organization.  Leaders  take  direct  actions  on  the  moving  parts  of  an  or-­‐  ganization;  they  influence   organization  members  to  enable  the  organization  to  make  changes  like  implementing  palliative   care  on  an  institutional  basis.     The  following  section  of  this  case  will  provide  both  understanding  as  well  as  action  steps  that  can   be  used  to  implement,  or  “engineer,”  an  innovation  like  palliative  care  into  an  institution  in  an   effective  and  efficient  way.  We  want  to  “pull  it  all  together”  to  illustrate  at  a  very  high  level  how   the  actions  can  be  used  for  the  real-­‐world  implementation  of  palliative  care.   Pulling  it  all  Together…  A  Palliative  Care  Success  Story     Take  for  example,  the  introduction  of  palliative  care  at  M  D  Anderson  Cancer  Center  in  Houston.   The  Chief  Executive  made  the  decision  to  move  toward  palliative  care  and  hired  a  leading  physician   to  come  to  Anderson  and  “run  the  show.”  Upon  arrival,  the  newly  ap-­‐  pointed  Palliative  Care   Department  Head  encountered  stiff  resistance  and  many  logistical  obstacles  that  were  almost   impossible  to  overcome.  At  the  end  of  the  first  18  months,  progress  in  gaining  acceptance  of   palliative  care  was  very  slow,  and  the  third-­‐third  popula-­‐  tion  of  resisters  had  made  themselves   heard.  The  situation  was  uncomfortable  enough  for  the  Department  Head  to  say  “that  he  felt  like   he  had  parachuted  in  behind  enemy  lines.”     In  an  effort  to  move  the  ball,  M  D  Anderson  retained  the  services  of  a  change  consultant  to  work   directly  with  the  Department  Head  and  his  palliative  care  team  of  department  member  physicians   and  administrators.  The  implementation  steps  taken  included  the  following:     • Instruction  of  and  consultation  with  the  palliative  care  team  in  the  change  concepts  that  are   described  in  this  paper.  The  Department  Head  stated  that  the  consultations  and  training  has   “opened  a  window  into  the  world  of  organizations”  that  allowed  them  to  better  see  and   understand  the  actions  that  he  and  his  team  needed  to  take.     ©  2011  Endeavor  Management.  All  Rights  Reserved.     Page  3  
    • The  Adoption  of  Palliative  Care:     The  Engineering  of  Organizational  Change                         • Decision  of  the  palliative  care  team  to  “ignore  the  third-­‐third  detractors”  and  to  find  and   work  with  “first-­‐third”  professionals  only  (i.e.,  working  only  with  those  who  were  relatively   positive  and  eager  to  look  at  palliative  care  as  a  treatment  alternative).   • Formation  of  a  Palliative  Care  Steering  Team  made  up  of  volunteer  senior  physicians/faculty   members  (all  of  whom  were  first  third)   • Arranging  an  early  meeting/workshop  of  the  Steering  Committee  to  hear  directly  from  the   MDACC  Chief  Executive.  The  Chief  Executive  explained  to  the  steering  team  his  reason  for   moving  the  institution  toward  palliative  care,  his  reasons  for  selecting  the  Department  Head   and  his  vision  of  palliative  care  as  a  legitimate  and  important  treatment  modality  for  the   institution.   • These  key,  friendly  members  helped  establish  a  vision,  mission,  and  strategic  plan  of  action   and  not  only  provided  extremely  useful  feedback  but  by  the  same  process  they  were  sold   • This  strategic  plan  was  later  moved  upwards  in  the  administration  to  con-­‐  vince  remaining   senior  management,  and  a  process  of  continuous  monitoring  of  the  level  of  adoption  of   palliative  care  was  established.   • The  palliative  care  team  and  Steering  Team  worked  directly  with  administrative  officers  of  the   institution  to  ensure  that  processes  were  in  place  to  handle  business  and  scheduling  aspects   of  palliative  care.   • With  a  palliative  vision  and  strategic  in  place,  the  Department  was  able  to  launch   communication  and  public  relations  programs,  clinical  education  sessions,  as  well  as   consultations  inside  and  outside  the  institution.  The  focus  on  these  programs  was  initially   on  the  first-­‐third.  As  a  result  of  positive  acceptance  by  the  first-­‐third,  members  of  the   second  third  began  to  sign  up  ...  and  before  long  the  first  two  thirds  were  chiding  members   of  the  third-­‐third  as  “being  behind  the  times.”   • The  result  of  this  implementation  approach  was  the  large  growth  in  referrals  to  the  palliative   care  program  that  have  succeeded  in  fully  establishing  it  as  a  viable  clinical  and  financial   program.  Note  the  rapid  rate  of  palliative  care  consultations  in  the  chart  below.     (insert  chart  entitled:  “The  Impact  of  Palliative  Care  Services  on  overall  hospital  mortality  in  a   comprehensive  cancer  care  center,  ”by  Bruera,  et  al.)   • The  palliative  care  initiative  has  continued  to  increase  in  use  and  popularity,  with   ©  2011  Endeavor  Management.  All  Rights  Reserved.     Page  4  
    • The  Adoption  of  Palliative  Care:     The  Engineering  of  Organizational  Change     consultations  continuing  to  increase,  and  the  number  and  cost  of  deaths  in  intensive  care   continuing  to  decline.     Blending  the  messages  from  the  three  framework  elements  is  essential  to  effective  change.  The   essential  message  of  this  white  paper,  therefore,  is  for  leaders  to:     1.   take  strong,  aggressive,  visible  action  ...   2.              with/through  the  “first-­‐third”  managers  and  professionals  ...   3.   to  alter  the  mechanical  attributes  of  the  organization  that  will  enact  palliative  care.     In  summary,  key  to  the  success  of  the  effective  and  efficient  introduction  of  palliative  care  will  be   the  continuing  partnership  between  the  committed  chief  executive  and  leaders  in  the  management   cadre.  Dedicated  action  in  the  engineering  framework  described  in  this  chapter  ...  along  with  huge   doses  of  “blood,  sweat,  and  tears”...  should  lead  to  another  palliative  care  success  story.                                                           ©  2011  Endeavor  Management.  All  Rights  Reserved.     Page  5  
    • The  Adoption  of  Palliative  Care:     The  Engineering  of  Organizational  Change         About  Endeavor     Endeavor  Management,  is  an  international  management  consulting  firm  that  collaboratively  works   with  their  clients  to  achieve  greater  value  from  their  transformational  business  initiatives.  Endeavor   serves  as  a  catalyst  by  providing  pragmatic  methodologies  and  industry  expertise  in   Transformational  Strategies,  Operational  Excellence,  Organizational  Effectiveness,  and   Transformational  Leadership.     Our  clients  include  those  responsible  for:   •   Business  Strategy   •   Marketing  and  Brand  Strategy   •   Operations   •   Technology  Deployment   •   Strategic  Human  Capital   •   Corporate  Finance     The  firm’s  40  year  heritage  has  produced  a  substantial  portfolio  of  proven  methodologies,  deep   operational  insight  and  broad  industry  experience.    This  experience  enables  our  team  to  quickly   understand  the  dynamics  of  client  companies  and  markets.    Endeavor’s  clients  span  the  globe  and   are  typically  leaders  in  their  industry.       Gelb  Consulting  Group,  a  wholly  owned  subsidiary,  monitors  organizational  performance  and   designs  winning  marketing  strategies.    Gelb  helps  organizations  focus  their  marketing  initiatives  by   fully  understanding  customer  needs  through  proven  strategic  frameworks  to  guide  marketing   strategies,  build  trusted  brands,  deliver  exceptional  experiences  and  launch  new  products.     Our  websites:   www.endeavormgmt.com   www.gelbconsulting.com   www.gulfresearch.com     ©  2011  Endeavor  Management.  All  Rights  Reserved.     Page  6