National Hospice and Palliative Care Organization’s Palliative Care Resource Series Creating Support for Your Community-Based Palliative Care Program Daniel Maison, MD FAAHPM

Introduction Hospice staff are invited guests Hospice organizations are dependent on physician referrals Community partners will impact the success of a new palliative care program

Objectives Understand what motivates referral sources to make decisions. Describe three key ways to collect practical information to help serve referral sources. Identify the main strategy for creating buy-in from referral sources.

Take a Step Back! Why do your partners refer patients to your hospice or hospice at all? What is in it for them? If you are in a competitive environment, why would they chose your program over another one?

Motivation in Decision Making It is the right thing to do It benefits me in some way It benefits someone I care about (patients) in some way It is what I have always done

Conduct a Needs Assessment Why don’t they refer? Determine the type of information you wish to gather Decide how to ask the questions

Many Forms of Assessment Facilitate one on one interviews Conduct a survey Hold a focus group Form an advisory board Invite key physicians to join any and all above!

Challenges to Assessing Need Labor intensive, time consuming for staff Low response rate Limited participation No one best way to gather information

Benefits of Asking Physicians feel “heard” Gain buy-in Old administrative trick – inviting biggest critic to the decision making table

A Coupe of Caveats Do not be discouraged when what is requested is not what is wanted Physicians may say one thing and want another Trial and error are needed when trying to drill down to what a physician wants

Case Example 1: Lessons Learned Issue Physician had concerns about hospice program Never hears from hospice until after patient dies Plan Met with physician Outlined course of action for future referrals

Case Example 1: Lessons Learned What happened after next referral Called physician for orders Consulted at every change in patient condition Sent death certificate Physician did not return any communications!

Case Example 1: Lessons Learned New plan After next referral hospice took care of everything and contacted physician when patient died Result Began receiving 1-2 referrals per month (up from 1-2 per year) Physician is ‘very pleased’ with services

Case Example 2: Lessons Learned Issue Minimal referrals from large physician group Plan Met with physician group Barriers to referral discussed Developed comprehensive plan

Case Example 2: Lessons Learned What happened next No change in referrals or length of stay Emergency room incident during the night Invited head of physician group to join advisory board Result Referrals have increased

Conclusion Creating support for a new program involves understanding motivation and need. Many ways to gather information. The process itself is often as helpful as the information gathered. Let those you hope to serve help shape the program you plan to offer. Stay focused, work through challenges, and success is sure to follow.