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

2. 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

3. 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.

4. 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?

5. 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

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

7. 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!

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

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

10. 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

11. 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

12. 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!

13. 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

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

15. 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

16. 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.