Program Characteristics to Consider
The design of a successful palliative care program reflects the unique mission, needs and constraints of the hospital it serves. Following are some of the program characteristics that the planning team needs to consider before working through the operational design:
Cost Control and Revenue Generation
Integrating and Leveraging Existing Services
Palliative Care Program Structures and Models
Deciding Where to House the Program
Coordinating Patient Care Across Settings
Interdisciplinary Resources
Because the needs of seriously ill patients and their families are multidimensional, a palliative care program requires an interdisciplinary team. The ideal team has the following members with appropriate training and education in palliative care:
- Physician
- Nurse and
- Social worker.
Other team members may include clergy, rehabilitation professionals, pharmacists, psychologists and psychiatrists. For more information on the makeup of a palliative care team and skills required, go to Staffing a Palliative Care Program.
Visibility and Accessibility
The administrative structure of the program, its administrative home, and the model chosen (e.g., consultative vs. inpatient service) has a large impact on:
- How visible the program is to colleagues
- How it is perceived
- How it functions with other departments and
- How patients will be served.
Things to consider are:
- Who are the team members?
- How does the team interact with colleagues?
- How does the team integrate with hospital culture?
Cost Control and Revenue Generation
The palliative care program will not generate a great deal of direct revenue for the hospital. However, it can be cost-neutral. A program reduces costs for the hospital through cost avoidance and covering its own costs.
To help the team choose a realistic program size and structure, take into account:
- How much revenue the program can generate given estimated patient volume
- Revenue from increased capacity and
- The level of cost savings palliative care will bring the hospital.
For more information, go to Financing the Palliative Care Program.
Integrating and Leveraging Existing Services
A palliative care program may leverage, collaborate with, or supplement related services, such as a pain management program, case management or hospice. It is important to determine what related services are at the hospital and how the program can best be positioned to fully partner and integrate with those services and share resources.
Palliative Care Program Structures and Models
Palliative care services are provided through a variety of structures:
- Inpatient beds scattered throughout a hospital
- Dedicated inpatient units
- Consult services and
- Outpatient clinics.
In addition, some hospitals have established programs that combine an inpatient palliative care unit with a contract for inpatient hospice care.
There is no single correct palliative care program model. Each has strengths and weaknesses. Any variation can be adapted to ensure the resulting program structure best fits the needs, culture and resources of each institution.
Deciding Where to House the Program
Successful programs have been administered by a range of professional specialties, including:
- Oncology
- Geriatrics
- Critical care
- General medicine
- Neurology
- Hospitalists
- Nursing
- Hospices and
- Case management programs.
In fact, many mature programs deliver care in a variety of settings and/or coordinate with other programs to deliver care. There is no ‘right’ administrative home. The planning team will need to consider the pros and cons to each location.
Coordinating Patient Care Across Settings
Ideally, whatever the care model, the palliative care program contributes to an integrated delivery system. Most seriously ill patients will receive care in multiple locales, and more than once, over the course of a long illness. A typical patient will receive care:
- At home (with or without hospice or visiting nurses)
- In the emergency unit
- In the hospital and
- In a nursing home.