System and Needs Assessment
The planning team should conduct the following:
- System assessment that focuses on existing strengths.
- Needs assessment that identifies weaknesses, opportunities and challenges.
These assessments are essential. They determine how a palliative care program can best leverage existing resources to address needs of both the hospital and the patients being served.
The system assessment identifies existing strengths within the hospital system that could benefit a palliative care program through partnership, collaboration and support. Examples of possible existing resources include:
- MD and RN clinicians with interest and training in palliative care
- Existing relationships with hospice
- Case management and discharge planning programs
- Hospital chaplaincy program
- Hospital focus on length of stay, ventilator days and pharmacy/ancillary costs per day
- Palliative care leadership based on personal experience or professional interest
- Pre-existing pain program
- Computerized medical records
- Community interest in and support for palliative care
- Trustee interest in and support for palliative care
A System Assessment Tool helps the planning team identify strengths within their organization. Another tool, the Palliative Care Decision Checklist, provides strategic questions to consider as data is collected and evaluated.
Once a system assessment is performed, identifying areas of need within the hospital can highlight where palliative care programs make the greatest contribution. Major areas of need that have shown improvement as a result of palliative care include:
- Pain and symptom management
- Patient and family satisfaction
- Nurse retention and satisfaction
- Bed and ICU capacity
- Length of stay
- Pharmacy costs
- Establishment and strengthening of hospice partnerships
- Fragmented subspecialty care
- Time demands on physicians for complex communications and decision making
- Costs associated with outlier cases
The Palliative Care Needs Assessment Checklist helps the team identify the greatest opportunities for the program.