Diane E. Meier, MD, shares how her mentee – who was overwhelmed by increasing volume and limited staff – turned her program around.

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Just over two years ago, I visited the NorthStar Network, a group of health organizations in and around Rochester, NY, who work together to improve access to quality care. I was asked to speak at a conference titled Cracking the Code On Healthcare, to deliver a talk on how to take care of people living with serious illness in their own homes. At the end, I invited members of the audience to speak with me, as I look forward to seeing new and familiar faces, and hearing about programs’ challenges and successes.

That day, I had the pleasure of meeting Chin-Lin Ching, MD, medical director of the palliative care program at Highland Hospital (Rochester, New York). I asked her how things were going, and through her body language, facial expression, and the sentiments she shared, it was clear that she was overwhelmed. She was just a few years post-fellowship and had inherited leadership of a rapidly growing program that was seeing ever more patients, but without any matching increases in staff. Chin-Lin was exhausted, and unsure if she could turn the program around. She was considering walking away.

"[...] through her body language, facial expression, and the sentiments she shared, it was clear that she was overwhelmed. She was just a few years post-fellowship and had inherited leadership of a rapidly growing program that was seeing ever more patients, but without any matching increases in staff."

Diane E. Meier
Center to Advance Palliative Care (CAPC)

I was concerned for her and for the survival of her program. But since this is not an uncommon problem amongst palliative care programs, I offered to mentor her. We exchanged contact information, and have kept in touch through phone, email, and video conference ever since. Since then, Chin-Lin has put in a tremendous amount of work, and successfully turned her program around, taken on additional leadership roles, and established a healthier work-life balance.

When I asked Chin-Lin if she would share the story of her program’s turnaround with other leaders, she was happy to help. And that’s where this blog post and the accompanying videos come in. I invite you to follow Chin-Lin’s story below, which we both hope will inspire you to turn any feelings of despair and frustration into constructive action.

Crisis

While Chin-Lin’s program was considered successful (based on high and rising volume), it was unsustainable because of strains on staffing, causing her and her team to feel overwhelmed and burnt out.

She was successful in building strong relationships with colleagues in her hospital, leading to increasing referrals, but was stretched very thin – an all-too-common occurrence in our field. Chin-Lin said, “I think you found me at perhaps the lowest point in my professional career. I was so burnt out that I didn’t know which way was up […] I felt like the weight of the world was on my shoulders. I had this program that looked successful on paper, but I was just really trying to hold myself and my team together.”

“I think you found me at perhaps the lowest point in my professional career. I was so burnt out that I didn’t know which way was up."

Chin-Lin Ching, MD
Highland Hospital

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Getting From Then to Now

After a significant amount of work (detailed steps below), Chin-Lin is now able to take some deep breaths. Her team’s staffing has grown significantly – quadrupling since the day we met, a little over two years ago. There’s now 1 additional full-time attending physician, 2 full-time inpatient Advanced Practice Providers (APPs), 2 outpatient APPs, and several other outpatient providers.

This change has allowed Chin-Lin to spend more time with her young family, as well as grow professionally as a leader. As a measure of the respect she has garnered through leadership of her palliative care program, she was recently asked to take on additional leadership roles within her health system. In turn, she has gained exposure and professional relationships outside of her community hospital, launching her on a broader leadership path.

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From Despair to Optimism

Chin-Lin can now reflect on the steps that she took to get to the much more optimistic perspective that she has today.

She explains the significance of mentorship, and how taking time to explore resources on capc.org (specifically how to write a business plan and conduct a needs assessment) was a significant turning point for her, to chart a plan for moving her program forward.

She says, “I think there’s something to be said about finding a mentor who allows you to worry and despair, but not to wallow in it.”

“I think there’s something to be said about finding a mentor who allows you to worry and despair, but not to wallow in it.”

Chin-Lin Ching, MD
Highland Hospital

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Staffing and Impact

After learning how to write a business plan, Chin-Lin performed a comprehensive needs assessment with key stakeholders within her hospital (e.g. the chief nursing officer).

This was important, not only to align her business plan proposal with what key leaders most need and care about, but it also strengthened relationships and cultivated broad support for her and for palliative care across the organization. Treating each assessment like a family meeting, Chin-Lin did much more listening than talking, learned about the challenges that each stakeholder was facing, what was most important to them, and how the hospital’s palliative care program might help them achieve their goals.

Being able to leverage these relationships, take feedback to the C-Suite, and share data significantly helped Chin-Lin move her program forward.

"Being able to leverage these relationships [with key stakeholders], take feedback to the C-Suite, and share data significantly helped Chin-Lin move her program forward."

Diane E. Meier
CAPC

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Using the Impact Calculator

Chin-Lin explains how she used one of CAPC’s most popular resources, the Impact Calculator, to project her hospital’s overall cost savings due to inpatient palliative care consultations.

She states that while her program doesn’t make money on fee for service billing like surgeons do, the program helps save the hospital a lot of money. For every patient that’s in the hospital or ICU, the impact calculator allows her team to show “how much money [palliative care] save[s] when that patient is able to leave the hospital much earlier than they would have in the absence of our service.”

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Planning and Peer Support

In order to expand her program’s staffing, Chin-Lin talks about the multi-year staffing plan she presented to leadership projecting growth in the team as patient volume increased. Having a plan allowed hospital leadership to see and sign off on her long-term vision (with associated metrics), instead of having to repeatedly go back to ask for more resources.

During the first COVID surge, Chin-Lin also founded a peer support group, which is comprised of other local program leaders, who connect and help each other on a weekly basis. She is now helping other CAPC members to develop similar leadership peer supports.

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Sustainability: Hospital Leadership

While it is essential to bring data on your program’s finances, patient volume, and impact during C-Suite presentations, it is equally important to share stories of high-quality patient care delivered by your team. Chin-Lin says, “I assumed that [leadership] knew what palliative care did. And that’s not an assumption you should make.”

“I assumed that [leadership] knew what palliative care did. And that’s not an assumption you should make.”

Chin-Lin Ching, MD
Highland Hospital

In this video, Chin-Lin offers suggestions for including patient and family stories in leadership presentations. She offers, “I think that’s what really strikes [our leaders]. And that’s when they can really connect the dots of, ‘yes they save us money, yes palliative care is important, and this is why’.”

Remember: never walk in to a meeting with just data, and never walk in with just stories – you need both.

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The Measure of Success

Reflecting on her program’s journey, Chin-Lin says, “the measurement of success can be a double-edged sword,” as she was told for over ten years that the only thing that mattered was the number of consults she was able to deliver. She’s since learned that while volume is important, it’s not the only thing – and that you have to think about measuring success beyond numbers, by identifying both what’s most important to your organization and to your team.

For example, your team might spend time during the day to teach colleagues how to run family meetings or manage pain requiring opioids – both the teaching and the empowering of front line clinicians will reduce consult numbers, but increase the number of patients receiving the care they need. “Every program is different and every program’s and organization’s priorities are different – just like every patient is different.”

"She’s since learned that while volume is important, it’s not the only thing – and that you have to think about measuring success beyond numbers, by identifying both what’s most important to your organization and to your team."

Diane E. Meier, MD
CAPC

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The Future – What the Pandemic Has Revealed

This series ends with Chin-Lin asking me about the future of palliative care. I share how the COVID-19 pandemic may end up positively influencing health care delivery, as it has exposed the health care system’s vulnerability in multiple areas.

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