By Jordane Jolley, LMSW, Manager of Community Initiatives, CAPC
Palliative Care Leadership Centers™ (PCLC) are exemplary palliative care programs—selected through a competitive process—that provide in-person training to teams seeking support in new program development or in strengthening existing programs. The two-day face-to-face immersion training on the nuts and bolts of writing a business plan, interviewing key stakeholders, effective marketing, and making the case to leadership for the necessary resources is followed by a year of distance mentoring from PCLC faculty. The first round of PCLCs, starting in 2003, has trained more than 60% of current US hospital palliative care programs, yielding successful and sustainable clinical teams. The stunning impact of this training model is almost certainly due to the long-term relationships that develop between PCLC faculty and the visiting learners.
Based on the success of the hospital PCLC program, CAPC is launching PCLC 2.0, adding community settings such as home care, nursing homes, and office settings, to the PCLC curriculum. Demand for palliative care delivery in community settings is far outpacing the field’s capacity to respond, a gap that requires urgent attention. Therefore, in addition to our six veteran PCLCs, in January 2017 three new PCLCs will begin offering training and mentoring focused specifically on home and office/clinic settings.
As one of CAPC’s newest employees, charged with scaling access to palliative care in community settings, I visited one of the veteran PCLCs to see for myself how it works. I had heard about the tremendous success rate of the PCLC training model in supporting successful implementation of palliative care programs around the country, so I was very curious to attend the in-person portion myself. As a clinical social worker who previously worked in hospice in the community setting, I viewed the experience through the lens of both a potential learner on an interdisciplinary team and as the person who would soon become responsible for explaining PCLC training to the outside world.
I joined a PCLC training with a palliative care team from Norton Hospital of Louisville, Kentucky. This eight-person team was comprised of the hospital’s Chief of Nursing, their chaplain, Palliative Care Director, a nurse practitioner, a registered nurse, two social workers, and two chaplains. Their goal was to drive growth and improvement of their existing services, and the training was hosted by the PCLC at Mount Carmel Health System in Columbus, Ohio. Norton’s palliative care director explained their motivation for attending PCLC: “We want to expand the palliative care program throughout our health system and into all our other hospitals. We’ll have a better health system by providing better care. But first, we want to be the model program, the gold standard of palliative care within our hospital, before we branch out to the other hospitals in the system.”
The curriculum covered the essential skills necessary for a successful program in actionable terms. For example, during the “measurement module,” PCLC faculty member Lori Yosick told the team, “Tell your story. You need to prove what you do, all the time!” in order to be seen as a reliable and professional partner, and in order to be sure your palliative care team is actually delivering on the triple aim of better care, better quality, and lower costs. Until then, the team had not been recording any data for their service line. Although they believed they were doing great work, they had no way to quantify it—and their word alone was not enough to gain the support of their many key stakeholders.
For me, the most useful component of training was the time built in for discussion, exchange of ideas, and relationship building with PCLC faculty. For example, as part of the training a Mount Carmel social worker and PCLC faculty member escorted Norton’s palliative care social workers to their in-patient palliative care unit to demonstrate Mount Carmel’s palliative care psychosocial assessment process and the tool used to standardize it. That exchange introduced a new tool to the Norton team, alleviating the social workers’ concerns about capturing the “right” information for their measurement strategy. The visiting team also sat in on a clinical team meeting to see how it was structured and conducted to ensure inclusion of the interdisciplinary team voices and to come together to work on the most challenging problems facing patients and families. The sheer level of access to PCLC faculty who are also experienced palliative care clinicians in the actual clinical setting, and the ample opportunity for talking through concerns and questions, confirms that PCLC provides more than content knowledge and practical technical assistance. Because of the attention to relationship building and focus on the issues of greatest concern to the visiting team, PCLC is routinely described by participants as a “transformative” experience.
As PCLC faculty worked through the curriculum and visiting team members completed the stages of the training process, excitement stirred in the room. Their dialogue changed from reports of frustration and discouragement to clarity on next steps, awareness of the access to supports, and optimism about the likelihood of success. I witnessed an intense transformation in attitude, confidence, and direction.
I asked the PCLC faculty leader how these team changes are sustained over time. She described PCLC as a process, including the year-long period of mentorship from PCLC faculty. The benefits gained from sustained relationships, coaching, encouragement, and just-in-time guidance are keys to the success of the PCLC initiative.
At the close of the 15-hour onsite training, I saw the Norton team huddled at the end of the table, reviewing their action plan. I heard the PCLC faculty say “Ok, pull out your calendars; we need to schedule our first mentoring call one month out. We’ll discuss your progress on the work plan and troubleshoot together.” In unison, the team did just that. Preparing to leave, I recalled how less than 24 hours earlier I heard a Norton team member say “working on our palliative care service has been very challenging.” As I walked out the door, I smiled when I heard the team confidently speak about their plans to “restructure the program.”
The Palliative Care Leadership Centers (PCLC) initiative began in 2003 with generous support from the Robert Wood Johnson Foundation. To date, the PCLCs provide training, mentoring, and support to almost 1,200 teams, more than 80% of which went on to establish a successful and sustainable hospital palliative care program. In fact, more than 60% of all U.S. hospital palliative care teams were trained by one of the PCLCs.
The secret ingredient behind the success of this training model is the long-term mentoring and collegial relationships that develop between the visiting teams and the PCLC faculty. In addition to the hands-on, customized technical assistance, it is the relationships, moral support, coaching, and encouragement that gets new and developing teams over the hump. Creating something from nothing in the world of clinical medicine is hard work. The Palliative Care Leadership Centers are a proven strategy for the transformation of American medicine.
Learn more about PCLC training and see upcoming dates.