Guiding Change

Over the course of 18 months more than 120 palliative care providers, working in 15 community-based teams throughout Ontario, were interviewed. As a result of this intensive study — which detailed the trials and errors each of the participants faced — we discovered how best to build a successful palliative care model in the community.

The outcome, Re-Thinking Palliative Care in the Community: A Change Guide, details five definitive steps you can take, in your community, to ensure a better, more realistic path forward. One that can lead to an effective, sustainable palliative care program.

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A Tool to Help You Get Started Now

It is our hope that you’re inspired enough to take that all-important first step toward establishing palliative care in your community.

Based on all we’ve learned during our journey, we’ve created a workbook which is designed to get you started on yours. In it you’ll find activities and worksheets you can use for brainstorming and implementing the tools outlined in the Change Guide:

  • achieving the 7 commitments of palliative care
  • community assets assessment
  • reflection on PEP (people, entrepreneurialism and purpose)
  • evolution framework

Using these tools will help you:

  • formulate strategies to achieve the quality commitments for improved patient/family care
  • determine the existing strengths and limitations of your local community so you can build an effective team
  • reflect on the presence, or absence, of key components required to build a strong team
  • identify the key opportunities, challenges and appropriate outcomes measures — according to your team’s evolution stage

Key Learning

For Providers

  • The secret to success wasn’t about using the best tools and processes but, instead, ensuring the “PEP” was there to build a strong team:
  • People — an essential factor, so it is critically important to create and nurture trusting and respectful relationships
  • Entrepreneurial spirit — a must-have because of the need for flexibility and willingness to continuously monitor, refine and improve
  • Being Purposeful — collaboration is key — all stakeholders need to have a shared vision and sense of responsibility

Most important — don’t reinvent the wheel. The teams we interviewed, along with many others currently providing palliative care, have already done the ground work and overcome existing barriers. So learn from them.

For Policymakers

Standardization is possible without taking a cookie-cutter approach. Each of the teams studied were very different — in size, in the number of caseloads and their home base — yet the impact they made was significant; and every single one helped patients avoid emergency department visits and hospitalizations.

In the end we learned that focusing on patients and providing good care, rather than focusing on particular outcomes did, in fact, lead to good system-level outcomes. The research also revealed 7 universal quality commitments that not only focused on improving care for patients and families, they also had benefits for the system and providers.

A key lesson is to use outcomes that are appropriate to the stage teams are at in their development. All the teams we talked to went through a process of evolution, with clear and distinct milestones. Using measures aligned with each of these stages set them up for success!

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Proving It Works

In the landmark BMJ study we found:

  • There is strong evidence that providing palliative care in patients’ homes can help improve quality of life, manage complex systems and avoid unnecessary hospitalizations and emergency department visits.
  • No one team model works best. The most successful were built around local strengths and assets — so don’t compare or expect your model to replicate that of another region. Every region needs a unique team.
  • Where there was no deviation, was in the core services they provided — 24/7 availability, consistent staffing and broad admission criteria
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To best answer questions about how to build effective and sustainable community-based palliative care we turned to more than a dozen experts, the champions — the innovative nurses, doctors and administrators who have led the charge — those who have already implemented palliative care in communities, both large and small, across Ontario. We asked them:

  • how to achieve role clarification and avoid turf wars among varied hospice palliative care organizations
  • how to foster trust, mutual respect and the critically-important interdisciplinary relationships
  • how to move forward in the absence of new resources, buy-in from primary care physicians, overcoming system barriers and, simply, getting started
  • for advice they would give to new or developing teams

To view the answers to these important questions and more click here

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