It can be challenging for a large health care organization to fundamentally change to improve care, but the two winners of the 2017 Circle of Life Awards, which honor innovations in palliative and end-of-life care, are doing just that. In Kentucky, Bluegrass Care Navigators has transformed itself from a well-regarded hospice with a national reputation to an organization that goes well beyond the traditional definition of hospice, such as by creating a transitions program to reduce readmissions. And in California, Providence TrinityCare Hospice and TrinityKids Care, Providence Little Company of Mary Medical Center Torrance, and Providence Institute for Human Caring in Torrance are not only committing to providing “whole-person care” to every patient, they are also expanding the use of mindfulness techniques to help clinicians and caregivers cope with their sometimes draining work.
The Circle of Life Awards are supported by the California Health Care Foundation and Cambia Health Foundation and sponsored by the American Hospital Association, the Catholic Health Association, the National Hospice and Palliative Care Organization and the National Hospice Foundation. Co-sponsors are the American Academy of Hospice and Palliative Medicine, the Center to Advance Palliative Care, the Hospice and Palliative Nurses Association/Hospice and Palliative Credentialing Center/Hospice and Palliative Nurses Foundation, and the National Association of Social Workers.
For Providence TrinityCare Hospice and TrinityKids Care, Providence Little Company of Mary Medical Center Torrance, and Providence Institute for Human Caring, it hasn’t been enough to set up a comprehensive inpatient and outpatient palliative care program for both adults and children. The organization has taken on a much more ambitious goal: to provide “whole-person care” to every patient, essentially embedding the principles of palliative care throughout its system.
Glen Komatsu, M.D., chief medical officer for Providence’s TrinityCare Hospice, sees no reason to limit the values of palliative care to patients with life-threatening illnesses if others can benefit from having a more holistic approach to their needs. “All patients deserve the palliative care approach,” he says.
The approach is based on a model designed by Balfour Mount, M.D., and colleagues at McGill University in Montreal and modified by Komatsu and Ira Byock, M.D., who founded Providence’s Institute for Human Caring and serves as its chief medical officer. Providence started its Institute for Human Caring in 2014 when it decided to make a major commitment to person-centered care to help people make conscious choices about how they interact with the health care system, particularly when dealing with a chronic or life-limiting illness.
Specifically, that means making it routine to have an advance directive on the chart before a patient goes to surgery, even for a relatively minor procedure. Hospital employees insured by Providence can earn health savings account incentives to do their own advance care planning. “This helps change the culture so it becomes normal,” Byock says.
Mindfulness is helpful for clinicians to allow them to be present with their patients. Komatsu’s pediatric palliative care team opens every weekly meeting with a half hour of reflection and mindfulness, sometimes in conversation or writing to a prompt.
Margaret Servin, clinical supervisor for TrinityKids Care, says the Tuesday mindfulness exercises “have been hugely impactful for staff to have that time to really process feelings and take time to get in touch with what is going on for us. It helps us to manage how difficult the work is and acknowledge it and find the beauty in it.”
The whole-person care approach has been adopted as one of the organization’s six strategic pillars and is aligned with its existing hospice and palliative care programs, which are comprehensive. Providence TrinityCare Hospice maintains two adult hospice teams along with a dedicated pediatric hospice team that cares for 158 young patients on average. It also maintains both inpatient and outpatient palliative care based at Providence Little Company of Mary Medical Center Torrance, a 436-bed community medical center.
Both Komatsu and Byock see the concept of whole-person care as fundamentally transforming care at Providence, with the pilot at the Torrance hospital expanding to Providence’s whole 50-hospital, 825-clinic system. “Health care at its best is highly personal,” Byock says. “Personalized medicine is not just about your genome, it’s about who you are as a person, what matters most to you as a person. The best health care is never a one-size-fits-all model.”
Circle of Life Award Citations of Honor
LifeCourse, Allina Health, Minneapolis: A unique program that assigns trained laypeople as advocates for patients on care teams for the seriously ill.
Midland Care, Topeka, Kan.: A longtime hospice provides services across the continuum to seriously ill patients in a large, rural section of northeast Kansas, innovating with a Program of All-Inclusive Care for the Elderly that helps elderly patients stay at home.
University of Wisconsin Palliative Care, Madison: Academic medical center palliative care program specializes in helping clinicians better communicate with patients and families with research-based techniques.
The Circle of Life Awards honor programs that strive to provide effective, patient- and family-centered, timely, safe, efficient and equitable palliative and end-of-life care; show innovation in approaches to critical needs and serve as sustainable, replicable models for the field; demonstrate significant impact on people with life-limiting illness and those around them; and actively work with other health care organizations, educational and training programs, and the community. For complete criteria and other information, visit www.aha.org/circleoflife.