Building and Supporting Effective Palliative Care Teams
Strong team management can determine whether the palliative care program succeeds in its mission and operates within budget—and the first step is to build an effective palliative care team. In addition to meeting quality standards and providing interdisciplinary care, your staffing plan and team protocols must reflect your patient population, organizational culture, and financial environment.
Given that the specialty palliative care workforce is limited, hiring and retaining strong staff is critical. Use this toolkit to make decisions about team staffing, program operations, and healthy team functioning.
What’s in the Toolkit
Hiring and Onboarding
Hiring and onboarding methods to ensure strong team culture and clinical standardization.
A summary of the practical tips and strategies related to recruitment and retention from CAPC's workshop session.
Hire a stable, high-performing team. Center to Advance Palliative Care, 2018.
Watch this CAPC on-demand webinar, Improving Team Effectiveness: Hiring and Onboarding. Find more webinars at capc.org
Best practices for onboarding new staff to the palliative care team. Center to Advance Palliative Care, 2018.
Course catalog for CAPC's clinical training curriculum. All courses provide continuing education credits for physicians, nurses, social workers, and care managers from all specialties and are free for CAPC members.
Concise, practical, peer-reviewed, and evidence-based summaries on topics important to clinicians and trainees caring for seriously ill patients. Use Fast Facts to onboard staff and for ongoing team education.
Sample Job Descriptions
A catalog of palliative care position descriptions that can be modified for use with new hires.
Shared by Mount Carmel.
Shared by University of California San Francisco.
Shared by UVA Medical Center.
Shared by University of California San Francisco.
Shared by Fairview Health Services.
Shared by Mount Carmel.
Shared by University of California San Francisco.
Shared by Massachusetts General Hospital.
Shared by UVA Medical Center.
Shared by UVA Medical Center.
Shared by Mount Carmel.
Shared by University of California San Francisco.
Shared by Mount Carmel.
Day-to-Day Program Operations
Tools and strategies for managers to promote efficient teamwork, strong communication, and quality care.
Part of the Improving Team Effectiveness series, this session covers building and sustaining a stable, effective interdisciplinary team. Ask questions on topics such as hiring and onboarding, role clarity, team communication, and preventing burnout.
Best practices in efficient, effective IDT meetings.
Learn to effectively lead meetings that help patients and caregivers become aligned around the patient’s goals.
Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.
Recommendations for measures and approaches to evaluating palliative care services that enable growth and improvement.
Strategic planning for new or veteran programs, and a framework for identification of barriers to team efficiency and team health.
Sample clinical rounding tool. CAPC.
Interdisciplinary Team Roles
Clarifying team roles and responsibilities on the interdisciplinary team to ensure positive relationships and productivity.
Clarify team roles and responsibilities to ensure positive relationships and productivity.
Webinar presentation.
Ask questions about the role of the social worker on the palliative care team, including distinguishing the role from other disciplines on the team and navigating competing demands on palliative care social workers from the social work department.
Watch this CAPC on-demand webinar, Improving Team Effectiveness: A Virtual Case Conference on Building and Sustaining High Performing Teams.
A summary of tips and suggestions for integrating spiritual care on the palliative care team, from CAPC's virtual workshop.
Team Health and Resilience
Healthy palliative care teams are a product of strong leadership, clear roles and responsibilities, and attention to team well-being and dynamics. Use the resources below to assess and strengthen team wellness in support of staff retention and effectiveness.
In this on-demand webinar, Donna Stevens, MHA, and a panel of palliative care leaders will explore the benefits of consistent, honest feedback offered in different formats.
This session covers how conscious and unconscious reactions impact communication with patients and families, and offers techniques to improve self-awareness and personal resilience.
In this on-demand Master Clinician session, speakers describe three different outpatient palliative care models, and share strategies to maximize team productivity and collaboration in outpatient palliative care clinics.
This on-demand Master Clinician session will present and illustrate a systematic, case-based approach to managing expectations during times of uncertainty.
Ensure strong morale and healthy team functioning.
Watch this CAPC on-demand webinar, Improving Team Effectiveness: Team Health and Resilience. Find more webinars at capc.org
Monograph on processes that promote team health. Center to Advance Palliative Care, 2014.
CAPC case reviews of complex patient cases cover topics such as pain management, family dynamics, service partnerships, disease-specific care, spiritual care, and more.
Identify obstacles to team wellness and resources to support healthy functioning.
Watch this CAPC on-demand webinar, Improving Team Effectiveness: Team Communication. Find more webinars at capc.org.
Patient Identification and Trigger Tools
Ensuring that appropriate patients are systematically referred to palliative care.
Checklist of triggers for referral to a specialty palliative care team.
Presentation examining criteria for palliative care services.
Guidance on needs assessment, screening criteria selection, implementation planning, and evaluation.
Identifying patients with frailty who are at high risk for health care utilization and adverse outcomes.
Webinar on building assessment and trigger protocols into the EHR.
General palliative care referral criteria for children with serious illness, and for specific diseases including cancer and pulmonary, genetic, neurologic, metabolic, and other diagnoses.
Predicts risk of death within one year of hospitalization. Used by home-based palliative care programs to identify patients for enrollment.
Used to identify patients at high risk for readmission or death.
Online tool that predicts risk of death within one year of hospitalization, specific to patients aged 70+.
Working With Referrers
Whether your palliative care consults are triggered based on standard clinical criteria or depend upon individual referrers, collaboration is necessary. Use these tools to build, evaluate, and improve relationships with referrers.
Assess referral processes and referrer satisfaction.
Guidance for palliative care teams to build collaborative relationships with referrers.
Self-study tutorial on improving referrer relationships.
Faculty
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Diane E. Meier, MD, FACP, FAAHPM
Founder, Director Emerita and Strategic Medical Advisor, Center to Advance Palliative Care
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Andrew E. Esch, MD, MBA
Director, Palliative Care Program Development
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Tom Gualtieri-Reed, MBA
Partner
Spragens & Gualtieri-Reed -
Brynn Bowman, MPA
Chief Executive Officer, Center to Advance Palliative Care
