Dr. Steven Radwany’s career has focused on education and program development. To name just a few successful initiatives, he has helped build a four-year medical school curriculum, a hospice program, four palliative care consult services, a palliative care clinic, two palliative care inpatient units, and home- and nursing home-based palliative care programs.
By Dr. Steven Radwany, IAHPC Board Member
We all face unique challenges in building palliative care programs to serve patients and families. Yet no matter the setting, the challenges and how to best address them have much in common.
The questions below derive from extensive personal experience, as well as that of colleagues around the world who have allowed me to visit their programs. Some successes and many setbacks form this bank of knowledge, producing an inventory that is intended to assist you as you grow your own programs.
These questions apply to a greater or lesser extent depending on your regional circumstances, and may not occur in sequence, but all offer some guidance in helping you to achieve your goals. Some may seem too obvious, but if overlooked could greatly hamper progress.
As a point of reference, in my own previous setting it required 15 years of sustained effort by our team to develop what became a mature and multifaceted program.
Do you have a clear vision of what your program should and could be? In order to start, you must articulate a vision that is both realistic and aspirational, and be able to communicate this vision to others, lay and professional alike, in just a few minutes. The vision must account for the important unmet needs among patients, families, and providers that you are hoping to address.
Have you identified mentors? For best results, seek at least one local mentor and one who works elsewhere. They don’t have to be palliative care leaders (at least locally) but they should be visionaries who have successfully grown and nurtured programs in health care or related areas. And your mentors should be clearly interested in you and invested in your growth as a leader.
Have you identified at least one senior management advocate in your region, health system, or hospital? Not to belabor the obvious, but without the support of someone who greatly influences your budget and resources, you will not succeed. Once you’ve identified this person, nurture your relationship with regular progress reports and, if possible, face-to-face meetings. It is critically important that you give them the opportunity to witness and truly feel the personal side of your work, its human impact, and its effect on those who are suffering.
Have you recruited interdisciplinary allies who come to share (and may even reshape) your vision? Nurses, physicians, social workers, lay health workers, volunteers, chaplains, psychologists, etc. will become essential parts of your palliative care teams, depending on their availability. It is essential to recruit, support, and — most importantly — learn from people outside of your own discipline. The work of palliative care will attract great people if you’re able to communicate your vision in the context of regional and local cultural norms.
A corollary question is: “Are you wasting too much time trying to convince people who will never understand the importance of your program?” Some folks will never get it, and they can become a black hole sapping your energy and efforts.
Have you incorporated research and built the capability to evaluate your team’s impact into the program? This may be easily overlooked when we are overwhelmed with the urgency of the clinical needs of our patients and their loved ones. But without data it will be extremely difficult for your program to improve and generate support, and nearly impossible to intelligently allocate scarce resources. You may need to seek outside help — such as local universities — for such expertise.
Have you identified potential “early wins,” opportunities to demonstrate the potential and impact of your program? Focus early efforts on achievable goals with demonstrable outcomes important to you and those to whom you report. A mantra for palliative care leaders of growing programs is: “Underpromise and overdeliver, but do not overextend.”
On the flip side, ask yourself: “Have team members received sufficient recognition for their efforts?”
Are you optimizing your resources? Again, our idealism and compassion may compel us to try to do more than our budget and personnel can sustain. We may need to make peace with the better angels of our nature and seek creative ways to expand the reach of our services within existing limits. Strategies such as local and regional partnerships, growing volunteer services, and collaborating with other clinical departments can begin to address unmet needs. Create a community leadership committee of laypersons and health care professionals to help marshal and steer these collaborations.
Have you learned from your setbacks? No matter how well you plan or how capable you are as a leader, you will face setbacks. Your ability to persevere and learn from these while sustaining your team will ultimately determine your success.
Have you identified leaders to succeed you and sustain the program? Planning succession can never start too early. Opportunities to recruit leaders often naturally follow from your activities as an educator, and recruiting leaders is one of your core responsibilities in palliative care. With each new person you draw into the palliative care team, you should be assessing them as future leaders. Nurture those with potential and give them opportunities to grow by assigning them projects or roles on important committees.
During 30 years of developing programs, my answers to many of these questions required me to significantly adjust our goals and my own methods. Nonetheless, our teams met with some success and have helped thousands of patients and families. I’m sure yours will, too.