Providence Health & Services, Palliative Care Services, Connections Program
The community of Providence Health & Services, Connections Palliative Care program, is dedicated to the principles of social justice, as the department mission statement reads: “As people of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service,” (Providence Health & Services, 2013). The five Catholic sisters from Montreal,Canada found Providence in 1843. While the sisters tirelessly planned to build schools and hospitals that now resemble the largest healthcare organization in the state of Washington. The mission statement clearly reminds professionals across disciplines throughout the Connections Palliative Care team of Social Worker’s, Nurses, Primary Care Physician’s, and Physical therapist’s to deliver patient-care compassionately. The fundamental core values of Providence Health & Services, exemplifies the relationship between patient-care and the faith-based preserverance of Providence as an organization. The core values as Respect, Compassion, Justice, Excellence, and Stewardship. In summary, the primary message of Providence Health & Services remains true: “We as people of Providence Health & Services, deliever patient care to nurture the spiritual, physical and emotional well-being,” (Providence, 2013).
The Providence Health & Services, Connections Palliative Care Program of Oregon, strives to ensure patients receive quality comfort care. The primary organizational goals are driven by the national healthcare initiative the, Triple-aim (2010-20), which provides incentives for healthcare agencies to improve services that include: the patient experience, the inclusion of holistic medicine, and provide cost-effective treatment options (Oregon Health Network, 2013). The Connections Palliative Care program, according to director, Rob Luck: “The program assists families in identifying what needs to be done, what resources are available, and to begin the healing process,” (2014).
Kirst-Ashman and Hull Jr. (2012) connect a structural communication framework relative to the role of the Social Worker in the Connections program. The Connections Palliative Care Social worker, communicates with the patient and the family as a unified asset. Often, when identifying goals of care, family member’s decide and modify the most effective treatment option; for example, the author’s describe the goal attainment process as the patient and the family as the input, the intervention as the process, and the benefits to the patient and family as the product (pg. 147). First, the patient is met as they are; the social worker reflects the patients’ strengths, hopes, desires, and values. The primary purpose of the Connections Social worker is to facilitate, validate, and ease the treatment planning process. The conversations at the end-of-life are painful, and necessary to instill the values of dignity, respect, and improve the quality of life for the patient and the family. Currently, as a Palliative Care Intern, my primary role is to listen earnestly, validate strong emotions sincerely, and remain present despite persistent grief.
The Contingency Theory accurately outlines the assessment process for Medical Social Worker’s in the Connections program, primarily because both theory and practice demand flexibility to improve the quality of life for the patient and the family, as a clear direction for successful outcomes—the primary treatment goal in Palliative care is to alleviate pain and suffering. The contingency theory, (Hassenfeld, 2009) suggests that the patient, family, treatment team, and the comfort measures provided are directly interconnected as a benefit system to alleviate pain and suffering. In order for the Connections Palliative Care program to remain effective, there must be congruency between the services provided by the program, and the reality of the environment. The Connections Palliative Care program relies on the partnership between Home Health Services and Hospice to coordinate flexible, adaptive treatment option’s according to the self-determined needs of the patient and family. The Connections Social worker relies on the Primary Care Physician to provide a timely provider-release, and the patient care plan to draft a congruent assessment of the patients’ social supports, resources, treatment goals, and anticipated risks. The Connections Social worker applies the Contingency theory framework to acknowledge the relationship between the environment and the program as a complex strength that warrants on-going evaluation for the anticipated risks for treatment options and the likely benefits for the patient and the family.
The Connections Palliative Care program receives input from families of deceased patients by administering a comprehensive patient satisfaction survey. The survey requests the patient to rate their experiences from strongly disagree to strongly agree, while the patient is asked to rate the communication process in terms of clarity, listening, and assistance developing plans for the future. According to Rob Luck the director, “The purpose of the surveys is to monitor the areas for improvement and pinpoint how we are serving clients in relation to lessening the painful impacts of transitions.” Further, annually employees are invited to fill-out an employee satisfaction survey to develop strategic goals and employee incentives for the upcoming year. Lastly, the Connections Program works closely in the community to gauge available resources in the community for caregiver support and bereavement. On a larger scale, Providence Home-services is assessed every three-years by the Joint Commission, which ensures that Providence as an organization is meeting the federal requirements to receive the federally deemed healthcare status accompanied by benefits.
According to Ashman and Hull, Jr. (2012) the survival of social service agencies depends on the health of our financial and political economy on a local, national, and global scale. The common scenario agencies face while persevering through the harsh realities of capitalism, is remaining stuck between cost reduction while improving the value and efficacy of the service provided. Rob Luck, the director of the Connections program is hopeful while describing the relationship between the macro environment and the possible future impacts on the organization. Over the year’s he has seen substantial cost-reduction in healthcare services when patients are able to treat their illnesses in the home with the proper skilled care and coordination of medications. He directly sees a correlation between increasing access and utilization of in-home services with a decrease in emergency room visits and overnight hospital stays. Both ER visits and overnight hospital treatments account for the highest cost expenditures, he concludes. Similarly, from a legislative perspective, according to Oregon Health Authority (2012), Medicaid will receive an initial $1.9 billion in funding to support the development of coordinated care organizations that largely support the triple aim, and are comparative to the current ethical decision making model Providence uses to sustain In-home services.
The management style in the Connections Palliative Care program is best characterized by Ashman and Hull, Jr.’s (2012) idea of servant leadership, which calls for, “leaders should be attentive to the concerns of their followers and empathize with them; they should take care of them and nurture them (pg. 179). In supervision, we are reminded that we are called to do this work, that we have been given a gift in listening, that we are capable of reflecting awareness of ourselves and the patients best interest, and above all else we find growth in healing.
The possible barriers that prevent access to the Providence Connections Palliative Care program are: fear, family dysfunction, and past emotional abuse. The common barrier in accessing Palliative care and Hospice care services extends beyond organizational shortcomings, and personality clashes within the agency, instead the common barrier most patients experience is the fear of death. Often when patients and families are fearful of death, the common reaction is to pursue aggressive and expensive medical treatments. The Connections Palliative Care program strives to facilitate a consultation where the patient and family can embrace fear and begin to accept this reality as an opportunity to heal.
According to Jennifer Levi, LCSW the organizational structure is primarily collaborative and decentralized, although the administrative management such as: task delegation, salary/raises, paid-time off, and scheduling are primarily top-down decisions decided by supervisors of each department. Further, Jennifer mentioned the organizational structure within the Connections Program is dependent on a collaborative environment where team members are encouraged to grow and create new processes together. The collaboration Jennifer describes, resembles Ashman and Grafton (2012) concept termed, “multihelp,” (pg. 152). The premise of multihelp suggests communication between co-worker’s in each department is neither linear nor simple but instead an illustration of the varying personalities, life experiences, and biases that influence how the needs of the patient’s are articulated. The concept of multihelp supports the idea that Providence Health & Services, must assess personality differences, personal biases, and varying life experiences to ensure quality assurance for patient-centered care.
To conclude, according to Mary Ellen (Providence, 2013) the compliance manager of Home-Health services, staff influences policy decisions through an open invitation to participate in the Home-Health services policy committee. A manager and a supervisor represent each department while policies are reviewed every two years. While the employee safety committee and Community Board oversee the local ministries, monitoring quality outcomes and developing action plans.
The P.R.E.P.A.R.E model of Ashman & Hull, Jr. (2012), provide a point of reference for social work practice in an organizational context; for example, the model aims to identify the problem, operationalize strength’s, and apply the intervention process. According to Rob Luck, the director of Connections, the problem’s that must be addressed include duplication of services, and medication mismanagement. In the context of healthcare legislation, the Oregon Health Authority, in partnership with the State of Oregon, made a long-term Medicaid investment of $1.9 billion for the development of Coordinated Care Organization’s. Conversely, from a quality improvement perspective, medication mismanagement and duplication of services remains highly cost-ineffective. As an outpatient healthcare organization, we aim to identify relevant people of influence within the organization to develop a clear perspective of the target problem. First, we aim to directly involve service users by eliciting current and past patient’s feedback, and supplementing the information with the organizations’ perspective including: director’s, administrator’s, and direct-service employees. We further assess the potential financial costs in contrast to the yearly budget. We review the professional and personal risks by identifying our strength’s and weaknesses. My personal contributions are characteristic of the conserver, as I thrive in a structured and regulated environment. In conclusion, I implement the P.R.E.P.A.R.E model through examination and evaluation of the existing agency and procedural policies that aim to mitigate medication mismanagement and duplication of services.