From The Chair
“Show me your palliative care business plan.”
“What does your business model look like?”
Has anyone ever asked you such questions? What was your response? Why can it sound so foreign to clinicians?
The idea that palliative care clinicians are generally versed in business models, understand financial spreadsheets, and can present a 10-minute executive brief that will win favor amid competing hospital, academic and operational priorities has always struck me as odd. Most of us come from critical care, oncology or other subspecialty backgrounds. Most of us do not hold MBA’s. We haven’t run private practices. We may have never prepared a budget for a large grant. Yet, I have experienced, and continue to hear from others, the challenge from hospital leadership that seems to become an impediment to the growth and development of mature and sustainable pediatric palliative care services. So what are we to do?
The availability of training through the recognized CAPC Palliative Care Leadership Centers in order to learn financial and operational basics, and to study successful, model programs should certainly be noted. Everyone confronted with the aforementioned needs should consider educating themselves and their team, and arrange a site-visit to one of the two CAPC-endorsed pediatric sites (Akron Children’s Hospital or Children’s Hospitals and Clinics of Minnesota). You may also be interested in visiting the CAPC website . CAPC even has a book for purchase entitled: A Guide to Building a Hospital-Based Palliative Care Program, a veritable “how-to manual” drawn from the experiences of others. And an audio-conference from Dr. Sarah Friebert in 2009 is also available, entitled “Making the Financial Case for Pediatric Palliative Care.”
A business model needs a conceptual basis before it can address a financial rationale. So, here I present one such model for your consideration:
Looking at this model, I think most of us meet resistance, or get “stuck”, at the point where we need to design mechanisms to capture value and identify gaps. Beyond that, it can be difficult to measure and report such value in a manner that also allows for growth and attending to new opportunities which could feed the cycle and move services forward. Sure, there are challenges in confirming and realizing revenue streams, but could these be better met if we captured and marketed our value? What is it that palliative care services bring to the client (hospital staff across units of service, patients and families)? How can we best measure, and best report, our value to leadership and operational staff to win favor and priority for both sustainability and growth? I’d like to challenge us all to put our minds to these models (please, design your own!) as we move forward in realizing enhanced palliative care services throughout the age spectrum and across care environments.
Many of us can feel gratified at how we have raised expectations for families and enhanced their experiences in extremely difficult circumstances. As we mature as a field and as individual programs, we need to respond to the challenges of a different balance in our approach. We have addressed many unmet needs in our institutions. But we must also become savvy in the skills that will guarantee ongoing success and justify our importance in the boardroom as well as at the bedside. I suspect many of us find ourselves facing this. The trick is to remind ourselves that it is not a distraction so much as a critical part of moving forward.
Brian Carter, MD, FAAP