By JULIE MINDA
Representatives of Providence St. Joseph Health organizations and other champions of palliative care gather at the Circle of Life Award ceremony in San Diego. Seated from left are Jennifer Kozakowski, executive director, Providence Institute for Human Caring; Yvonne Corbeil, director of program development and education, Providence Institute for Human Caring; Mary Kingston, chief executive, Providence Little Company of Mary Medical Center Torrance; Terri Warren, vice president, hospice and palliative care, Providence Senior and Community Services; and Marianne Ayala, manager of palliative care for Providence Little Company of Mary Medical Center Torrance. Standing from left are Tina Picchi, past executive director of the Supportive Care Coalition; Salve Bautista, nurse practitioner, TrinityCare Hospice; Michael Rodgers, CHA senior vice president of advocacy and public policy; Dr. Matthew Gonzales, associate medical director, Providence Institute for Human Caring; Dr. Glen Komatsu, chief medical officer, TrinityCare Hospice and Providence Southern California regional palliative care; Dr. Ira Byock, founder and chief medical officer, Providence Institute for Human Caring; Dr. Colin Scibetta, associate medical director, Providence Institute for Human Caring; Nusha Safabakhsh, director, quality and measurement, Providence Institute for Human Caring; Anne O'Halloran, Komatsu's administrative assistant; Dr. Melinda Estes, a member of the American Hospital Association board of trustees and president and chief executive of Saint Luke's Health System, Kansas City, Mo.; and Russell Kieffer, director of palliative care, TrinityCare Hospice.
A group of Providence St. Joseph Health organizations in Southern California has earned a top American Hospital Association award for implementing palliative care programming that considers the needs of patients across the care continuum — not just at the end of life.
In giving a Circle of Life Award to the trio of Providence St. Joseph organizations, AHA said in award materials that they had taken on an ambitious goal "to provide 'whole person care' to every patient, essentially embedding the principles of palliative care throughout" Providence St. Joseph's operations in Southern California.
The awardees — Providence TrinityCare Hospice, Providence Little Company of Mary Medical Center in Torrance, and the Providence Institute for Human Caring — received AHA's top recognition for palliative care providers at a July 28 ceremony in San Diego. CHA is one of the sponsors of the annual award.
TrinityCare Hospice provides inpatient and outpatient palliative care and hospice care to patients of the Providence Little Company of Mary Medical Center's two campuses. TrinityCare has been working with the three-year-old Providence Institute for Human Caring to develop and implement palliative care approaches and protocols for patients across all the hospital's settings, including primary, inpatient, outpatient, long-term and home care. At the heart of the work is a "whole-person" care model.
Under this model these Providence St. Joseph organizations have been:
- Training clinicians on how to have difficult conversations with families, including about the goals of care.
- Enabling clinicians to document in patients' electronic health records conversations about the goals of care and to note whether the patients have advance directives in place.
- Hosting advance directives drives for employees and patients.
- Providing patients and families with videos on such topics as feeding tubes and cardiopulmonary resuscitation.
- Providing all staff with access to courses on pain management and other palliative care topics.
- Encouraging storytelling among patients, family members and clinicians, as a way to connect these groups.
- Launching a "Get to Know Me" campaign, with the goal of helping patients express who they are and what their preferences are, to caregivers.
Palliative care team members discuss ways to help Marcus Bell, a patient with Providence Little Company of Mary Medical Center, to better manage his pain. From left, nurse Marianne Ayala, Dr. Yuichi Yanami and Dr. Glen Komatsu are palliative care experts connected with Providence St. Joseph Health. Also taking part in the visit are Marcus Bell's fiance Brilliant Johnson and his grandmother Vera Bell, who is at far right.
While TrinityCare's 197-member staff has been driving much of this work at Providence Little Company of Mary, the model relies on clinicians and staff outside of the palliative care team to embrace the work. According to the AHA award booklet, the staff has "significant allies among hospitalists, critical care specialists, surgeons, cardiologists, oncologists and others who are working together to add an element of the personal to all aspects of care."
The Institute for Human Caring has been piloting the whole-person care model at Little Company of Mary since 2015 and it plans to identify other Providence St. Joseph sites for a broader rollout.
The institute has put in place what it describes as robust quality-improvement measurements and success metrics for whole-person care.
In a press release on the Providence organizations' honor, AHA said that "by concentrating on the values, preferences and priorities of patients and their families, the (Providence) collaborative is able to use a data-driven and metrics-backed approach to ensure a clear patient voice is at the center of care."
AHA also said in the release that "Providence believes there is no reason to limit the tenets of palliative care to patients with life-threatening illnesses if others can also benefit from having a more highly personalized approach to their emotional, psychosocial and spiritual needs." The whole- person care approach prompts members of the health care team to ask about patients' spiritual beliefs, practices and needs. For instance, the Get to Know Me campaign encourages patients and their families to document patients' spiritual care preferences for their caregivers.
AHA also awarded a 2017 Circle of Life Award to Bluegrass Care Navigators in Lexington, Ky. Three other organizations received citations of honor.
Providence incorporates mindfulness into palliative care
Mindfulness — or the practice of maintaining a heightened state of awareness of one's thoughts, emotions or experiences — is central to Providence TrinityCare Hospice's approach to palliative care, said Dr. Glen Komatsu, chief medical officer of TrinityCare and chief medical officer of palliative care for Providence St. Joseph Health's Southern California region. He said TrinityCare staff applies mindfulness to their own work and encourages its use with their Providence colleagues, patients and families.
Regular team meetings of the TrinityCare pediatric hospice staff start with a ritual of mindfulness, which may include poetry and scripture readings, silent meditation and reflection.
Komatsu said, "The point of the reflection is to ground us in the present moment — to be mindful of the here and now. It's the 'anti-multitask.'"
He said research shows that mindfulness meditation changes the brain's anatomy and structure in a positive way, thickening areas of the brain that govern compassion and happiness while downregulating areas that govern the fight-or-flight response.
He said TrinityCare's staff has found "that making space for introspection and connectedness helps complement our human tool kit and our ability to better serve our patients, their families and ourselves."
Komatsu said the staff's understanding of the science behind mindful meditation, as well as their own extensive experience with it, convinces them of its value for those they serve, and so they encourage its practice among hospital colleagues, patients and family members. He said meditation has helped many patients and others to "deal with pain, in addition to the emotional, interpersonal, social and spiritual dimensions of the mind.
"We just know that if you allow it, mindfulness works," he said.
— JULIE MINDA
Posters help staff see patients as individuals
The Providence Institute for Human Caring has created fill-in-the-blank, 11-inch-by-17-inch "Get to Know Me" posters for use at Providence St. Joseph facilities. A patient — or his or her loved ones — write in things the patient is proud of, things they like to do, people who are important to them and movies they enjoy.
The posters can be displayed in the patient's room to give staff insight into the individual under their care.
Several Providence St. Joseph hospitals are providing the posters to patients in the ICU and those who are in the last stages of illness. Many of these patients might not be speaking for themselves.
Caregivers have used the posters to broach the topic of advanced care and to discuss goals of care. The posters also can prompt discussions about patients' spiritual care preferences.
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