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Influence Requires Empathy

By Kevin E. O’Connor, CSP

ACPE faculty member Kevin E. O’Connor, CSP, will present focused sessions on Relationship Building and Change Management at the AAHPM Leadership Forum: Ascend program, September 14-16, 2014. AAHPM Ascend is a new intensive program included in the AAHPM’s comprehensive new Leadership Forum.

“The greatest problem in communication is the assumption that it has taken place.” – George Bernard Shaw, playwright

When we wish to influence, we need to know others in a special and unique way. Empathy requires accurate listening, but it also requires an ability to communicate your understanding.

Summarize what you think you heard and ask if you have accurately understood. This shows the participant and the rest of your audience that you take the feedback seriously and that you are open to their viewpoint.

Influence Means Action
You must take action on what others are unwilling or too fearful to consider at any given time. Influence is about having a vision and a plan that is so elegantly simple that others will have a “why didn’t I think of that?” experience.

In presentations, that can simply mean helping your listeners figure out how they feel about a new idea or perspective. Take a poll. Share visions. Brainstorm solutions.

Afterwards, pay attention to their verbal and nonverbal feedback. See where there is room for improvement, where there is an opportunity to smooth out sections or make areas more clear.

Influence Through Simplicity
Everyone always has at least two major concerns as they enter meetings or presentations: “What is this about and what does it have to do with me?” Answer those questions, and you will increase your influence.

  • Steer clear of surprises.
  • Use less jargon. Don’t create confusion by using less than clear language.
  • Avoid acronyms. State the words until you know your audience understands what the acronym letters stand for.
  • Use smart analogies that make sense, not worn out clichés that no longer connect with the listener.

Finish Strong
When you conclude a presentation, you need to reach inside other people and encourage them to be innovative and to try new things: “what would happen if we did this?” Always remain open enough to change your mind to welcome new ideas.

Why Focus on Goals When Coaching?

by William “Marty” Martin, PsyD MA MPH MS CHES

ACPE faculty member William “Marty” Martin will present a focused session on Coaching and Mentoring at the AAHPM Leadership Forum: Ascend program, September 14-16, 2014. AAHPM Ascend is a new intensive program included in the AAHPM’s comprehensive new Leadership Forum.

“A dream is just a dream. A goal is a dream with a plan and a deadline.” – Harvey Mackey

You cannot coach without goals. And goals without follow-up often results in dreaming, hoping and wishing. Coaching and goals together move you closer to achieving results. What are the results of coaching in palliative care/hospice settings? There are three levels of results: (1) individual; (2) group/team; and (3) organization. At the individual level, if physicians and other providers are meeting and exceeding performance expectations, then results are likely to be achieved. At the group/team level, if members of the team feel psychologically safe, experience support from each other, hold each other accountable, and meet or exceed expectations, then results are likely to be achieved. At the organizational level, if individuals can offer feedback to others, either in a supervisor: subordinate or peer: peer relationships, then results are likely to be achieved.

How do you set goals when you coach? A useful tool for setting coaching goals is the SMART tool. SMART goals are Specific, Measurable, Attainable, Relevant, and Time-Bound. As a coach, it is not your job to set SMART goals but to engage in a coaching conversation to enable the coachee to develop his/her own SMART goals. As a coach, you may want to ask questions about how the SMART goals were set and if they are formulated in a way to set the coachee up for success or failure. Part of your role as a coach is to guide the coachee to experience success and to constructively learn from failure. Resilience is desirable outcome arising from constructively learning from failure.

In closing, when you are coaching a peer or a subordinate or even yourself, remember that if you don’t have any goals, then you are not coaching. And remember that goal setting is not a vague, aspirational process but a deliberate process captured by the pneumonic SMART. The benchmark of success in coaching is the achievement of specific results.

Highlights of the September Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Relationship Between Symptom Burden, Distress and Sense of Dignity in Terminally Ill Cancer Patients
Karin Oechsle, Marie Carlotta Wais, Sigrun Vehling, Carsten Bokemeyer, and Anja Mehnert

Nurse and Physician Barriers to Spiritual Care Provision at the End of Life
Michael J. Balboni, Adam Sullivan, Andrea C. Enzinger, Zachary D. Epstein-Peterson, Yolanda D. Tseng, Christine Mitchell, Joshua Niska, Angelika Zollfrank, Tyler J. VanderWeele, and Tracy A. Balboni

Symptom Clusters in Patients With Advanced Cancer: A Systematic Review of Observational Studies
Skye Tian Dong, Phyllis N. Butow, Daniel S.J. Costa, Melanie R. Lovell, and Meera Agar

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM

The Coleman Palliative Medicine Education Program

Recognizing the importance of palliative care service and the shortage of trained palliative care providers, the Coleman Foundation of Chicago awarded a grant to the Chicagoland Palliative Medicine Physicians’ Collective to train medical and interdisciplinary providers at hospitals across the Chicago area.

The Mission
Improve the quality of palliative care services at hospitals in the Chicagoland area

Improve patients’ and families’ access to palliative care services

Build a supportive network of palliative care providers across Chicagoland

Coleman Palliative Medicine Fellows
20 existing fellows will become junior mentors

25 physicians, advanced practice nurses, social workers & chaplains will be accepted into cohort 2, 2015-2017

Faculty and Mentors
Interdisciplinary mentors from medicine, nursing, chaplaincy, and social work

Expert clinicians, educators and researchers in palliative care representing 10 10 leading academic medical centers, community-based hospitals, health care systems and hospices in the Chicagoland area

The Fellowship
A 2-year training designed for health care professionals consisting of bi-annual workshops focused on skill-building, one-on-one mentoring, direct observation, e-learning. Fellowship mentoring centers on creating, implementing and evaluating a sustainable practice improvement project.

To learn more about the program and how to apply please click on the following link to the program website http://colemanpalliative.uchicago.edu/

Applications are due November 1, 2014.

Sean O’Mahony MB BCh BAO, MS
Section Director Palliative Medicine
Medical Director Inpatient Services Horizon Hospice and Palliative Care Organization
Associate Professor, Department of Internal Medicine, Rush Medical College
Associate Professor, Department of Community, Systems
and Mental Health Nursing, Rush University College of Nursing

Stacie K Levine MD, FAAHPM Associate Professor Co-Director Palliative Medicine Fellowship Director, Hospice and Palliative Medicine University of Chicago Medicine

Food and the Dying Patient

I’m at the Intensive Board Review course in Boston and in the middle of a whirlwind of learning. Dr. Joseph Shega’s lecture on Dementia and feeding tubes provided excellent clinical evidence to support my article in yesterday’s New York Times Well Blog post, Food and the Dying Patient

By Jessica Nutik Zitter, MD

Highlights of the August Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Highlights of the August issue include all the papers from the
Special Section on Studies to Understand Delirium In Palliative Settings (SUNDIPS)

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM

How high to set the bar? Debates over TJC standards are healthy and familiar

The Joint Commission has proposed “enhancements” to the advanced certification requirements for palliative care programs and has requested comments by August 21, 2014 via online survey. A healthy debate about some of the new requirements is taking place on AAHPM listservs and social media platforms. I love seeing the passionate concerns about how best to define high quality palliative care programs. Some of the themes that have emerged remind me of debates at other points in our young history as field. I thought it might be useful to reflect on a few of the past points when the field had to draw a line in the sand and say “this is what good palliative care looks like.”

In the mid ‘80’s the initial hospice Conditions of Participation (COP) laid out in fine detail what was required to be a hospice that could get Medicare reimbursement. Some hospices passionately resisted Medicare certification, feeling that the rigidity in the COPs would negate the “hospice spirit.” But it is worth noting that those initial Conditions of Participation enshrined certain aspects of the “hospice spirit” that were revolutionary for health care at the time, notably the emphasis on interdisciplinary care planning, the requirement for meaningful volunteer participation, and the requirement for bereavement follow up for families.

In the early and mid 2000’s, we had a series of debates about standards for certification of physicians (lots of concern about whether requiring two years of experience was too high a bar for entrance for the old ABHPM exam – or not high enough), accreditation of fellowship programs (with actual raised voices – if I remember correctly – around the issues of how much time in a hospice rotation and how many home visits should be required for trainees), and articulation of the competencies for hospice and palliative medicine specialists.

All of these processes for setting standards shared a common challenge:
finding a balance between two competing goals. On the one hand is the goal for clearly stipulating each structure, process and outcome that effectively enhances the quality of patient care. On the other hand is the need to be parsimonious so that the requirements, including the reporting burden, are achievable and reasonable.

People arguing for a tougher standard usually claim its necessity for ensuring the quality of care, while people arguing for a lower standard usually point out how difficult (or impossible) the standard will be to meet for the “average” program. I remember during the debate about fellowship accreditation standards that one of our very wise leaders pointed out that a higher standard was actually a very useful tool that program leaders could use in the fight to get resources for a program. This fellowship director – whose program at the time did NOT have a hospice rotation – said that he had been fighting to get a hospice rotation but couldn’t get approval from various GME office higher ups. There were too many objections about sending trainees out of the institution, vetting the hospice faculty, etc. But if the accreditation requirements specified a hospice rotation – whether of one month or 6 months (the amount under debate at the time) – he would easily get his GME office on board. “If it’s required, they’ll do it.”

I think it would be useful to keep this in mind when thinking about some of the proposals for TJC standards that may be very difficult for current programs to meet. For instance, some argue that palliative care programs should be able to provide consults 24/7, not just during business hours. This is consistent with the National Consensus Project standards, but is not the current norm for most hospital-based palliative care programs. And it would be a VERY difficult standard for small programs to meet. N of 1 programs would find it virtually impossible, unless they got very creative and worked out call sharing arrangements with other services. Or argued with the hospital C-suite – backed up by stiff TJC requirements – that they HAVE to expand and hire more palliative care service staff.

The realities are that workforce shortages and financial limitations may make it very difficult for many programs to achieve a standards bar set at a high level. But the very fact of setting the bar so that it is a challenging goal to shoot for, and not just an easy ratification of existing practices, may help raise the level of the entire field. In the push-pull between the highest standards and easy achievability, there is some just right place in between. I think we would do well as a field to continue our history of setting the bar high enough for a challenge – and then working to make sure all programs can get there. The guiding question – would I want to be cared for in a program like this? – won’t steer us wrong.

I invite others to comment and share their perspective, including on the TJC’s proposed revisions.

Dale Lupu
Consultant, Quality Initiatives
American Academy of Hospice and Palliative Medicine

AAHPM participates in ABIM MOC discussions

On July 15, we had the opportunity to participate in a Summit convened by the American Board of Internal Medicine (ABIM) and attended by ABIM leaders and 26 societies representing both primary internal medicine and medicine subspecialties. The Summit was scheduled in response to the dissatisfaction with the ABIM Maintenance of Certification (MOC) program expressed by the greater internal medicine community. Stakeholders were provided the opportunity to share feedback from their constituents and discuss the MOC program. We presented the somewhat unique concerns of hospice and palliative medicine specialists:

  • Hospice and palliative medicine has 10 co-sponsoring boards with varying expectations for MOC making the creation and approval of MOC activities that are relevant to HPM practitioners a challenge.
  • At present, there is a lack of reciprocity between Boards for MOC activities.
  • There is additional strain created on our already limited workforce by the requirement to maintain primary board certification. This is particularly onerous for those who practice HPM full time, as the vast material tested on the primary exam may be irrelevant to their practice.

A brief word of context: Since Hospice and Palliative Medicine received formal recognition as a medical subspecialty by the American Board of Medical Specialties (ABMS) in 2006 and the American Osteopathic Association (AOA) in 2007, AAHPM has been meeting with and advocating for the needs of the Hospice and Palliative Medicine (HPM) community related to certification, maintenance of certification (MOC) osteopathic continuous certification (OCC), and fellowship programs.

The American Board of Internal Medicine (ABIM) has been evolving its MOC program and there has been a great deal of communication between the ABIM, ABIM specialties and subspecialties, and ABIM physicians in the last few months. On July 10, ABIM announced several changes to the MOC. ABIM stated that it will:

  • Increase flexibility on deadlines. ABIM’s Board agreed to create a year “grace period” for those who have attempted but failed to pass the MOC exam.
  • Ensure transparency of information. In response to questions raised about ABIM’s governance and finances, they have added information to their website and ABIM’s 990s are publicly available on Guidestar.
  • Ensure a broader range of CME options for medical knowledge/skills self-assessment (Part 2). To reduce redundancy and give physicians credit for relevant assessment activities in which they are already engaged, ABIM will align its knowledge assessment requirements and standards with already existing standards for certain types of CME products and providers.
  • Provide more feedback regarding test scores. The ABIM agreed to provide more in-depth, actionable feedback on individual performance on all exam score reports by 2015.
  • Evolve the “Patient Survey” requirement to a “Patient Voice” requirement. This requirement focuses on a variety of structured mechanisms to hear from patients. In addition to patient surveys, educational and training programs in patient communication, participation in patient/family advisory panels, and use of shared decision-making tools, activities which many of our members may already be doing, may also meet the patient voice requirement.
  • Reduce the data collection burden for the practice assessment requirement. ABIM is re-designing the process to provide additional pathways to meet the requirement and focus more on measurement and improvement activities.

In a letter dated July 28, 2014, ABIM summarized the major issues presented at the Summit and reiterated that the purpose of the ABIM is to “issue a publicly recognized credential that indicates an individual has met professionally-determined standards in a defined discipline”. Specifically, they agreed that the secure exam “must evolve” and they announced plans to form a committee to explore how to move forward. Formal mechanisms for society input will be developed. Addressing extremely negative feedback related to Part 4 (self-evaluation of practice assessment), the ABIM promised dramatic changes over the next 12-24 months.

We are encouraged to learn of ABIM’s proposed changes to its MOC program and will continue to work closely with the ABIM to improve the MOC program. We welcome your comments and concerns . Your feedback enables us to accurately represent the concerns of our members. Please share your thoughts with us via the AAHPM blog.

Tara Friedman, MD, FAAHPM, AAHPM Board Member
Holly Yang, MD, FACP, FAAHPM, AAHPM Board Member

Caring for the Human Spirit: Integrating Spiritual Care in Healthcare

The HealthCare Chaplaincy Network held its first major conference on spiritual care in health care this past spring. The attendees were very pleased with the results and encouraged us to hold the event yearly.

We are now in the planning stages of our 2015 Conference titled “Caring for the Human Spirit: Integrating Spiritual Care in Healthcare”. Our aim is bring together a multidisciplinary international group of presenters and attendees to explore and discuss the latest research, clinical practice, education and advocacy issues in the integration of spiritual care in healthcare.

The conference will be on April 20-22 in Orlando, FL. Plenary speakers include Christina Puchalski, Betty Ferrell, George Handzo, John Swinton, Lucy Selman, and Lilliana Delima.

In addition to the plenaries, we have added sixteen 90 minute workshop slots to allow for small group interaction and networking and a broader range of topics. We are currently seeking proposals for these workshops.

    Workshop proposals should include:

  • Title of workshop
  • Name(s) and credentials of the presenter(s)
  • Three learning objectives
  • An abstract of no more than 300 words describing:
  • The issue the workshop will address.
  • The relevance of this issue to the focus of the conference.
  • The content to be presented to address that issue.
  • The experience of the presenter(s) with this issue.
  • The learning modalities to be employed.

All workshops should be aimed at the advanced practitioner/researcher and should maximize dialogue with participants. Preference will be given to multidisciplinary teams.

Proposals should be e-mailed to Sandra Jamison (sjamison@healthcarechaplaincy.org) by August 15, 2014. Questions should also be addressed to Ms. Jamison.

AAHPM Leadership Forum: Ascend – Assess Your HPM Leadership Skills & Competencies

“All leaders are born, but exemplary leaders are made” (The Leadership Challenge®, A Wiley Brand)

Leadership is an observable set of skills and abilities that can be measured and learned. In fact, leadership development is really self-development.

AAHPM Leadership Forum: Ascend is an intensive two-day opportunity to explore leadership as it relates to relationship building, change management and coaching and mentoring. The model is highly interactive, because let’s face it – the complexity of the hospice and palliative care environment requires not only clinical expertise but also skilled communications in order to develop the care team in a way that ensures optimum patient experience. AAHPM Ascend is presented in partnership with the American College of Physician Executives (ACPE) and designed to equip emerging hospice and palliative physicians with effective leadership skills in their practice settings.

AAHPM Ascend brings nationally recognized ACPE faculty members Marty Martin and Kevin O’Connor, in addition to AAHPM Facilitators, who are hospice and palliative physicians. The facilitators will explore small group discussions around scenarios and topics that directly impact your work and role. In addition, a guided tour of the Leadership Practices Inventory® (LPI®) 360-degree Assessment will be provided by a certified LPI® coach to deepen the experience for attendees.

The Leadership Practices Inventory (LPI® 360) assesses five leadership domains, including:

  • Model the Way
  • Inspire a Shared Vision
  • Challenge the Process
  • Enable Others to Act
  • Encourage the Heart

Over 30 years ago, Santa Clara University Business School Professors Jim Kouzes and Barry Posner set out to discover exactly how ordinary people accomplish great things. In fact, they wrote the book that has stood the test of time to become the modern classic on leadership. More than 2 million people worldwide have read their BusinessWeek bestseller, The Leadership Challenge®

Effective leaders develop higher performing teams and foster renewed loyalty and commitment, as well as higher levels of engagement and focus to meet patient’s needs; provide opportunities for engagement, clinical expertise and a self-reflective approach to leadership; and inspire teams to exceed expectations through a self-reflective, self-renewing model.

So what is the LPI® 360 and how can it be an effective development tool? The Leadership Practices Inventory®, (LPI®) 360 is an evidence-based assessment tool. Assessing frequency of 30 leadership behaviors serve as a basis for a development plan. It’s a journey, and this assessment measures one point in time, based on 30 observable behaviors. The insights discovered through the LPI® 360 process and report fosters a proactive, development approach to increasing frequency of leadership skills in practice, in order to become more self-aware and more effective as a leader.

Registration is limited to 70 participants, so early register today – space is filling up fast!

Register Today for AAHPM Ascend