外文翻译一个关于养老院和临终关怀医院的成功建立合作伙伴关系的案例Word下载.docx
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原文:
AModelforSuccessful
NursingHome–HospicePartnerships
SusanC.Miller,Ph.D.,M.B.A.
Abstract
Background:
Whilebenefitsofhospicecareinnursinghomeshavebeendocumented,interorganizationalchallengessuchasstaffconflictsregardingplannedcareortheirrespectiveroleshavealsobeendocumented.
Throughcasestudies,thisresearchaimedtocharacterizethepartnershipsofsuccessfulnursinghome–hospicecollaborators.
Methods:
Sixnursinghomesandhospiceswithself-identifiedsuccessfulcollaborationswerestudied.Interviewsofcareprovidersandchiefexecutiveandfinancialofficerscollectedinformationonpracticesrelatingtosevendomainsidentifiedascriticaltothecollaboration.Theorganizationalfactorsandactivitiesrelatingtoinfrastructuredevelopmentandcarecollaborationandprovisionmostcommonacrosssiteswereidentified.
Results:
Nursinghome–hospicecollaboratorswerephilosophicallyandotherwisealigned;
theyhadsimilarmissions,understoodtheirdifferingapproachestocare,andadministratorsdemonstratedanopennessandsupportforthecollaboration.Hospicesdevelopedinfrastructurestocorrespondtotheuniquenessandcomplexityofthenursinghomeenvironment.Forexample,theyhirednurseswithnursinghomebackgrounds,createdteamsdedicatedtonursinghomecare,andtrainedhospicestaffinproblemsolvingandconflictresolution.Carecollaborationprocessesfocusedontheimportanceoftwo-waycommunicationbyactivelysolicitingandsharinginformationwithnursinghomestaffandrespondingtonursinghomestaffandadministrators’concerns.
Conclusion:
Whilesuccessfulcollaboratorswereorganizationalaligned,hospiceleaders’acknowledgementthatpalliativecareprovisioninnursinghomesiscomplexanduniquewasimportanttosuccess.Accordingly,theprevalentpartnershipmodelwasaproductofstrategiceffortsbyleadersaimedatmatchingtheirstaffingtothenursinghomeenvironmentandpromotinggoodcommunicationandskillsneededforproblemsolving.
Introduction
Over25%ofAmericansdyingfromnotraumaticcausesspendthe‘‘finalchapter’’oftheirlivesinnursinghomes.1Increasingly,nursinghomeend-of-lifecareisprovidedtomorediverse,frail,andclinicallycomplexindividuals.Whileprovidinghigh-qualityend-of-lifecaretothesediverseindividualsischallengingfornursinghomes,thischallengeisintensifiedbythereimbursementandregulatoryenvironmentsinwhichU.S.nursinghomesoperate.Furthermore,thesecuringofpalliativecareexpertiseandsupportthroughpartnershipswithhospiceproviderscanaddtoexistingcomplexity,giventhechallengesknowntobeinherentwithinterorganizationalcollaborations.Perhapsbecauseofthis,22%ofU.S.nursinghomesin2004didnotpartnerwithhospices,andforthosethatdid,themagnitudeofhospiceusevariedwidelyacrossandwithinU.S.states.
In1982theU.S.CongresspassedlegislationallowingpaymentforhospicecaretoterminallyillMedicarebeneficiaries,andin1986thebenefitwasextendedtoterminallyillMedicarebeneficiariesresidinginnursinghomes.NursinghomescanofferMedicarehospicecarebydevelopingworkingrelationships(includingformalcontracts)withcertifiedMedicarehospiceproviders.Researchatteststohospice’spositiveimpactonthecareandoutcomesofnursinghomeresidentsenrolledinhospiceandsuggestshospicepresenceinnursinghomesresultsindiffusionofhospicephilosophyandpracticestothecareofresidentsdyingwithouthospice.
Whilehospicebenefitshavebeendocumented,interorganizationalcollaborationspresentchallengesthatcanaddtonursinghomeoperatingcosts(forexample,byincreasingmanagementtimeneededtoaddressconflicts)andarisefromfactorssuchaspoorlycoordinatedcareand=orstaffconflictsregardingplannedcare(e.g.,theuseofmorphine,other)andtheirrolesincareprovision.Additionally,regulatoryoversightpresentschallengessincesurveyorsmaycitenursinghomesfordeficienciesrelatedtohospiceapproachestocarethataredifferentfromwhatnursinghomeregulationsencourage(i.e.,palliativeapproachestocareversusrestorationorrehabilitation).Furthermore,selectedstateMedicaidnursinghomereimbursementpoliciesandpracticesappeartopresentnursinghomeswithfinancialincentivestonotpartnerwithhospices.Forexample,somestatesmanually(versuselectronically)reviewnursinghomeMedicaidclaimsforresidentsenrolledinhospiceandthisresultsinslowerpayments.
Sincesuccessfulnursinghome-hospicecollaborationshavethepotentialtoleadto‘‘partnershipsynergy’’whereprovidersanddyingresidentsandtheirfamiliesbenefitfromthedifferingcareexpertiseandculturesofnursinghomeandhospiceproviders,effortstofacilitatesuccessfulcollaborationsareimportant.Withthisinmind,theresearchreportedhereaimedtounderstandtheorganizationalfactors=resourcesandactivitiescommontosuccessfulnursinghome–hospicecollaborators.Togainthisunderstanding,giventhecomplexityofpalliativeandnursinghomecareandofinterorganizationalpartnerships,casestudieswereconducted.Thegoalofthisresearchwastodocumentanddisseminatethepracticesofsuccessfulrolemodels(i.e.,positivedeviates),whichproviderscouldthenemulatetoachievesimilarsuccesses.
Organizationfactorsandactivities
presentatstudysites
Organizationalfactors/resources.Bothnursinghomeandhospicechiefexecutiveofficers(CEOs)reportedtheirorganizationshadcommunity-focusedmissionsandtheyverbalizedsharedphilosophiesandgoalsofcare.Inparticular,nursinghomeCEOscitedtheirnursinghomes’recognitionoftheneedtosupportthespecialneedsofdyingnursinghomeresidentsandfamilies,andatbothsettings,staffspokeaboutthenursinghomeandhospicehavingacommongoal—thatofprovidingqualityend-of-lifeexperiencestoresidents=families.MosthospiceCEOshadmuchfamiliaritywithnursinghomecareandthechallengingregulatoryandreimbursementenvironmentsinwhichU.S.nursinghomesoperate,andseveralwereactivelyinvolvedwithnursinghomemembershiporganizations.
WhilecommitmenttothepartnershipwasvoicedbybothCEOs,thehospiceCEOappearedtobethedrivingforcebehindsuccess.Infact,twonursinghomesreportedtheircollaborationsimprovedsubstantiallywithachangeinhospiceleadership.
Theactivities—establishingtheinfrastructure.Hospicesplannedorganizationalandstaffinginfrastructurescapableofsupportingtheuniquenessofnursinghomesettings,suchasthehighprevalenceofdementia,theintenseregulatoryoversight,andthegenerallystressfulenvironments.Contributingtothisplanningandthushelpingtomoldthepartnership,nursinghomeCEOssharedtheirexpectationswithhospices.Forexample,oneCEOstatedshemadeitclearshewantedhospicetobeavailable24/7andeducationprovidedtoallshifts.
Thefourlargerstudyhospiceshaddedicatednursinghomecareteamswhowereconsistentlyassignedtothesamenursinghomes,promotingtheformationofstrongrelationships.Thetwosmallerhospices(inCaliforniaandNewJersey)withoutdedicatedteamsreportednosignificantnursinghome–hospicestaffissuesbutalsohadlong-standingnursinghomerelationships(20and14years,respectively).Criticaltohospice’sinfrastructurewasthe‘‘right’’hospicerecruitmentand/orassignment.Also,almostallnursesonthededicatednursinghometeamshadnursinghomeworkexperience.Severalnursescommentedhowtheirnursinghomebackgroundshelpedthemtoempathizewithnursinghomestaffandtogagethelevelofenvironmentalstressorsonanyparticularday,andthustomodifytheirbehavioraccordingly.Forexample,onehospicenurseexplainedhowonhigh-stressdaysshemodifiedwhenandhowsheapproachednursinghomestaff.
Thepresenceofliaisonsalsoappearedcriticaltosuccess.Forhospices,thenursinghomeliaisonpositionwasformalizedwithitbeingfull-timeatthelargerhospices.Innursinghomes,however,nursesupervisorsordirectorsofnursingoftenassumedtheliaisonduties.Hospiceliaisonsinteractedwiththeirnursinghomecounterpartsandraisedandrespondedtoconcerns,addressingproblemsnotresolvedatthestafflevel.Hospiceliaisonsreportedtheneedattimestoreassignanurseoraidewhowasnotagoodfitataparticularnursinghome.
Theactivities—processesrelatingtoimportantcollaborativedomains.Staffviewedhigh-qualitycommunicationascriticaltobothmanagingthecollaborationandtoprovidingwell-coordinatedcare.Infact,staffmostfrequentlycited‘‘communication’’atalllevelsasthemostimportantfactorforpartnershipsuccess.Anexampleofacommonconsistentcommunicationpracticewashospicestaff’sapproachtothenursinghomevisit—staff‘‘checkedin’’withdisciplinecounterpartsuponarrival,askedforinputontheresident/family’sconditionandneeds,and‘‘touchedbase’’afterthevisittoreportfindings/other.Importantly,processeswereinplacetoacknowledgenursinghomestaffandtoensurerespectwasconveyed.
Nursinghomestaffreportedone-on-oneinformaleducationprovidedbyhospicestaffwasmostimportantinadvancingtheirpalliativecareknowledge,butalsovaluedtheformaleducationprovidedbyhospices(onaverage,twotofourprogramsperyear).Mosthospicesprovidedtheirstaffwitheducationonrelationshipbuildingandonnursinghomesandtheirregulatoryenvironment.Hospicemedicaldirectorsattwohospiceswereparticularlyinvolvedinstaffeducationalefforts;
oneperformed‘‘rounds’’atnursinghomeswithnursinghomestaffinattendanceandanotherreportedempoweringhospicestaffbyhelping