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Experience Model IDT
The Experience Model is an interdisciplinary
team (IDT) approach which is patient/family need-driven regarding
end- of-life care issues. The IDT participates in the admission
visit together. The patient/family's response to the question, "What
do you need from your Hospice team today?" guides the direction
which the IDT takes on this visit and plans for future visits. The
IDT begins the assessment process on the initial visit. The
team disciplines who can meet the most urgent needs begin to
do so and others participate as feasible. Patient/families
understand the IDT as a unit advocating for them. They
only have to tell their story one time and action begins. The
IDT meets regularly during the week to clarify their patients'
needs, who can best meet them, and when. The required standards
of information, forms signed and advance directives,etc., are
met as the patient/family needs have begun to be met. Reassessment
and care planning are ongoing with the Experience Model IDT. Alliance
of Community Hospices & Palliative Care Services, Inc., Hospice
of Louisville, Louisville, KY (This Great Idea is also
listed in the Clinical section)
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Developing Teamwork
At our team meeting the last person who saw the patient is the person who conducts
the meeting and updates the care plan. This includes volunteers, aides, chaplains,
nurses, social workers. Union County Home Health Hospice, La Grande, Oregon
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Zippy Idea for the Hospice Team
At team meetings it might be better to reverse the "status" of team
members who present patients. For example, the volunteer speaks first, followed
by the HHA, then spiritual counselor, etc., ending with the RN. This may better
balance the "medically driven" aspect of hospice/team care. Benton
Hospice Service, Corvallis, Oregon
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Orange Sheet
At our weekly team meetings, we present new patients
and them work through one half of the team's caseload A through
L one week, M through Z the next- Bringing up changes and problems
for team discussion. We also pass around care plans on the patients
discussed that week so that nurses and social workers can document
to care plans during team meeting. We have a new care plan form
that helps us to simplify with boxes we can check for ongoing,
resolve, change, etc. Hospice at Greensboro, Greensboro, North
Carolina
Return to Great Ideas
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Morning Report
Our on-call staff and patient care staff
(nurses, HHA's, chaplains, SW's) meet each morning
for the report, along with the executive director and
part-time coordinator and admission nurse. This gives
the on-call nurse the chance to pass on what happened
last night. The admission nurse gives report on patients
admitted the day before, and everyone a chance to laugh,
talk, share, and for fellowship. Hospice of Lubbock,
Lubbock, Texas
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Social Services Work-Day Retreat
Agency endorses a one-half to three-quarter
day release time for all social service staff members.
Projects that require planning--issues that impact
the agency, but are the responsibility of the department,
etc.--are on the agenda, with a focus on things that
are specific, goal-oriented, but not overwhelming.
Outcomes have been: an integrated approach to projects,
new P/S assessment, and bereavement support groups.
This reinforces self-esteem of staff. Hospice of Galveston
Co., Texas City, Texas
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Get Acquainted
Our hospice has merged with a home hospice
and to get acquainted with the other group we are inviting
small groups for lunch and then letting them visit
with whatever discipline they work in. This allows
staff to get to know each other, to share stories,
and to know what outpatient and inpatient caring is
like. Whispering Pines Hospice, Jackson, Mississippi
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Bimonthly Meeting of Immediate Clinical
Supervisor With Clinical Staff
Clinical supervisor sets up brief one-on-one
meetings with Home Health Aides, RNs to provide feedback
to clinical staff and to allow staff to discuss concerns,
issues, and to self-evaluate. A great way to build
team and evaluate, discuss and resolve, and correct
issues rather than waiting until annual performance
reviews, or until a problem has grown or snowballed.
Hospice Services of California, Culver City, California
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Vision Quest: Metaphors for a Preferred
Future
For leadership/staff retreats: a) Name
all your fears about the next year (rocks in your path)
b) If you had ropes and a safety net, what would it
look like? What would the qualities and characteristics
of your program and colleagues need to be (e.g., humor,
compassion)? c) What specific skills do you individually
bring to the climb? d) Flip your fears into the opposite.
For each state I will... We will..... We are......
(e.g., from "I fear losing our ethics in the market-driven
health field" to "We have thoughtful ethical
processes for decision making and a commitment to doing
what is right." Share or write at table and then
share with big group. Group Health Cooperative of Puget
Sound, Seattle, Washington
Return to Great Ideas
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What's In a Name?
Frequently we are required to name what or who
we are; it is a form of identification. The hospice program
had the opportunity to branch out into other geographic areas.
This
required the development of a second team in the new geographic
area. Since the original team was called Team A, it seemed
natural to name the second team Team B. After much discussion,
the new
team was renamed Team 1 and everyone smiled. We have found
that the Team A, Team 1 titles work better than Team A and
Team B,
or Team 1 and Team 2 because no one wants to be on a "B" team
or a number "2" team. ITS Hospice, Omaha, Nebraska
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Rotating Team Leadership
A new way to run team conference. In the past,
it was always done (lead) by the nsg director or manager. We
had many complaints from other disciplines so: sw,chaplains,
etc. took turns (1 month at a time) running the conference.
This made everyone feel "important" and gave them
a sense of how difficult it can be to control their peers and
give everyone
equal time. Anonymous
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Team Nursing
Pairing of RN/LPN; carry larger caseload; RN is
mentor to LPN; shared caseload: each is familiar with patients,
so if one is ill or on vacation, the patient has someone available
who is familiar with them; RN visits each patient at least once
every other week; allows flexibility in schedule: if RN has emergency
or admission, it is possible to shift more stable patient visits
to LPN that day. LPN often does personal care visits especially
on more seriously ill patients. Barr Hospice and Palliative Care,
Kansas City, Missouri
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Worship Leaders' Luncheon
Our volunteer coordinator started an annual
Worship Leaders' Luncheon to honor the contributions of all
who contribute
to the spiritual well-being of those in our community. It also
serves to give special recognition to a few chosen "leaders" who
embody hospice principles, increases awareness of hospice care,
and builds new relationships. Hospice chooses three people to
receive awards of appreciation based on specific contributions
in supporting the terminally ill and bereaved. Invitations are
mailed to all community clergy. Volunteers/staff are asked to
extend a personal invitation to their own clergy. This is a great
chance for volunteers/staff to share two meaningful aspects of
their lives. We try to keep the focus of the luncheon on the "thank
you" rather than self-promotion of our hospice services.
Hospice of Anchorage, Anchorage, Alaska
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How We Enhance Interdisciplinary Character of
our Team
To develop and maintain the interdisciplinary
character of our team we use several approaches 1) whenever a
new team member starts, time is allotted for members to share
something about themselves as well as the new member 2) periodically
the self-determined seating arrangement is deliberately disrupted
and discussion about interdisciplinary activities held. This
has resulted in increased participation, especially by the aides.
Community Health and Hospice, Laconia, New Hampshire
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Call Teams
Several months ago we divided hospice staff into
3 calls teams of 4 staff each (3 nurses, 1 social worker) to
take call evenings and weekends. We have 2 nurses and 1 SW on
call working together to better serve our patients. It is the
first time our SW
have been on call and is working well. Rice Hospice, Willmar, Minnesota
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Ways We Reduce Team Burnout
1) Case closure = we discuss every case and the
death of the patient, usually within 1- 2 weeks. We minimally
include the primary nurse, the nurse attending the death, involved
volunteers and involved clergy, and social worker. Staff's personal
grief
issues discussed. 2) Debriefing- once a month the entire team meets with an
outside facilitator to discuss team issues of grief/coping. 3) Every 3 months
we have an outside clergy facilitate a spiritual debriefing for the entire
team. Staff spiritual issues are addressed. St. Luke's Hospice, Cedar Rapids,
Iowa
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Goal Setting/Dream Day for Staff
First we pick a theme: then one entire day, each
year devoted to 1-, 3-, 5- and 10-year goal setting and dreaming;
We break into teams; after we play a game (to tap the creative
side of the brain) and teams come up with 1-year dreams. Then
they have
to think of a creative way to present to the group (rap song, poem, story,
play, etc.). These are posted on the wall. We then play another game; groups
and 3-year goals and dreams, etc. At the end of the day, all employees makes
statements of how they personally will contribute to meeting the goals/dreams.
Has worked very well. South Wind Hospice, Pratt, Kansas
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Medical Director Runs Team Meetings
Asked medical director to run team meeting. S/he
addresses comfort, spiritual, emotional issues in an efficient
manner. Team tends to abbreviate their report. Keeps medical
director interested and involved. Heart of America Hospice, Kansas
City,
Missouri
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Mission and Value Statements
Using a storyboard technique, our interdisciplinary
teams wrote mission and value statements. They then chose a color
to print these on, representing their team (e.g., purple = passion,
blue = healing). These are posted. It's a great team building
activity and helpful when one needs a boost. Hospice of Northern
Virginia, Falls Church, Virginia
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Role Exchange
We orient new employees to all the different
departments of hospice. They stay in the department the entire
day or half day.Thcursoris get s them acquainted with the working
procedures of different departments so they have a thorough
understanding
of the entire operation. Hospice of Palm Beach County, West Palm Beach, Florida
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Memory Scrapbook
Our hospice looked for a way to remember the
stories about our patients that unfolded during our journeys
with them. We started a Memory Scrapbook: On colored index
cards any member off the IDT would write out what they had
learned from the patient/family, stories, poems, or memories
shared. The book was a source of inspiration for the team
members. Example: One family which had spent the patient's
final hours
with the nurse during a rainstorm. Following the death, they
said "There must be a rainbow outside for Mom." As
the nurse and family stood on the porch a beautiful rainbow
appeared. Amicare Hospice Services, Farmington Hills, Michigan
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