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Great Ideas...Team
  • 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)

  • 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

  • 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

  • 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

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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

  • 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

  • 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

  • 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

  • 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

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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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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,

  • 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

  • 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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©2011 Dale G. Larson, Ph.D.