From November 2002 through January 2003, consultants Lynn Hill Spragens, M.B.A., and James Block, M.D., worked with two academic palliative care centers that were struggling financially and helped the physician leaders establish business plans and stabilize the centers.

The consultants worked with physicians at the Massey Cancer Center at Virginia Commonwealth University in Richmond, Va., and the Lombardi Cancer Center at Georgetown University Hospital in Washington.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Targeted End-of-Life Projects Initiative.

Key Results:

• Project staff worked closely with physician leaders and other staff of the two palliative care centers to help them:
  • Better explain the use of and importance of the centers to the hospital.
  • Develop tools to measure their activity and track cost-savings or other contributions to the cancer center and/or hospital.
  • Take a leadership role in promoting the centers.
  
  Both centers are now stabilized, according to Spragens.

Lessons Learned: Based on her work, Spragens said that palliative care programs within cancer centers need the following characteristics to be effective and sustainable:

• Leaders need to be identified, developed and mentored to be effective advocates and managers as well as excellent clinicians. Physician leaders of palliative care programs are passionate and talented but often lack basic management and leadership skills.
• Leaders need to identify a palliative program's plans, services and goals at the start of a program and revisit them regularly rather than let them evolve in an informal manner.
• Palliative care directors should measure their activity in clinical, educational and research areas in order to learn where they are spending their time and then identify who should pay for that time.
• Palliative care programs should manage inpatient and outpatient care so that inpatient cost savings can help fund outpatient services.