Leading with Courage and Love 

A Strategy for Reclaiming the Bright Potential of Our Field 

Hospice and palliative care have demonstrated that much better care for seriously ill and dying people is both feasible and affordable, yet the transformative potential of our field remains unfulfilled. People living with life-threatening conditions and their families are still at risk of suffering from symptoms that are inadequately treated, feeling bewildered and overwhelmed, and depending on over-stretched healthcare providers. Access to and quality of hospice care are highly variable and inequitable.  Multiple media exposés and government reports that document fraud and abuse by unscrupulous hospice companies have damaged public confidence. Palliative care programs have proliferated unevenly and insufficiently to meet the needs of seriously ill Americans. Outdated accounting and faulty assumptions about the financial impact of palliative care continue to constrain our clinical capacity, workforce development, and program growth. Our field’s founding purpose and core values – and our remarkable successes – suggest a practical path forward. Dr. Byock offers a realistic strategy with 5 key elements for addressing the hard problems we face and realizing our field’s dual mission of providing the best care for ill and dying people, and helping society integrate illness, caregiving, dying, and grieving within a continuum of living fully. 

Learning Objectives 

At the completion of this session participants will be able to:  

1. Articulate the dual clinical and cultural mission of hospice and palliative care.  

• Describe origins of our field in the mid-20th century in response to widespread clinical deficiencies and pervasive social and cultural denial of death. 

2. Dispel the myth that palliative care services cost health systems more than they contribute to the systems’ financial bottom lines 

• Recognize ways in which shorter hospitalizations may simultaneously improve quality of care, clinical outcomes, while reducing costs. 

• Identify one or more measures of value (higher quality and/or diminished costs) associated with goal-of-care conversations and in-patient palliative care consultations. 

3. Overcome reticence within our field to call ourselves by our real names – Hospice and Palliative Care 

• Recognize that fear-based avoidance of terms including hospice, palliative care, and dying is self-inflicted and self-perpetuating.  

• Identify current disagreements and alternative ideas regarding what we call our specialty and how we explain what we do – and be prepared to discuss the “brand” our field is known by. 

• Identify what we do that constitutes our “brand”. Many clinical disciplines can competently care for seriously ill and dying people. As a specialty, hospice and palliative care is distinguished by going beyond consistently excellent care to support and accompany patients and their families, guiding them as needed and desired in growing individually and together through the end of life. We intentionally foster well-being. That is our authentic brand!  

4. Name 3 or more components of our field’s response to the current threats to our field:  

• Zero tolerance of fraud and abuse in hospice care – collegiality stops at criminality – our state and national organizations can set up and/or support “hot lines” for reporting suspected fraud and abuse in our industry. It is government agencies’ job to enforce the law, but we can assist in uncovering acts that harm vulnerable patients.  

• Standards: Publishing clinical and programmatic standards or best practice expectations for safe and effective hospice and palliative care. 

• Measures: Identifying metrics and measurement methodologies for evaluating programs and practices in comparison to our field’s published standards and best practices. 

• Quality-based Competition: Freeing the healthcare market to base competition on measured quality of hospice and palliative care, including patient and family experience. 

• Owning our brand: We deserve to be proud of our specialty and can honestly assert that we provide services to patients and families that are medically excellent and reliable for preventing and alleviating suffering, aligning treatments with personal goals, and fostering wellbeing.