This spring, Mountain Valley Hospice & Palliative Care became the first provider to achieve Accreditation Commission for Health Care’s newly launched Distinction in Palliative Care. For Denise Watson, MVHPC executive director, distinction has made a world of difference.
MVHPC, which has been ACHC-accredited for hospice since 2007, began providing palliative care services about five years ago. In late 2015, ACHC invited MVHPC to join a team – facilitated by Judi Lund Person of the National Hospice and Palliative Care Organization – that helped to develop ACHC’s Palliative Care Standards based on the National Consensus Project’s Clinical Practice Guidelines for Quality Palliative Care. In early 2017, MVHPC served as ACHC’s beta test site for those standards, undergoing a survey and ultimately earning the distinction. It was an experience that Watson says helped to make MVHPC’s palliative care program stronger and more structured, and that put the organization “a step above.”
ACHC followed up with Watson to learn more about MVHPC’s experience.
ACHC: Talk about your experience incorporating the ACHC standards into your practice.
DENISE WATSON: I put a team together with some of our top leadership and our medical director and our practitioners, and we started reviewing our (palliative care) policies and comparing what was lacking and where we did not meet the standards. We found we had a lot of work to do. So we went standard by standard to make sure that we had a policy. And we of course had to educate the practitioners and everybody that was a part of the program on what they had to do, because it was additional work, additional assessments. So it was a transition of changing a lot of the way we were doing things.
ACHC: What was an area in which you found your agency needed work?
DW: We didn’t really have any formal policies related to the interdisciplinary team. We were meeting once a month, roughly. We had to change the time and make it regular and really focus on that team care as opposed to just “here’s a referral; the nurse practitioner needs to see them.” So there was more structure and they had to follow certain policies and standards and processes that we were really very vague before.
ACHC: How did ACHC work with you to amend the standards based on your feedback?
DW: I really appreciate the fact that ACHC was open to listening to how the standards worked for us, per se, by changing policies and our processes. It was nice to know that we were part of making sure that we didn’t have overkill on the standards or maybe we didn’t have them strong enough. There was some movement there and flexibility that we could all come to an agreement, especially around the comprehensive assessment. Sometimes there’s a “one and done visit” and you never see (the patient) again, so we had to take that into account. Palliative Care, it’s different from hospice.
For example, with hospice there’s a comprehensive assessment for the nurse, chaplain, social worker. The issue is when our practitioners go out there to do the (palliative care) assessment, they have to ask questions about psychosocial; it’s all embedded in all these comprehensive assessments. What we elected to do is to have them ask a couple of simple questions. If they identify from those questions a need for spiritual or psychosocial assistance, then they make the referral to that discipline to do all those questions. What we were trying to do was limit the amount of detailed information a nurse practitioner or a physician had to get.
ACHC: Can you comment further on how does palliative differs from hospice?
DW: In Palliative Care, you’re focusing on a symptom, e.g. pain management. In hospice you’re focusing on all kinds of symptoms.
Hospice is much more intensive. You’re really supporting the entire family. We’ve tried to bring that into palliative care, but these patients are mobile. You may not have the family at the bedside. 60-70 percent of our patients in palliative care end up coming to hospice. You bring that interdisciplinary piece to it, but it’s not as involved. You’re focusing on that symptom, and you may find other stuff when you get in there, e.g. they need emotional support.
ACHC: How has MVHPC most benefitted from having achieved the Distinction in Palliative Care?
DW: We had tried, the entire time we were doing palliative care, to make our program structured. But we were lacking in structure and lacking in everybody knowing what they really should capture in a visit and then how they bring this back and share what they’re doing as a team, and then really talk as a team about goals of care.
It was fragmented, in my opinion, and this really brought structure to our program. And it made us do stuff that we had wanted to do, or had intended to do, forever. Our policies were very vague. It forced us to really put structure and meat to the program.
"I feel like our program is just much more structured. Everybody’s on the same page. It has been beneficial for us, for sure."
ACHC: What does acheiving the ACHC Distinction in Palliative Care mean to you?
DW: It means we have taken the extra step to ensure our program provides quality service. We are taking steps that we didn’t have to do to improve our program. I think it says that we are doing this for the right reasons. The ultimate goal is to provide the best care to these patients. It’s a sense that somebody’s looking over our shoulder. Somebody’s looked at our program. Somebody has said, “You’re doing what you’re supposed to be doing.” It sets us a step above.
Mountain Valley Hospice & Palliative Care provides hospice services to terminally ill patients and their families in 17 counties from eight locations in North Carolina and Southern Virginia. Denise Watson has served as executive director since 1999, and has worked for MVHPC since 1994.