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Unlike traditional industries, hospice & palliative care providers have organizational & operational structures that pose unique challenges to alignment.

While team members may be philosophically aligned around the idea of providing great personalized care to each patient, each team and team member can often find themselves so focused on their tasks and specific goals that they find themselves disconnected from other parts of the agency.puzzle pieces being put together on a desk

This disconnect can lead to a host of problems:  nurses over-promising what the DME team will do when they bring equipment into a patient’s home,  marketers not understanding why the admitting nurse rejected a potential patient from care,  not being aware until after the fact that a social worker removed a patient from a SNF and placed them at another SNF, clinicians grumbling that your marketers ‘have it easy’ because all they really do is bring people coffee and chat all day, and more.

Company wide alignment is too often an afterthought wish-list without recognizing that misalignment is a drain on efficiency and morale and turns issues into problems and problems into operational failures.


5 Tips to Improve Alignment Across Your Hospice & Palliative Agency

1. Visualize Quality

It’s not about getting on the same page, it’s about everyone moving in the same direction. At the heart of alignment is understanding.

All your staff will never and shouldn’t expect to totally understand the needs, concerns, and functions of every other team member in every discipline across the agency. The goal is not for everyone to understand everyone else’s positions completely and thoroughly. The goal is to get everyone pushing in the same direction.

Visualizations are a tool praised and used by leaders across professions, industries, and cultures. Creating visualizations are one of the best ways to make sure everyone understands all the services your agency provides and how everyone’s jobs fit together to create a great whole.

Get everyone in a room in front of a large whiteboard and make sure everyone understands how your agency operates.

Start with pre-referral and map out your agency’s operations all the way through the end of bereavement.

There are so many ways to create these visualizations and it works wonders as a group activity. Most importantly though, it will ensure that everyone understands each teams’ goals, which teams handle what and when, and also, what they don’t handle.

Visualizations like these are wonderful tools that can be kept and used for training and creating or adjusting workflows and expanded over time.

2. Know Where You Are and Know Where You’re Going

Transparency and honesty are only buzzwords if you don’t know how to put them into practice.

Often team members are so focused on their tasks and their individual goals that they lose sight of the bigger picture and where they fit into it.

A great way to keep everyone pushing in the same direction is to regularly share key operational metrics across the company. Issue a monthly or quarterly Agency Health Report.

Your agency health report should include key operational metrics such as:

– Daily census

– CAHPS survey results rankings for key CAHPS topics,

as well as other agency specific metrics that will provide an honest view of your agency’s operations. The health report should present month over month comparisons and target goals of where you as an agency want to be.

The report should be emailed out across the company and/or posted and updated regularly on internal communications boards. Producing an agency health report is a transparent and honest sharing of information that allows everyone to stay focused on their tasks, but also see how the company has been doing over time and what are the overall goals with a glance.

Bonus tip:  While the health report can be presented in detailed business intelligence dashboards with interactive charts of all types, we prefer a simple table of bars created in a spreadsheet. Remember, the goal isn’t a cool interactive dashboard, the goal is alignment with an at-a-glance understanding. 

3. Bottom Up Instead of Top Down Meetings

Typically meetings are called for by executives and managers to address high-level concerns and institute procedures & policies as operating directives. And often, those attending the meetings don’t know why they are there, what the point of issuing the directives in a meeting as opposed to an email, what’s the point of the directive in the first place, and if the whole thing isn’t just about meeting for meetings sake.

Try something different before your next meeting. Send a form out to those who would be attending the meeting. Lay out the high-level concern that the meeting will address and ask what other or related concerns/issues those team members want addressed. Build the meeting agenda around the team member responses.

Yes it means giving up some control of the meeting agenda and flow, but the point of the meeting is not about ego & control, and it’s often not even about or just about the underlying directive that will be presented. The true goal of meetings is to share information and increase alignment. Empowering team members who deal with the day to day operations to share their issues and create the meeting agenda will supercharge the meeting productivity and culture of alignment.

Bonus Tip: Make sure anyone working remotely who is attending the meeting electronically has their video on and can see and be seen.

4. IDG Your Agency

CMS, in the Medicare Benefits Handbook, describes IDG as: “The Interdisciplinary Group (IDG) is the team responsible for the holistic care of the hospice beneficiary.”

The point of IDG meetings is not simply perfunctory reviews of each patient by each discipline simply to check a regulatory box. The goal of IDG is to align these disparate disciplines so that all team members are working towards the same goal, as Medicare puts it, “the holistic care of the hospice beneficiary”. That sounds awfully like what we’re discussing here, getting disparate team members aligned for the holistic care of your hospice agency.

Two main agenda items to start with:

  1. Review frustrations & failures: What went wrong? What could have been done differently?
  2. Propose new initiatives, projects & workflows

Whereas even with the bottoms up meeting approach from the previous tip, the key agenda item is still initiated from the top down, these meetings do not flow from a high level executive or managers need to issue a directive, but is purely boots on the ground driven. The meeting should have a single admin/director/executive present and a single team member from each discipline, including the far flung reaches of your agency, billing, DME etc. These attendees should be team members, not the team leader of each discipline.

The single member of administration that attends should kickoff the meeting, but their job in this Agency IDG is to prompt others to talk, keep the meeting flowing & on track, take notes, and issue a summary report that will be sent out company wide.

These meetings should be held once a quarter, take no more than 30 min and the attendees, other than the admin participant, should change so that over time a variety of voices and perspectives will be heard.

Trust is one of the most important elements in team alignment. Creating the time & space for non-managerial team members to share situations and identify problems and solutions is an effective method for empowering employees while building trust.

5. Planned Integration 

Most companies arrange some sort of company/region/office wide meetings throughout the year. Your agency may bring in professional speakers, engage in role-playing or other team building exercise, and usually food is involved.

Having attended numerous versions of these events as both participant and speaker one point that stands out is how naturally type self organizes by type. You’ll look across the room and see most of the nurses seated in a cluster, the marketers in another cluster, aides, social services etc.

This involves a bit of prep work but quite simply, for your next gathering, arrange the seating.

If you have tables in a hall type setting, number each table and set seating cards with number, like you may find at a wedding. If chairs are in rows auditorium style, create a seating chart, hang it near the entryway, and place names on each chair.

Arrange seating so that each person is, at least on one side, seated next to someone in a different discipline.

The knowledge, communication, and connections that will arise from subtly creating an integrated environment will astound you.

Bonus Tip: Don’t announce who or why the seating has been arranged. Pointing out what you’re doing in an announcement explaining the seating arrangements will make the seating the focus and can mitigate the positive effects. 

Incorporating these tips will help keep your team on track and create efficiencies through greater understanding of how each role fits into the greater whole, improve communication across disciplines, and help build a culture of empowerment & alignment. Transforming transparency & alignment from buzzwords to action items is good for your team, your agency, and your patients.

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