I have been giving a lot of thought to hospice quality this week for two reasons: 1) I am still working on the Hospice Item Set: A Step by Step Implementation Guide (shameless plug, but we are nearly done!); and 2) I am still reeling from the horrific comments about negative hospice experiences in the comments section of the most recent Washington Post hospice diatribe. The resulting feeling is one of frustration and worry.
I am frustrated because the Hospice Quality Reporting Program (HQRP) which includes the Hospice Item Set (HIS), does not strike me as something that is actually going to do much (at least not yet) to improve the quality of hospice care - despite the significant time, effort and money it is going to cost hospices to implement it. And I am worried because there were very few positive comments about hospice to counter the negative ones posted as a result of the Washington Post article. This lack of positive testimonials correlates with my awareness of a subtle (actually, not so subtle) trend of shifting perceptions regarding the value of hospice and the quality of care it provides. Instead of being defensive or wringing our hands, we need to do something. I have been thinking about it a lot this week and I have an idea: Hospice Quality Made Simple.
First we need an acronym: HQMS works perfectly. Even though it is never likely to be sanctioned by the Centers for Medicare and Medicaid Services (CMS) or the National Quality Forum (NQF) or be a part of the HQRP, to have any hope of legitimacy, we need an acronym. Let's go with HQMS.
The beauty of HQMS is its simplicity. Any hospice can do it and it won't cost much or any money. Here is a step-by-step implementation guide to HQMS:
Close your eyes. Think about someone you love with all your heart who has a terminal illness. You are afraid because this beloved person has a really hard road ahead and you desperately want him or her to be comfortable, to be safe, to not be in pain. You are scared that you won't know what to do. How to help when things get worse. Stay with those feelings for a moment before moving to Step 2.
Keep your eyes closed. Think about the hospice you work for (or worked for, own, manage, know about, or whatever). Think about the people who work there. Think about the services offered. Is there continuous care? What about options for general inpatient care? How comprehensive is the care planning? Pain management? Nursing care? Spiritual care? Spend a few more moments thinking about everything you know about that hospice and then move to Step 3.
Open your eyes. Ask yourself this question: Can I say, without reservation or compromise, that I want the person I love with all my heart to be cared for by this hospice?
If the answer is yes, great, all is well. If the answer is no, you need to help the hospice fix whatever is causing the no answer.
Too simple? Maybe. Not scientific enough to qualify as anything close to a quality measure? Probably not. Wouldn't work with a hospice's QAPI program? Actually I think it could.
But you know what? I don't really care if it is too simple or not scientific enough or whether or not it works with a hospice's QAPI program. I think it gets to the heart of the matter. I remember back when I was a new hospice manager and needed to hire a chaplain for our program. My gut criteria when I was interviewing candidates was "would I want this person sitting at my bedside if I were dying?" That was more important than all the credentials in the world (and the chaplain I ended up hiring was fabulous). HQMS is based on the same principle: If we don't have hospices that we trust to take care of our precious loved ones, how can we hope, and why would we expect, that people in our communities will trust us anyway?
Posted by: Heather P. Wilson, Ph.D. CEO, Weatherbee Resources
PS We expect to have the new HIS implementation guide available in about two weeks. If you would like to be alerted to its publication and receive an order form, send an email to: firstname.lastname@example.org with "Interested in the manual" in the subject line.