With a grant from two foundations, one Lutheran and one Catholic, Gundersen Lutheran Medical Center and its Catholic counterpart, Franciscan Skemp Healthcare in La Crosse, WI, set up joint training sessions for priests and ministers to address end-of-life issues. In one-and-a-half day workshops, clergy were trained with healthcare professionals to provide advance directive education and to facilitate advance care planning. In a separate project, the health care coalition in La Crosse began to work with the La Crosse County Bar Association to offer end-of-life training around legal issues at its monthly meetings. As a result, Gundersen Lutheran now enjoys a collegial relationship with many of the lawyers who draft advance directives. The hospital often contacts lawyers whose clients may need to revisit or clarify advance directives.
In rural North Carolina, Albemarle Home Care, which spans twelve counties, is establishing a statewide demonstration through the state's office of rural health. The program would create a single point of entry for patients with life-limiting diseases. At September's annual meeting of North Carolina public health associations, end-of-life issues will be considered. Albemarle Home Care is also working to develop a North Carolina Collaborative to Improve End-of-Life Care, in conjunction with medical schools, healthcare organizations, and others throughout the state. According to Kay Cherry, "Whether or not the grant fails, we will still meet." In a presentation at the St. Louis National Congress, Cherry told participants that the keys to success are "persistence, passion and patience."
A similar effort is underway in Minneapolis, where three large healthcare systems have joined forces to propose the Minnesota Partnership to Improve End-of-Life Care. Allina Health Systems, Health Partners, and Fairview Systems have submitted a joint proposal to Robert Wood Johnson. Together, the three systems cover 85 percent of Minnesotans. Barry Baines, M.D., Associate Medical Director of Health Partners, says the groups share several attributes. "Minnesota has a history of collaboration on public health issues. Each of us views end-of-life as a societal issue," he said. "Each of us has a doctor or an executive who is a champion of better end-of-life care. There is no distinct competitive advantage to staking out turf in this area - and there is a comfort level among collaborators."
Baines acknowledges that at the corporate level, competition is stiff, but at the care level, collaboration is always encouraged. Allina's Ed Ratner, M.D., described some barriers to collaboration, among them the usual concerns about a desire for recognition, payment and cost issues, oversight and audit, governance of the collaborative, and the need to have a common focus for effort. For instance, he noted that the HMOs and healthcare networks have different priorities. However, the group's financial concerns have been lessened by relying on Minnesota's Area Agency on Aging to be the group's fiscal agent. The coalition's board of directors will include two representatives from each partner and the fiscal agent.
Fairview's Mary Lou Irvine, R.N., says that regardless of whether it receives a grant, the group will press for changes in end-of-life care. "We want to focus on public policy initiatives in the state, such as the new advanced care planning law. We hope to do some public education and outreach to the community."
Irvine says the strength of a collaborative is in the ability of partners to learn from one another - and she credits the IHI Breakthrough Series for having brought together Minnesota's key players in improving end-of-life care statewide.