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How to Establish a Palliative Care Program

Stages of Organizational Change

Organizational change can be conceptualized in 4 broad stages:

   1.  awareness
   2.  adoption
   3.  implementation
   4.  institutionalization

Each stage is important in the development, implementation and maintenance of a palliative care program.

Once the program has been institutionalized (stage 4), change continues within the program and the organization through an ongoing cyclic process of assessment and innovation.

Stage Components Operationalization
 1. Awareness
  • identify unmet needs
  • search for possible solutions
  • create tension for change
  • conduct needs assessment
  • brainstorm / research ways to meet needs
  • communicate needs to key leaders
 2. Adoption
  • decide upon a course of action
  • formulate policy/procedure for implementing change
  • allocate initial resources
 3. Implementation
  • resources allocated for implementation
  • carry out innovation
  • observe reaction of organization members
  • define roles
  • obtain resources to launch program (money, staffing, physical space, etc.)
  • begin palliative care practice and observe response.
  • market palliative care program.
  • form clear roles among program staff
 4. Institutionalization
  • integrate innovation into routine organization operations
  • internalize goals and values surrounding innovation
  • referrals to palliative care program become regular
  • policies and procedures guide care
  • palliative care throughout institution improves
  • evaluation leads to improved care

*Based on the Four-stage Model described in:
Glanz K, Lewis FM, Rimer BK. Health Behavior and Health Education: Theory, Research, and Practice, 2nd Edition. Jossey-Bass, October 1996.

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CAPCManual Attribution:  von Gunten CF, Ferris FD, Portenoy RK, Glajchen M, eds. CAPCManual: How to Establish A Palliative Care Program. New York, NY: Center to Advance Palliative Care, 2001.   © Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001

Permission to reproduce for non-commercial educational purposes with display of attribution and copyright is granted.
Last updated: February 20, 2002

Select section:
Change, Groups, Phase 1, 2, 3, 4

•  Change
      In Individuals
      In Organizations
         Stages of Change
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•  Small Group Structure / Function
      Group Formation
      Group Function
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•  Phase 1: Prepare to Plan
      Potential of Planning Process
         How Much is Enough?
         Ensuring Impact
      Form Initial Workgroup
      Elaborate Initial Idea
         Stakeholders, Customers
         Need, Purpose of Program
         Planning Questions
         Planning Steps, Timeline
         Resources Needed to Plan
            Use of Consultants
            Use of Retreats
      Write Planning Proposal
      Selling, Getting Approval
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•  Phase 2: Plan the Program
      Form Planning Workgroup
      Review, Revise Process
      Strategic Planning
         What is Strategic Planning?
            How Much is Enough?
         Review Stakeholders, Customers
         Conduct Needs Assessment
            Conduct SWOT Analysis
            Case Study - United Hospital Fund
         Define the Program
            Purpose, Values
            Mission, Vision
            Service Delivery Model
            Goals, Objectives
            Strategies, Tactics
            Strategic Decision Points
      Business Planning
         Case Examples:
            Cleveland Clinic
            University of Virginia
         Organizational Structure, Leadership
         Financial Plan
         Implementation Plan
            Human Resources
            Physical Resources
            Informational Resources
            Community Resources
         Marketing Plan
         Targets, Timing
      Write Proposal
         Suggested Proposal Outline
      Sell Plan
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•  Phase 3: Implement the Program
      Staff Recruitment
         Staff Training
         High Functioning Team
      Standards of Practice, Policies, Procedures
      Clinical Evaluation
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•  Phase 4: Review Program, Revise Plan
      Form Review Workgroup
      Program Evaluation
         Plan Evaluation
            Continuous Quality Improvement
         Utilization Review
            Appropriateness of Hospitalization
            Respond to Denials
      Revise Plan, Further Development
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