When considering entering the value-based contracting arena, hospices usually focus on the financial, workforce, and capacity challenges that this will bring on. However, just as impactful is the cultural readiness of an organization. If the staff, including both administrative and clinical employees, are not ready to embrace the transitions that possible service line diversification will bring, then the whole organization may be unsuccessful in taking on value-based care, no matter how ready the rest of the organization is.
When working with post-acute care providers as they manage this transition, I suggest that this matter be addressed openly and proactively. One way to do that is to ask the staff “What is our mission?”. While the standardized, public mission statement is vital, I suggest going under the surface a bit and asking staff about their personal mission surrounding the work that they do. If this is a hospice provider and the responses are “to provide hospice” or “to care for people when they are dying”, this may indicate that the specific service line of hospice is the core identity for staff, and they may be hesitant to provide the care to non-terminal patients that a comprehensive palliative care program could entail. If what is heard includes “to care for seriously ill people” or “to support families navigate chronic illness”, then they may be more ready to take on additional tools/models of care to accomplish this. There is no right or wrong answer – this is just a way to gage where the organization is on the path to care models other than traditional hospice.
Connecting with the current cultural readiness of the organization, and of the individuals within it, is vital to adjusting to the broader spectrum of services that value-based care can entail. Value-based care can allow clinicians to be more flexible in how they deliver care and can be very empowering, allowing them to make the most of their skill sets and access resources unavailable to them previously. However, if staff do not engage and invest in the new way of doing things, the whole organization may be set up to fail in the challenges before them. Though harder to quantify and plan around than other aspects of program development, investing in meaningful and proactive cultural change is fundamental.
“How Value-Based Care Could Change a Hospice Organization’s Culture” by Jim Parker, posted by Hospice News on August 3, 2023, and accessible at https://hospicenews.com/2023/08/03/how-value-based-care-could-change-a-hospice-organizations-culture