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How do you achieve role clarification and avoid turf wars among all organizations in hospice palliative care ?

Health Care Professional – South East: 

The turf wars may have happened in the early days but it is now well know that everyone plays an important role in the care of palliative patients and their families. All providers work together as a team and I do not think there is any overlap or redundancy.

Helen Pyle – Lead Physician, Ian Anderson House, Oakville, ON: 

Our biggest challenge can be the Family Doctor of record who says that they want to care for the patient until the end. But they often are not comfortable with pain and symptom management and they do not want to be accessed urgently when a crisis develops. These are often our patients who end up going to ER because of pain. When you work as a team, as we have, you grow together and you learn to respect what each and every one of us brings to the table. We can all learn something new every day. We strive to support each other. I try personally to encourage the nurse to email or text me at any time even if it isn’t one of my patients. We mandated a long time ago to try to support our patients as best we can until the end.

Palliative Nurse Practitioner – Niagara North: 

Many hands make light work. It takes the whole community to make this work. There is no turf war because there is always plenty of work to go around.

We are very clear that the HPC team does not provide hands on care. We have worked very hard to develop relationships and the trust of the community nurses and palliative physicians. We work in partnership and help each other to be successful.

Cheryl Moore, Director, Stedman Hospice: 

I always say “does it matter who’s doing what when it’s all in the best interest of our patients and families?”

Denise Marshall – Chair of Ontario’s Collaborative Palliative Care Clinical Council: 

It’s important to acknowledge that turf wars will happen. It is a type of organizational linear thinking natural to a group of people. By anticipating this phenomenon you can see it starting, step back, and adjust thinking by vocalizing what is needed by everyone and making sure it gets done. When we do that, we find common ground and role clarification emerges.

Russell Goldman – Director, The Temmy Latner Center for Palliative Care:

To avoid turf wars, I worked really hard to build trusting relationships with the other providers in the region. Fortunately I’ve been working in the field for a number of years and know the front line workers. As such, we partner very closely with the visiting nurses, with the CCAC, the care coordinators, and we are really fortunate to be able to bring those front line relationships and that sort of credibility, forward to an administrative level. That trust with front line workers is imperative.

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