What piece of advice would you give to developing teams ?

Health Care Professional – South East: 

Start!!! Any form of palliative care that exceeds what is currently available can only improve the patient’s quality of life.

Helen Pyle – Lead Physician Ian Anderson House, Oakville, ON: In Palliative Care we are dealing with patients at their end of life. One day that will be a journey that each and every one of us will walk. Our goals of care are to make that journey as symptom free as we possibly can. We strive to provide a “safety net” of support around the patient and their family or caregivers so that they all know what may happen and how we will help them to deal with it. The network, the crisis management available from a team knowing what can be done and who to call to get it done is incredible. Don’t give up! It is so worth the aggravation! Stay committed.

Palliative Nurse Practitioner – Niagara North: 

Talk, talk and talk some more. Get boots on the ground and meet the others in the field. Make good notes, share them, and follow up when you say you will. Be clear to patients and families on who does what and when. Don’t dump issues, even if someone else dumped them on you, just get it done. Better to beg forgiveness than ask permission sometimes. Hear the message, not the words. Talk more.

Clinical Navigator – Niagara North: 

Communicate with each other. Document as much as possible. Don’t be afraid to ask questions.

Health Care Professional – Central LHIN:

Collaboration and partnerships. Have a high standard of practice based on accepted best practice standards. Provide ongoing educational opportunities for the HPC Team in order to stay current.

Cheryl Moore, Director, Stedman Hospice: 

When starting a palliative care team you have to look at your own community and see who’s there and where the interest lies. Look into which physician(s) in your community is doing end-of-life, palliative care, and then how can you support that family physician trying to do this work so that there isn’t one person doing it alone. That is how our team evolved over the last18 years. Start somewhere, don’t wait until the pieces of the puzzle fit together – don’t be afraid. I think you start and learn from your mistakes and then change and adapt. I often say as I sit around some of these tables – while we’re trying to sort out best practice and understand what an interdisciplinary team should look like -start somewhere, because this person is dying NOW and they won’t be here tomorrow. This is where some of my frustration in this work bubbles up; if we wait until all the stars are aligned we will miss helping all those people who die while we wait around. Has it been perfect? No, probably some of my most difficult cases have been our greatest learning opportunities.

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

I think when starting a palliative care team it’s good to have an idea of what the community feels it needs. You need a team in response to what? My advice is that if that is not already outlined, the answer to that question could form into your vision Something that percolates up from the ground in the community that you’re going to serve My advice is to answer the following questions: What kind of palliative care team is the community wanting? What is the community in need of? What are the kinds of conditions in the community for a palliative care team? From your answers you can form your vision and a sense of readiness in the community for a team to exist.

Health Care Professional: 

Once you’ve looked at the resources that you have to work with and you have the vision of how you want to work, I think that you need to provide education for all for your team members within your own discipline and also as a group. Think about how you are going to provide care from an interdisciplinary shared team perspective, and once you’ve got that base, make sure you have some experts that you can call on if you have questions; people who have nursing, or medicine, or psychosocial expert skills. ‘Phone a friend’ is something we use and I think is important for primary care palliative care teams who don’t do this every day. Then you just start and you gain experience and confidence by doing the work and working through and solving the problems. Make a path with the help of team support and tapping into some external consultants you can call as you need, and by working very closely with community groups like hospice volunteers, church volunteers, and neighbors. You will quickly gain confidence that you can actually do this work very well.

Health Care Professional: 

Remind family physicians that it’s part of their role to take care of their patients and their families from cradle to grave. The family physician already has a relationship with the patient and their family, and really it’s about enabling the physician to continue to do this work and to connect them to other teams or experts, whether it is in tertiary or secondary settings. To have this communication so that the family physician can do the best job that they know how to do for their patients.

Health Care Professional: 

Just do it. Following a needs assessment, we began to hire staff quite quickly. I remember somebody saying to me, how do you do orientation when you haven’t got a program in place, and I still don’t know how we did it; but we did. We were very selective about the people we hired and very fortunate. There were people that had experience and were passionate about palliative care and it has just worked. It’s a gradual evolution, you can’t do it all at once, you have to be patient and learn from your mistakes. It’s very “two steps back and three forward”, hopefully in a way that improves the program. As we’ve run into barriers we problem solve and try to bring it back to the team meetings and go forward one by one.

Health Care Professional: 

Just start! Certainly when we put our teams together we did a lot of planning, a lot of preparation, but there comes a time when we just get going because you’re never really ready enough, and you never really have all the answers. Start and work things out as you can and learn from other regions. There are a lot of regions who have very successfully implemented these teams. Learn from them and then adapt as necessary.