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World Hospice and Palliative Care Day


October 7, 2006, is World Hospice and Palliative Care Day. This day is dedicated to raising the visibility of palliative care within the global community and to providing opportunities to support hospice and palliative care in the form of a unified day of action.

According to official organizers, the event’s theme is “Access to care for all—highlighting the fact that everyone has a right to high-quality end-of-life care, but that more needs to be done to enable everyone to access it.” In creating World Hospice and Palliative Care Day 2006, the event’s organizers aim to raise awareness and understanding of the needs of those living with a terminal diagnosis, as well as the needs of their families. Other goals include calling attention to the need for increasing hospice and palliative care availability throughout the world and raising funds to be used in supporting these services.

Like the first World Hospice and Palliative Care Day, held in 2005, this event will be carried out in conjunction with Voices for Hospices, a global music effort that supports concerts held around the world to raise awareness of this important topic. The Voices for Hospices group is one of many supporters of this cause.

It’s not about “helping someone die,” but instead about helping someone to live as comfortably as possible with their illness. It’s about seeing them as a living person, not a dying patient. It’s supporting those closest to them and adding life to days, whether or not days can be added to lives.

—World Hospice and Palliative Care Day 2006 Web site, Key Messages, page 1.

More than 1,000 events took place on World Hospice and Palliative Care Day 2005, and 74 countries supported the activities. Included in the 2005 event were a cycle rally in Nepal; art exhibitions in Australia, Hong Kong, and Austria; and palliative care conferences in Lithuania and Belarus. In addition, thousands of people from around the world signed a global petition calling for better quality care for people afflicted by terminal illness.

Hospitalists are asked frequently to lead and participate in initiatives meant to improve the identification and treatment of patients and families in need of palliative care. It is common knowledge that traditional medical training tends to focus on the efforts that must be made to cure and prevent illness. There are times when the first priority must be to look for a cure at all costs; however, it must be acknowledged that there are also times when the treatment of a patient’s symptoms should be looked upon as just as important. Conventional medical training frequently does not provide the tools needed to offer the best care for patients and their families when the latter goal becomes the higher priority.

This is why support of initiatives like World Hospice and Palliative Care Day can offer such value to the global community. Events like this one promote awareness of an important topic. For information and ideas on how to get involved in this or in future events, please consult Access the Web site’s “Get Involved” page for ideas on how to offer support. Suggested activities include campaigning, creating links and partnerships, and producing materials that will raise awareness.

On the “PR & Press” page of the Web site, in the “Key Messages 2006” section, the following question was posed: “What kinds of issues in general terms does World Hospice and Palliative Care Day hope to raise awareness of year on year?” One of the well-stated answers: “First and foremost we hope the Day helps to increase understanding of hospice and palliative care and how it supports those facing the end of life … . It’s not about ‘helping someone die’ but instead about helping someone to live as comfortably as possible with their illness. It’s about seeing them as [a] living person, not a dying patient. It’s supporting those closest to them and adding life to days, whether or not days can be added to lives.”


Your Legislative Advisor Speaks Out

By Laura L. Allendorf

Advocating for our members while promoting the value of hospital medicine to legislators and policymakers is an important priority for SHM. As SHM’s senior advisor for Advocacy and Government Affairs, I am responsible for monitoring federal legislation and regulations affecting hospital medicine and recommending appropriate action by SHM. In effect, I am your eyes and ears in our nation’s capital, where more than 34,000 of my fellow lobbyists live and work. Given the fast-paced and often unpredictable nature of legislative affairs, my job is never dull!

The opportunity to represent SHM in Washington, D.C., has been very rewarding. I am fortunate to work with SHM’s Public Policy Committee (PPC), an enthusiastic and hardworking group of 16 hospitalists committed to expanding SHM’s ability to influence healthcare policy in Washington. Under the able leadership of Eric Siegal, MD, from Madison, Wis., the PPC spends countless hours working on your behalf, providing me with valuable clinical insight and guidance on how proposed legislation and regulations would affect hospitalists and their patients, and crafting recommendations to the SHM board on an appropriate response.

In Washington, SHM works both independently and through coalitions with like-minded organizations in pursuit of its policy objectives. We analyze legislation and send letters to Capitol Hill in support of particular bills that are consistent with SHM’s guiding principles. For example, we recently wrote to sponsors of the “Health Partnership Act” (S. 2772) in support of their legislation, which aims to expand health insurance coverage for all Americans by making grants available to state and local governments so they can test various options for improving access.

On the regulatory side, the PPC reviews proposed regulations and coding changes affecting hospitalists. These are brought to our attention by our members, after which we provide input to the Centers for Medicare and Medicaid Services (CMS). Together with SHM’s Performance and Standards Task Force, we are analyzing CMS’ Physician Voluntary Reporting Program, launched in January 2006 and widely viewed as the foundation for a future physician quality reporting program; at the same time, we are educating SHM members about its implications for hospital medicine and providing feedback to CMS on how the program could be expanded to better reflect the services provided by hospitalists. Congress and CMS want to develop a system that ensures appropriate payments for providers while also promoting the highest quality of care, a goal shared by SHM.

We also ally ourselves with a variety of partners in coalitions, depending on the issue. We worked very closely with the American College of Physicians, for example, in support of proposed changes to work relative value units that should result in significant payment increases for hospitalists next year. We have joined with other physician groups, including the AMA, to block the projected cut in the Medicare physician update of 4.6% that will take place in 2007 unless Congress acts, and with the American Hospital Association on issues of mutual interest. Through the Friends of the Agency for Healthcare Research and Quality (AHRQ) coalition, SHM has advocated for increased funding for the AHRQ, the lead federal agency charged with supporting research designed to improve the quality of healthcare in this country.

I have always felt that politically active members are an organization’s best resource when it comes to influencing healthcare policy on Capitol Hill. It is not enough for me, as your Washington representative, to communicate SHM’s positions to members of Congress and their staffs. Lawmakers need to hear from their hospitalist constituents—by phone, by mail, or during a personal visit—concerning why they should take the actions we request. It is time well spent. The personal relationships you develop with your legislators can help influence how decisions on healthcare issues are made.

Recognizing that grassroots involvement by SHM members is critical to the organization’s success on Capitol Hill, PPC organized SHM’s first-ever Legislative Advocacy Day on May 3, in conjunction with the annual meeting. Armed with fact sheets describing hospital medicine and our positions on issues pending before Congress, 72 hospitalists representing 29 states met with their lawmakers and staff and began to develop what we hope will be long-term relationships with those congressional offices. More than 130 appointments were scheduled—many with members of Congress who sit on key health committees with jurisdiction over Medicare, as well as with those who sit on committees responsible for determining funding levels for the National Institutes of Health, the CDC, and the AHRQ.

The consensus from those who participated: Advocacy Day was a valuable opportunity to personally educate lawmakers about hospital medicine and about SHM’s proposals to improve the quality of care in our nation’s hospitals. The PPC hopes to keep the momentum and enthusiasm from Advocacy Day going and is exploring other ways to expand SHM’s grassroots capabilities.

We strive to keep you informed about our legislative and regulatory activities through monthly updates posted to the Advocacy and Policy section of the SHM Web site, the “Public Policy” department in The Hospitalist, and items in SHM’s E-newsletter. SHM’s letters to Congress and CMS are located on the SHM Web site as well. Depending on the issue, you might also receive an e-mail urging you to take action with CMS or Congress.

As SHM continues to expand its presence in Washington, we will call on you to help us get our message across in the halls of Congress and before the regulatory agencies. Your participation in the political process is integral to our ability to shape healthcare policy in Washington. In the words of former congresswoman Barbara Jordan: “The stakes are too high for government to be a spectator sport.”

The PPC and I appreciate your feedback. You may reach me at [email protected]. Check back with us next month when you will hear from Tina Budnitz, MPH, SHM’s senior advisor for Quality Initiatives.

Allendorf is SHM’s senior advisor for Advocacy and Government Affairs.

Smart Tools for QI Initiatives

SHM’s Quality Improvement Resource Rooms support hospitalists as QI leaders

The role and recognition of the hospitalist has evolved tremendously in the past 10 years, and hospitalists continue to be called upon to lead at their institutions, particularly in quality improvement initiatives. Based on their unique role within the hospital system (a job that requires interaction with many levels of hospital staff) hospitalists are clearly positioned to lead such efforts. As part of SHM’s dedication to promote the highest quality of care for the hospitalized patient, SHM’s Resource Rooms provide members and non-members alike access to information that will aid their knowledge in quality improvement around specific disease states. Currently, SHM provides four Resource Rooms: Venous Thromboembolism (VTE), Stroke, Antimicrobial Resistance (ABX), and Heart Failure. Two additional rooms, Geriatrics and Glycemic Control, will launch this fall.

Quality improvement for the patient will be successful if a systems-based multidisciplinary collaboration within the hospital is improved. Hospitalists are leading this challenging yet exciting opportunity to change the face of healthcare. It has been noted that medical school and residency training have failed to prepare the hospitalist for this leadership role. To this end, SHM provides users of the Resource Rooms with information describing how a specific disease state affects the population and explains why a hospitalist should act in initiating change, as well as what key knowledge, skills, and attitudes the hospitalist should possess. The user is offered information regarding didactic and bedside teaching, patient education, and opportunities for continuing medical education. These resources are useful for the novice as well as for the advanced hospitalist leader. Readers can also apply the concepts of these general mechanisms to any disease state they are seeking to improve at their institutions.

The QI workbook within each of the Resource Rooms is the most important feature and serves as a field guide to implementing a quality improvement program. The workbook includes the following aids:

  • Essential first steps: garnering institutional support, assembling a team, developing team rules, and understanding the framework for improvement;
  • Conducting an in-depth analysis of current processes and failures;
  • Collecting data and devising metrics to assess the impact of your QI initiative;
  • Moving from problems to solutions; and
  • Continuing to improve: monitoring and learning from the process, as well as holding the gains and spreading your improvement

Other important resources that are common to all of the rooms and will aid in leading the QI efforts of the hospitalist are the educational features. Complex problems need multidisciplinary solutions. The “Improve” and “Educate” areas of the Resource Rooms include information that allow the hospitalist to teach and be taught. In the “Improve” section, a user can find QI Theory slide sets on the foundations of quality improvement initiatives and core measures on specific disease states.

Didactic sessions and teaching tools, as well as professional development, including core competencies and CME opportunities, are all present in the “Educate” feature of each room. For example, in the Heart Failure Resource Room, a didactic session slide set concerning the management of heart failure for hospitalized patients is provided. The slide set includes a heart failure overview that describes the epidemiology, etiologies, and objectives surrounding the management of acute congestive heart failure.

Evidence, improvement, and education tools designed to enhance inpatient outcomes can help the hospitalist develop and lead initiatives that can create a more cost-efficient approach to the treatment of hospitalized patients, while at the same time improving patient outcomes. SHM’s Quality Improvement Resource Rooms provide a compendium of resources to support the hospitalist who is embarking on this enormous task.

SHM Chapter reports

Northern Illinois

The SHM Northern Illinois Chapter held its July meeting on Tues., July 18 at the Brio Restaurant in Rockford, Ill. Robert H. Harner, MD, associate professor of medicine at the University of Illinois College of Medicine in Rockford, and founder of Rockford Cardiology Associates Ltd., gave a presentation: “Advance Management of Cardiovascular Disease: Reducing the Burden of Risk.” The event was supported by Bristol-Myers Squibb and Sanofi-Aventis Pharmaceuticals.

Northern California

The Northern California Chapter held its meeting at Spataro’s in Sacramento. The chapter welcomed nominations for board members during the weeks prior to the event. The official board elections took place at the chapter meeting on the evening of Wed., June 28. We are proud to announce Sundar Natarajan, MD, as the newly elected chapter president. In addition to local chapter elections, the June meeting agenda also included highlights from the 2006 SHM Annual Meeting that took place in Washington, D.C., as well as opportunities to network with other hospitalists in the Northern California region.

September Leadership Academy

New Level II a great success

The recently completed 4th SHM Leadership Academy was a true success in every sense of the word. The event was nearly a sellout, with 160 hospital medicine leaders arriving in Nashville, Tenn., in September to learn—from nationally respected leaders—tangible skills that they could take back to institute in their own practices.

The Leadership Academy Level I was designed to provide leaders in hospital medicine with the skills and resources required to lead and manage programs successfully both now and in the future. Small group sessions gave attendees a chance to interact with faculty and to share personal experiences from their own institutions. Nationally recognized speaker Jack Silversin, DMD, DrPH, presented his infamous broken squares activity, which kept the group energized and working together creatively to learn about effective communication. This course allowed attendees to evaluate personal leadership strengths and weaknesses and then apply them to everyday leadership and management challenges.

HOSPITAL MEDICINE FAST FACTS click for large version

click for large version

HOSPITAL MEDICINE FAST FACTS click for large version

click for large version

Another highlight was the self-evaluation session presented by David Javitch, PhD. His exercise gave everyone an opportunity to learn about their own personality traits and to practice working with extreme opposites, both in the workplace and in everyday life. Attendees continue to rave about the content of this meeting and are looking forward to enhancing their leadership skills by attending Level II courses, scheduled for fall 2007.

“No matter how many times I plan this course, I am amazed at the enthusiasm of the attendees and the new questions that they pose,” says Russell Holman, MD, SHM Leadership Academy course director.

Level II resulted from more than 300 Level I course evaluations that requested additional and ongoing leadership development activities. The Level II course focused on discussions about culture change, negotiation skills, and finance. Keynote speaker Leonard Marcus, PhD, defined the term “meta-leadership” in hospital medicine as a type of leadership that links individuals through their leader’s vision, creating enthusiastic followers.

The Level II course is a must have for those who want to expand upon leadership skills learned in Level I or for those who already have an MBA and want to improve upon leadership in clinical care. The skills discussed in this session are essential to effectively developing and implementing quality improvement programs, patient-safety initiatives, and other programs whose goal is to make system changes that improve patient care.

“The level of attendees participating in Level II was challenging,” says Dr. Holman. “It had us all—faculty and attendees alike—collaborating to answer questions from real-life experiences.”

The phrase “all work and no play” doesn’t describe any SHM meeting, and it certainly can’t be used in reference to the Leadership Academy. Attendees had an opportunity to network with fellow participants and exhibiting companies during the Monday night reception sponsored by Cogent Healthcare. Participants also had ample time to get out and experience some southern hospitality, while enjoying the spa, playing golf, touring on steamboats, dining, and shopping at the Gaylord Opryland Resort and Convention Center.

Leadership Academy Levels I and II were jam-packed with relevant materials and tools applicable to business and the real world. This is an outstanding opportunity for individuals just beginning their leadership journey and for those wanting to take their leadership skills to the next level.

Don’t miss out on the next opportunity to become a leader in hospital medicine. The next meeting will take place during the week of February 26–March 1, 2007, at the Gaylord Palms Resort and Convention Center in Orlando, Fla. Log on to or call (800) 843-3360 for more information.

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