Herbst L H, Cetti J
San Diego Hospice Corporation, San Diego, California, USA.
Am J Hosp Palliat Care. 2001 Sep-Oct;18(5):327-33. doi: 10.1177/104990910101800508.
Over 20 years ago, hospice in the United States evolved to provide end-of-life care for terminally ill patients. However, three major barriers exist, which limit access to hospice care. The first two, cultural and regulatory barriers, are not under the direct control of hospices, although programs can be adapted to minimize their influence. The third, management focus, is controlled by hospice programs and has the greatest influence on access to care and quality of care. Under the influence of the Medicare Hospice Benefit and the peer pressure of managed care, many hospice programs use reimbursability as at least one criterion for determination of coverage of services. The fear is that limited reimbursement will cause some services and therapies to bring the programs to financial ruin. This case study shows the outcome of changing management focus away from restrictive policies about therapies and patient selection toward management of productivity and working capital. Some programs have contributed to growth and stability; the revenue thus produced has supported the new innovations. San Diego Hospice is now growing more than 30 percent per year in spite of competition and a fairly flat death rate in the community. This growth is attributed to finding and meeting unmet needs and making all decisions based on the right thing to do. Every staff member understands and supports the mission. The many programs within the agency contribute to fulfillment of the goal to transform end-of-life care. They are presented here as an example of what can be done with mission-based management.
20多年前，美国的临终关怀机构逐渐发展起来，为晚期绝症患者提供临终关怀服务。然而，存在三大障碍限制了临终关怀服务的可及性。前两个障碍，即文化和监管障碍，虽不受临终关怀机构的直接控制，但机构可通过调整项目来尽量减少其影响。第三个障碍，即管理重点，由临终关怀项目控制，对服务的可及性和护理质量影响最大。在医疗保险临终关怀福利和管理式医疗的同行压力影响下，许多临终关怀项目将可报销性作为确定服务覆盖范围的至少一项标准。人们担心有限的报销会导致一些服务和治疗使项目陷入财务困境。本案例研究展示了将管理重点从对治疗和患者选择的限制性政策转向生产力和营运资金管理的结果。一些项目实现了增长和稳定；由此产生的收入支持了新的创新。尽管存在竞争且社区死亡率相当平稳，但圣地亚哥临终关怀机构目前每年仍以超过30%的速度增长。这种增长归因于发现并满足未被满足的需求，以及基于正确之事做出所有决策。每个工作人员都理解并支持该机构的使命。机构内的众多项目有助于实现转变临终关怀服务的目标。在此将它们作为基于使命的管理所能取得成效的一个例子呈现出来。
