2013; Volume 14, No 12, December
Reflections of an IAHPC Board Member
Collaboration and Quality – Two key elements in the provision of palliative care
By Professor Julia Downing (Uganda)
This month, I attended the launch of a palliative care coordinating body in Novi Bečej, Serbia. The role of this body is to help co-ordinate palliative care service provision within the area in order to ensure continuity of care among the home care services, the Dom Zdravlja Health Center and the recently opened palliative care unit in Zrenjanin. It is the first such body to be set up in Serbia, and it is hoped that collaboration across different sectors of care will promote quality and assist in the development of palliative care within the region.
As I reflect on the launch and the tasks ahead, I think about the roles ‘collaboration’ and ‘quality’ play in the provision of palliative care. In their definition of palliative care, the World Health Organization[i] set the barrier high which is necessary if we are to improve quality of life, and relieve suffering ‘by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’. Yet how do we get this right? How do we ensure that we are collaborating well with all the various parties that need to be involved? How do we ensure that the quality of care that we provide is the best so that we can improve the lives of individuals (both adults and children) and their families?
I am privileged to work in many different parts of the world, and realize that this is a challenge that we all face, regardless of where we live and work, the resources that we have, and the length of time we have been working in palliative care. The Oxford Dictionary defines collaboration as ‘the action of working with someone to produce something.’[ii] Within palliative care it is about working together to provide the best possible care for the individual and their family. This includes the numerous issues faced by an individual with life-threatening illness while the family tries to adapt to the illness and eventual death of an individual. These situations exceed the expertise of any one professional, thus teamwork is an integral part of the philosophy of palliative care. Building a team, and working together is not an easy task, however, when multidisciplinary and multiagency teams work together in the provision of palliative care, they achieve more than is just the sum of the individual roles. Members of the team cover each other’s weaknesses and maximize each other’s strengths. Team members have the right to be heard and to influence a decision but, at the same time, they must respect the views and input from different disciplines. This is not always easy, thus it is hoped that bodies, such as the newly formed group in Novi Bečej, will help team members to work well together in the provision of palliative care.
On the other hand, the Institute of Medicine defines quality in healthcare as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” [iii] Quality is important not only in established programs but we must encourage new programs to think about quality of care and quality improvement from the start. Whilst thinking about how are we going to measure quality, and identify national indicators for palliative care in Serbia, I remembered how exciting it was to take part in a workshop at the recent African Palliative Care Association and the Hospice Palliative Care Association (APCA/HPCA) conference in Johannesburg on the APCA African Palliative Outcome Scale[iv] [v] and to see how the development and validation of such a tool has enabled participants to look at the outcomes of the care being provided, to carry out clinical audits and ultimately to improve the quality of care to the individual and their families.[vi]
Indeed, throughout the APCA/HPCA conference there was a commitment to collaborate, and work together, both locally, nationally, regionally and internationally, as well as a commitment to the provision of quality care.[vii] This commitment is also reflected in the work of many other organizations such as European Association for Palliative Care (EAPC), International Children’s Palliative Care Network (ICPCN) and the IAHPC. Together we can learn from each other, we can work together and achieve more than what we could as individuals, and we must continue to work together to provide quality care for all in need wherever they may in the world.
[i] WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/
[ii] http://www.oxforddictionaries.com/definition/english/collaboration
[iii] Institute of Medicine. Lohr KN, editor(s). (1990) Medicare: a strategy for quality assurance. Vol. 1. Washington (DC): National Academy Press. p. 21
[iv] Powell RA, Downing J, Harding R et al. (2007) Development of the APCA African Palliative Outcome Scale. Journal of Pain and Symptom Management 33:2:229-232.
[v] Harding R, Selman L Agupio G, et al. (2010) Validation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale. Health and Quality of Life Outcomes 8(10) http://www.hqlo.com/content/8/1/10
[vi] Defilippi K and Downing J. (In Press) Feedback from African Palliative Care Practitioners on the use of the APCA African POS. International Journal of Palliative Nursing.
[vii] Downing J, Namisango E, Kiyange F, Luyirika E, Gwyther L, Enarson S, Kampi J, Sithole Z, Kemigisha-Ssali E, Masclee M, Mukasa I. (In Press) The Net Effect: Spanning diseases, crossing borders – highlights from the 4th triennial APCA conference and annual HPCA conference for palliative care. ecancermedicalscience
Professor Julia Downing is Honorary Professor Makerere University, Kampala, Uganda, and International Palliative Care Consultant. She is also a Member of the IAHPC Board. Her bio may be found here.
Email: [email protected]