This is the second in a series on this blog: “Looking Back, Looking Forward: Our Legacy in Improving End-of-Life and Serious Illness Care.”
During his fall internship with Archstone Foundation, Ryan DoyLoo interviewed Joseph F. Prevratil, JD, who retired in 2019 after nearly two-dozen years as the Foundation’s founding president and CEO. Their discussion has been edited here for clarity and length.
Ryan DoyLoo: Can you describe your initial vision when starting to work in palliative and end-of-life care? Having made more than 130 grants for more than $16 million in this area, did you envision the work growing to this scale?
Joseph F. Prevratil: It's a hard one to answer because I had grandparents who came to the United States from Bohemia, today known as the Czech Republic. I didn't speak English until I went to school. I knew a lot of older people and grew up with a clear sense of respect for older generations and the sacrifices they’ve made.
When we started, using the term “end of life”, even acknowledging death, was a radical concept. We invested in this area because of the lack of national interest and the taboo that surrounded discussing and planning for better care at the end of life. I felt we needed to commit around $10 to $15 million over many years to truly make a difference. If you were to ask, "How'd you come up with that number?" I added up the key problems. I figured what it would take based on what was ending. It either was going to be successful or it was going to be a failure.
And it turned out to be successful! I envisioned it would grow rapidly because the need was there. It was a question of how we would meet this need. The success of our mission could really be superior in this area because there were few foundations active in this area.
You say 16 million bucks, my God! But for only 130 grants? Did you lose your mind? No, we were very careful. Each grantee had its own person involved with Archstone Foundation’s program officers. It was really important.
RD: What has been the most significant change in the field since you took the helm at the Foundation?
JFP: The organizations who controlled the money for palliative care were hospitals, academic organizations, and the government – and they didn’t always do the right thing from the perspective of the patient. In my opinion they were often more concerned about the bottom line. I looked at that and said, "We've got to have a plan and the plan's got to be good." But since nobody was doing this, there was no template. I sat in our first office and kept saying, "What will be the one thing that would make palliative care stand out?"
RD: Several enduring benefits have been documented due to the Foundation’s investment – increased quality of palliative care education and training, enhanced metrics and data collection, and proliferation of literature. What is the most profound for you?
JFP: The fact that we finally could come up with a plan in palliative care and end-of- life issues. Because everybody, at some point, reaches their end of life. It was up to us to make sure older people weren't forgotten in that process. We were successful because of the leaders we invested in. We were successful because of our partners doing the work and raising the issues of better pain management and training for nurses. This made a profound difference. It was profound because nobody wanted to try to address it in a comprehensive way before.
RD: Thinking about some of the Foundation's most successful grants in this area, do any particularly stand out to you now – whether for their creativity, lasting impact, or scale?
JFP: Absolutely. I'm going to tell you we sometimes missed scale in favor of testing smaller projects with direct impact, but we did have lasting impact and still do.
Steven Pantilat’s book, “Life After the Diagnosis,” and his work on the Palliative Care Quality Network was just fantastic. It was the first time anybody ever wrote about this type of issue. Not only is he brilliant, but he is a medical doctor. He knows what he is talking about, he brings real experience to the subject, and he was smart in building a high-quality team of clinicians and researchers to move their ideas forward.
The Center to Advance Palliative Care (CAPC) “State-By-State Report Card on Access to Palliative Care in Our Nation’s Hospitals” was very good. Dr. Diane Meier, The woman who was the founder of CAPC was really terrific and did tremendous work to increase access to palliative care in our nation’s hospitals,.
Regarding creativity, I think of Dr. Betty Farrell, who brought creativity and scale to training nurses through the End-of-Life Nursing Education Consortium. People were always proud to work with her and to learn from her.
We've accomplished so much that it even surprised me.
RD: Grants focused on spiritual care became a significant aspect of the Foundation’s efforts in this area, with 14 grantees receiving more than $3 million. This had been a largely unexplored dimension of this field, so what inspired you to invest in it?
JFP: Early on, I was criticized for this. People said, “$3 million could have been spent a lot differently! We could make a bigger impact, Joe, but you just keep pushing us on these things." So what inspired me? It was just, simply, I went into nursing homes, went to the jails, went to all the areas where older people were suffering but couldn't take care of themselves. And I knew we could do better. Spirituality is part of the human condition, so it should be part of end-of-life care.
People argue about which religion is right and which religion is wrong. They ought to just stop that argument and accept the vastness and peace that including spirituality in quality care can bring. The older I get, the more I realize how much more work there is to be done.
RD: Do you see any intersections between the Foundation’s new strategic plan and its past work in end-of-life care and spirituality in palliative care?
JFP: The Three Ts – teams, training, technology – is really good. Quality team care is what happens if clinicians and practitioners are trained properly. And if they incorporate technology, you're going to get a good result, you see?
To me, improving the health and wellbeing of older Californians and their caregivers is a really great objective. So is integration of health care and social supportive services. And the seven Cs: Cultural competence, client-centered, comprehensive, collaborative, coordinated, connected, compassionate. Goals should be developing good teams, having quality training and doing something with the technology and grants, technical assistance, evaluation, policy, advocacy, and convening.
These are words. But, as with the end of life and palliative care initiative, time will tell if these were the right approaches.
RD: I really appreciate all the time that you've given me.
JFP: Thank you very much. It's been a privilege to be able to speak with you.
