This is the fifth in a series on this blog: “Looking Back, Looking Forward: Our Legacy in Improving End-of-Life and Serious Illness Care.”
There is a lot of renewed attention to Batman these days. So, in the style of the Joker, “Riddle us this”:
What impacts healthcare across California, throughout the United States, and around the world and demonstrates the power of bringing together Teams, Training, and Technology?
In 2010, when then-California State University (CSU) Trustee Roberta Achtenberg and then-CSU San Marcos President Karen Haynes began a dinner discussion about palliative care education, they did not see themselves as solving a riddle. They were focused instead on how education of healthcare professionals and pre-professional students could improve quality of life for those with serious illness. Nor were they quite aware they were planting the seeds for a project that would be an early demonstration of the power of Archstone Foundation’s new vision of bringing together Teams, Training, and Technology.
At the time, and even more so today, America had an aging population: By 2050, it is estimated there will be 88.5 million Americans, one out of every five people, older than 65.[i]
And even before the arrival of Covid-19, the country was developing a “sicker” population: In the middle of the last decade, 60% of U.S. adults had at least one chronic disease, 42% had more than one, and 12% had five or more. Among those 65 and older, 81% had multiple chronic conditions.[ii]
There was also an enormous gap between the need for serious illness care and the workforce of providers specially trained to deliver it: A 2017 report estimated there were 6,400 hospice and palliative medicine-certified physicians nationwide, or one for every 6,370 Americans older than 65. By comparison, there were more than 22,000 cardiologists. The workforce of palliative-trained nurses, social workers, and chaplains was just as inadequate to demand.[iii]
In short, more aging Americans will require more care – and appropriate levels of care – at the same high quality they expect in order to maintain their quality of life and live at home as long as possible. But appropriate training of clinicians to provide such care is scant.
Expanding Palliative Care Education
Palliative care is personalized care, typically delivered by a team of professionals including doctors, nurses, social workers, spiritual care providers, and others. This care focuses on enhancing quality of life for those with serious illness while expertly managing their physical, emotional, and spiritual symptoms.
During the pandemic, palliative care professionals and their expertise in managing the symptoms of serious illness have proved vital. Their skills in communication, comfort, and ethical decision making have been essential at a time when families have been kept away from the bedside. In addition, members of the palliative care team, particularly social workers and chaplains, have played a critical role in supporting their institutional colleagues through the stresses of long hours, professional and personal disruption, and significant losses both at work and at home.
Hospice and palliative medicine has been recognized as an official medical subspecialty only since 2006 and is still rarely introduced in pre-professional education. If today’s health professionals get any formal training in palliative care, it is a “post-graduate add-on.” Instead, most learn it on the job. However, as an Archstone-funded project at San Diego Hospice demonstrated, such training is not a successful answer to the challenge of educating the existing workforce.
So, the riddle was: How do you increase the number of palliative care-trained professionals now while also educating the next generation of professionals?
CSU trustee Achtenberg had personally experienced the power of palliative care to transform the experiences of patients with serious illness as well as their families; she also knew that the CSU system was a healthcare and social sciences education powerhouse that trained 44% of all health- and medicine-related bachelor’s students and 37% of such master’s students in California,[iv] with many of those graduates going on to clinical and teaching positions throughout the country. To change the healthcare experience of those with serious illness, she knew it was vital to educate nurses, social workers, other future health professionals – and the community members they would care for – about palliative care. With a doctorate in social work herself, President Haynes shared this vision and took the lead in championing the Institute into existence, with critical early support from Archstone Foundation and the California Health Care Foundation.
Using Teams, Training and Technology to Advance Palliative Care Education
Since its launch in 2012, the Institute has invested in technology as the engine for delivering its education. From its beginning, long before it was common or fashionable, the Institute used the latest in online learning technology, together with subject matter experts and faculty, to create and deliver the most up-to-date educational programs for spiritual care providers, nurses, and social workers. Today, it continues to deliver these courses to both current and future practitioners where and when it works best for them – 24 hours a day, every day of the year. Notably, the Institute’s offerings are fully accredited for continuing education credit and much more affordable than equivalent offerings from other universities, contributing to the quality of access as well as content.
The impact of this alignment of training and technology directed at enhancing care teams has resulted in more than 25,500 enrollments by healthcare professionals in the Institute’s courses, from all 50 states and also 48 countries. The Institute has partnered with other CSU campuses to introduce palliative care content in undergraduate programs in nursing, social work, and other health-related disciplines and to encourage more community-focused palliative care education. Thanks to this collaboration, more than 25,800 students and 24,700 community members have learned more about palliative care and its value in enhancing quality of life for those with serious illness – and from the point of diagnosis, not only at the end of life.[v]
Important additions to the Institute’s offerings include an extensive care management curriculum for health plans and hospitals; the only multilevel, interdisciplinary certificate training programs in pediatric palliative care; and the only certificate course for physician assistants/associates in serious illness and palliative care. Increasingly, the Institute’s courses are used at the enterprise level to provide orientation and professional development to whole teams and cohorts of employees in a provider organization or health system.
The demand for palliative care education continues unabated – due to our aging and increasingly ill population, the pandemic, and the recognition of the skill and importance of palliative care providers in caring for patients and families dealing with serious illness. These days, thankfully, many practitioners in other specialties are seeing the value of adding palliative care skills to their tool kits.
The solution to one riddle often leads to another riddle. But in this case, we believe the solution to the palliative care riddle will solve other riddles in healthcare, and we are delighted to see Archstone Foundation’s focus on work that incorporates the vital elements of Teams, Technology, and Training. There are still many tough healthcare challenges and riddles to be solved, and we believe that this focus will help to bring about needed solutions.
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[i] The 2009 statistical abstract. Table 10. Resident population projections by sex and age: 2010 to 2050. The National Databook.
[ii] Buttorff, C., Ruder, T., & Bauman, M. (2017). Multiple chronic conditions in the United States. Rand Corporation. Available from: https://www.rand.org/pubs/tools/TL221.html.
[iii] George Washington University Health Workforce Institute, Salsberg, E., Mehfoud, N., Quigley, L., Lupu, D., GW Health Workforce Institute, GW School of Nursing, & AAHPM. (2017). A profile of active hospice and palliative medicine physicians, 2016; Becker’s Hospital Review. (2018, July 25). A cardiologist shortage is coming: 5 things to know.
[iv] https://www.calstate.edu/impact/docs/CSUImpactsReport.pdf
[v] Numbers presented in this paragraph are as of June 30, 2021.
