Week 13- Sustaining Innovative Environments

Longest (2010) emphasizes the cyclical nature of policy making. He asserts that there is a continuous feedback loop informing and shaping the policy. Those that initiated the policy and those affected by it will recommend some modification based on the outcomes. Positive outcomes should encourage further implementation of a policy and negative outcomes will demand a change.

This is clearly seen in the development of palliative care policies. SB 1004 in California was an outflow of the success of the AB 1745, or the pediatric palliative care waiver.  AB 1745 was passed in 2009 and allowed for palliative and curative treatment to occur concurrently for children utilizing California’s Medicaid program (Keim-Malpass, 2013). This began as a pilot program entitled Partners For Children (PFC). According to a brief published by the UCLA Center for Health Policy Research outcomes from the PFC program included:

  • A 32% reduction in the number of inpatient hospital days.
  • An 11% reduction in total medical expenditure.
  • An increase in families’ quality of life.

Building on this success, a similar provision was made in the Affordable Care Act (ACA), Section 2302.

Many challenges remain to the successful implementation of each of these policies. As we’ve learned through our dive into evidence based practice, sustainability depends on one’s ability to handle change. The same appears to be true with respect to policy making. Each of these policies, SB 1004, AB 1745 and Section 2302 of the ACA, requires continued action to be sustainable over time. Proponents of this legislation challenge policy makers and the public to support further research, training and access for palliative care.

  • Further research is needed to enhance the scientific foundation of palliative care.
  • Further training is needed to create a viable and sufficient workforce to meet the demand for services.
  • Further action is necessary within the health care system to create payment models that support this care, expand community access to services and create quality metrics to define success.

The Affordable Care Act provides a living and breathing example on a grand scale. How the implementation of this legislation plays out may guide future policy development for years to come. The public is not convinced that health care reform is in their best interest. A Gallup poll in November of 2014 demonstrated a 37% approval rating for this legislation (McCarthy, 2014). We should expect a myriad of changes as the implementation of the ACA continues.

It appears that creating a favorable environment for the sustainability of palliative care policy is paramount. The evidence needs to not only be strengthened but to be translated in a meaningful way to the American public. Individuals must recognize that it is in their best interest to have access to these services should the need arise.


Center to Advance Palliative Care. (2011). A state-by-state report card on access to palliative care in our nation’s hospitals. Recommendations for action. Retrieved from  http://reportcard.capc.org/recommendations#Research

Keim-Malpass, J., Hart, T. and Miller, J. (2013). Coverage of palliative and hospice care for pediatric patients with a life-limiting illness: A policy brief. Journal of Pediatric Health Care, 27(6), 511-516.

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL:  Health Administration Press.

McCarthy, J. (2014). As new enrollment period starts, ACA approval at 37%. Retrieved from http://www.gallup.com/poll/179426/new-enrollment-period-starts-aca-approval.aspx


3 thoughts on “Week 13- Sustaining Innovative Environments

  1. clarinet20 says:

    Wow! I was very impressed with the statistics you shared! I cannot count how many times we have the palliative care discussion at work and how ignorant some people are with the services provided. I was most intrigued with the increase in families’ quality of life when a loved one is cared for by palliative care. I recently had a patient whose family was anti palliative care for the longest time until we finally wore them down. It would have been helpful for me to have these statistics to show the benefit that palliative care is for not only the patient, but for the family as well. Look at all this additional knowledge I am getting from your blog!
    It is interesting that you mentioned the need for more research and training. That is so very true accross the board. I think that there is still quite a gap in general knowledge and fully understanding palliative care services especially in contrast to hospice. I also liked that you mentioned the need for further action regarding the implementation of your health policy change. this is very important. Once all of this is in play, it would be very interesting to see how things will have changed. Do you think it will take a long time for the healthcare world to fully embrace this change? What are your thoughts regarding how far we have already come with regards to palliative care and how much we still need to do?


  2. kelster71181 says:

    I love the post and agree that health policy is cyclical in nature. The hardest part is joining the circle and becoming continuously involved in the health policy making process and become a permanent member at the table. This is what we as future NP’s must overcome.


  3. lwarrenheft says:

    In my post on characteristics of innovators and change agents, I touched on the concept of the Triple Aim, a term coined by the Institute for Health Improvement (IHI) which emerged from efforts to reform healthcare in the United States. (1) The three components of this framework are: 1. Improving the patient experience of care 2. Improving the health of populations 3. Reducing the per capita cost of healthcare. (1) Achieving the Triple Aim requires healthcare systems to commit innovation and change. Thinking about the Triple Aim reminded me of an article that we were assigned to read when first introduced to the concept entitled, Palliative Care Hits a Triple Win. (2) The article described an innovative palliative care program called SPARK (Self-care; Pain and symptom management; Additional care; Respect needs; Kindness). The program was described as evidence-based and interdisciplinary, using both NPs and SWs. It was financially viable and achieved some noteworthy outcomes related to hospitalizations, advance directive completion, transfer to hospice and quality of life. Started in 2010 the program was still running in 2014 when the article was written, providing a great example of sustaining innovation in Palliative Care.

    1. Institute for healthcare improvement. (2015). IHI triple aim initiative. Retrieved from http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx.

    2. DiBello, K., & Coyne, N. (2014). Palliative care hits a triple win: Access, quality, and cost. Home Healthcare Nurse, 32(3), 183-190.


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