Supporting and
Sustaining the Current
and Future Workforce
to Care for People with
Serious Illness

__________

Laurene Graig and Joe Alper,
Rapporteurs

Roundtable on Quality Care for
People with Serious Illness

Board on Health Care Services

Health and Medicine Division

Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by the American Academy of Hospice and Palliative Care, American Geriatrics Society, Ascension Health, Association of Professional Chaplains, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, CSU Shiley Haynes Institute for Palliative Care, Cambia Health Foundation, Catholic Health Association, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, National Association of Social Workers, National Coalition for Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, New York Academy of Medicine, Patient-Centered Outcomes Research Institute (PCORI), and the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number – 13: 978-0-309-71212-5
International Standard Book Number – 10: 0-309-71212-2
Digital Object Identifier: https://doi.org/10.17226/27328

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Supporting and sustaining the current and future workforce to care for people with serious illness: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27328.

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PLANNING COMMITTEE FOR A WORKSHOP ON SUPPORTING AND SUSTAINING THE CURRENT AND FUTURE WORKFORCE TO CARE FOR PEOPLE WITH SERIOUS ILLNESSES¹

JOANNE REIFSNYDER (Co-Chair), Professor of Health Services Leadership and Management, University of Maryland School of Nursing, Representing the Hospice and Palliative Nurses Association

BRYNN BOWMAN (Co-Chair), Chief Executive Officer, Center to Advance Palliative Care, and Assistant Professor, Icahn School of Medicine at Mount Sinai

JENNIFER MOORE BALLENTINE, Executive Director, CSU Shiley Haynes Institute for Palliative Care (through December 2022)

AMY BERMAN, Senior Program Officer, The John A. Hartford Foundation

ROBERT ESPINOZA, Executive Vice President of Policy, PHI

ERNEST J. GRANT, Immediate Past President, American Nurses Association

DIANE MEIER, Founder, Director Emerita, and Strategic Medical Advisor, Center to Advance Palliative Care; Codirector, Patty and Jay Baker National Palliative Care Center; and Professor, Icahn School of Medicine at Mount Sinai

AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care

ARIKA PATNEAUDE, Director, Bioethics & Palliative Care, Seattle Children’s Hospital

CAROL PEDEN, Executive Director for Clinical Quality, Blue Cross Blue Shield Association

JOSEPH ROTELLA, Chief Medical Officer, American Academy of Hospice and Palliative Medicine

JOSEPH SHEGA, Executive Vice President and Chief Medical Officer, VITAS Healthcare, Representing the American Geriatrics Society

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Staff

LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness

SHARYL NASS, Senior Director, Board on Health Care Services

EMMA ROONEY, Research Assistant (through December 2023)

ISAAC SUH, Research Associate

Consultants

JOE ALPER, Consulting Writer

ROUNDTABLE ON QUALITY CARE FOR PEOPLE WITH SERIOUS ILLNESS¹

PEGGY MAGUIRE (Co-Chair), President and Board Chair, Cambia Health Foundation

PHILLIP RODGERS (Co-Chair), Professor of Family Medicine and Internal Medicine, The George A. Dean M.D. Professor and Chair, Department of Family Medicine, University of Michigan Medical School

JORI BOGETZ, Attending Pediatric Palliative Care Program Faculty, Palliative Care and Resilience Research Program Faculty, Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital and Research Institute

BRYNN BOWMAN, Chief Executive Officer, Center to Advance Palliative Care

KAREN BULLOCK, Ahearn Endowed Professor, Boston College School of Social Work, Representing the National Association of Social Workers

JANE CARMODY, Senior Program Officer, The John A. Hartford Foundation

STEVE CLAUSER, Program Director, Improving Healthcare Systems Research Program, Patient-Centered Outcomes Research Institute

RORY FARRAND, Vice President, Palliative and Advanced Care, National Hospice and Palliative Care Organization

LORI FRANK, Senior Vice President for Research, New York Academy of Medicine

MATTHEW GONZALES, Associate Vice President, Chief Medical and Operations Officer, Providence Institute for Human Caring; Representing the Catholic Health Association

ANNA GOSLINE, Senior Director Strategic Initiatives, Blue Cross Blue Shield of Massachusetts, Executive Director, Massachusetts Coalition for Serious Illness Care

MICHELLE GROMAN, President and Chief Executive Officer, The Greenwall Foundation

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

SCOTT D. HALPERN, John M. Eisenberg Professor of Medicine, Epidemiology, and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania

SHARON B. HAMILL, Interim Executive Director, CSU Shirley Haynes Institute for Palliative Care (from January 2023)

JOHN R. HENDRIX, Director, Ascension St. John Palliative Care Program, Ascension Health (through September 2023)

DENISE HESS, Representing the Association of Professional Chaplains (through November 2023)

REBECCA A. KIRCH, Executive Vice President of Healthcare Quality and Value, National Patient Advocate Foundation

TOM KOUTSOUMPAS, Co-Founder, Coalition to Transform Advanced Care

DIANE E. MEIER, Founder, Director Emerita, and Strategic Medical Advisor, Center to Advance Palliative Care; Codirector, Patty and Jay Baker National Palliative Care Center; and Professor, Icahn School of Medicine at Mount Sinai

AMY MELNICK, Executive Director, National Coalition for Hospice and Palliative Care (through October 2023)

R. SEAN MORRISON, Ellen and Howard C. Katz Professor and Chair, Brookdale Department of Geriatrics and Palliative Medicine; Director, National Palliative Care Research Center, Icahn School of Medicine at Mount Sinai

CAROL PEDEN, Executive Director for Clinical Quality, Blue Cross Blue Shield Association (through May 2023)

THOMAS M. PRISELAC, President and CEO, Cedars-Sinai Health System

JOANNE REIFSNYDER, Professor of Health Services Leadership and Management, University of Maryland School of Nursing; Representing the Hospice and Palliative Nurses Association

JOE ROTELLA, Chief Medical Officer, American Academy of Hospice and Palliative Medicine

LEONARD D. SCHAEFFER, Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California (through October 2023)

JOSEPH W. SHEGA, Executive Vice President and Chief Medical Officer, VITAS Healthcare; Representing the American Geriatrics Society

CARDINALE B. SMITH, Chief Medical Officer, Tisch Cancer

Hospital, The Mount Sinai Hospital, VP, Cancer Clinical Services at the Mount Sinai Health System

SUSAN ELIZABETH WANG, Regional Chief, Geriatrics & Palliative Medicine, SCPMG, Regional Medical Director, LCP & Serious Illness Care, SCPMG, National Executive Leader, Dignified Journeys & Palliative Care, The Permanente Federation

Roundtable on Quality Care for People with Serious Illness Staff

LAURENE GRAIG, Director, Roundtable on Quality Care for People with Serious Illness

SHARYL NASS, Senior Director, Board on Health Care Services

EMMA ROONEY, Research Assistant (through December 2023)

ISAAC SUH, Research Associate

JULIE WILTSHIRE, Senior Finance Business Partner, Board on Health Care Services

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Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BRUCE N. CALONGE. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies

and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Roundtable on Quality Care for People with Serious Illness wishes to express its sincere gratitude to the Planning Committee Co-Chairs JoAnne Reifsnyder and Brynn Bowman for their valuable contributions to the development and orchestration of this workshop. The Roundtable also wishes to thank all the members of the planning committee who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, we want to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants.

Support from the many annual sponsors of the Roundtable on Quality Care for People with Serious Illness is critical to the roundtable’s work. The sponsors of the Roundtable on Quality Care for People with Serious Illness include: American Academy of Hospice and Palliative Care, American Geriatrics Society, Ascension Health, Association of Professional Chaplains, Association of Rehabilitation Nurses, Blue Cross Blue Shield Association, Blue Cross Blue Shield of Massachusetts, CSU Shiley Haynes Institute for Palliative Care, Cambia Health Foundation, Catholic Health Association, Cedars-Sinai Health System, Center to Advance Palliative Care, Coalition to Transform Advanced Care, The Greenwall Foundation, The John A. Hartford Foundation, Hospice and Palliative Nurses Association, Kaiser Permanente, National Association of Social Workers, National Coalition for

Hospice and Palliative Care, National Hospice and Palliative Care Organization, National Palliative Care Research Center, National Patient Advocate Foundation, New York Academy of Medicine, Patient-Centered Outcomes Research Institute (PCORI), and the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California.

In Memoriam

The Roundtable on Quality Care for People with Serious Illness dedicated its April 2023 workshop to honor the life and work of Randy Curtis, who passed away in February 2023.

J. Randall Curtis, M.D., M.P.H., was an expert in critical care, palliative care, and pulmonary medicine. As a palliative care researcher, he received more than 25 years of continuous NIH funding. He authored more than 350 peer-reviewed research articles and more than 200 editorials and chapters. Dr. Curtis founded the Cambia Palliative Care Center of Excellence at the University of Washington. In 2022, he received a Lifetime Achievement Award and a mentoring award from the American Academy of Hospice and Palliative Medicine.

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Contents

ACRONYMS AND ABBREVIATIONS

INTRODUCTION

OPENING REMARKS

VOICES FROM A WORKFORCE IN CRISIS

Panel Discussion

Audience Q & A

OVERVIEW OF THE CURRENT AND FUTURE STATE OF THE HEALTH CARE WORKFORCE

SYSTEMS-LEVEL APPROACHES TO SUPPORTING THE WELL-BEING OF THE HEALTH WORKFORCE

Well-Being of the Pediatric Palliative Workforce

Well-Being of the Nursing Workforce

Well-Being of the Long-Term Care Workforce

Well-Being of the Clinical Workforce in Rural Areas

Panel Discussion

Audience Q & A

CREATING A COMPASSIONATE, CARING ENVIRONMENT FOR PATIENTS AND CLINICIANS

DIRECT CARE WORKERS: INDISPENSABLE, UNDERVALUED, AND IN SHORT SUPPLY

Audience Q & A

ADVANCING DIVERSITY, EQUITY, AND INCLUSION IN SERIOUS ILLNESS CARE

Panel Discussion

Audience Q & A

DEVELOPING PROMISING MODELS/INNOVATIVE APPROACHES TO WORKFORCE RECRUITMENT, TRAINING, AND RETENTION

Programs to Support Direct Care Workers

Midcareer Hospice and Palliative Medicine Fellowship Consortium

Striving for Goal-Concordant Care: Teaching Serious Illness Communication Skills

Healing Healthcare Initiative Pilot Program

Panel Discussion

Audience Q & A

THE SERIOUS ILLNESS CARE WORKFORCE: A CALL FOR RADICAL TRANSFORMATION

Audience Q & A

VIDEO MONTAGE: VOICES OF THE SERIOUS ILLNESS CARE WORKFORCE

Closing Remarks

REFERENCES

APPENDIX A: STATEMENT OF TASK

APPENDIX B: WORKSHOP AGENDA

Box and Figures

BOX

1 Suggestions Made by Individual Workshop Participants to Support and Sustain the Workforce to Care for People with Serious Illness

FIGURES

1 Demographic makeup of the direct care and physician workforce

2 Number of Medicare Advantage plans offering expanded supplemental benefits

3 Structure of the midcareer fellowship

4 Structure of the Serious Illness Communication Skills Curriculum

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Acronyms and Abbreviations

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