Coming to terms: a case study of hospice collaboration challenges

Recent research has focused on the growing phenomenon of mergers, collaborations, and alliances among nonprofit organizations and what makes such arrangements work. Examination of failed collaborative efforts is perhaps just as instructive. This case study examines recent attempts at collaboration between 2 nonprofit hospice organizations. The study finds that despite compelling reasons for and significant commonalities on which to base collaboration, the organizations were initially unable to forge any ongoing and substantive collaborative arrangement because of insurmountable cultural factors and past history. Furthermore, without imminent external pressures to collaborate, these organizations had insufficient motivation to attempt to move beyond their differences. The case also reviews the changed circumstances and factors that later facilitated partnering attempts.     

The first decade in experimental leprosy

Considerable developments have occurred in the application of the method for growing Mycobacterium leprae in the mouse foot-pad since it was first described about 10 years ago. The method has been used to study growth curves and histology in normal and in thymectomized irradiated mice, to identify supposed isolates of Myco. leprae that have been made in tissue-culture or in non-living media, to evaluate tests of experimental vaccines, to investigate applications to clinical investigations (the loss of infectivity during chemotherapy as a means of monitoring a drug trial, the demonstration of drug-resistance, and the clinical problem of the patient who responds poorly to therapy), and to study new drugs—e.g., dapsone, acedapsone, clofazimine, and rifampicin.     

Methylphenidate for depression in hospice practice: a case series

Psychostimulants such as methylphenidate have been used for depression in cancer patients. We report the successful use of methylphenidate to treat depression in 10 consecutive patients with advanced cancer. A rapid onset of effect was noted. Appetite, concentration, fatigue, and sedation also improved in some persons. No severe side effects were noted.     

Parenteral nutrition: first decade, trends.

Parenteral feeding has saved lives and enhanced therapy of patients who cannot eat. Future trends of this technique for patients, physicians, hospitals are discussed.     

The first decade of the Massachusetts Tobacco Control Program

This article provides a comprehensive overview of the first decade of the Massachusetts Tobacco Control Program (MTCP). Born after Massachusetts passed a 1992 ballot initiative raising cigarette excise taxes to fund the program, MTCP greatly reduced statewide cigarette consumption before being reduced to a skeletal state by funding cuts. The article describes the program's components and goals, details outcomes, presents a summary of policy accomplishments, and reviews the present status of MTCP in the current climate of national and state fiscal crises. The first decade of the MTCP offers many lessons learned for the future of tobacco control.     

Managing unused pharmaceuticals in a hospice setting: a pilot study

With the escalating use of pharmaceuticals in health care, there has been increasing anxiety over the potential health risks associated with pharmaceutical waste accumulating in the environment. This research provided nurses in a hospice care facility in Concord, California, with education and training to offer patients a medication disposal service through the use of mail-back envelopes. Over the 6-month study period, 160 of the 400 distributed mailers were returned for disposal. The total weight of pharmaceuticals diverted for incineration was 107 pounds, with an average weight of 0.66 pounds per mailer. This study suggests that the mailer system and proper education of medical staff have the potential to improve medical waste management, but alternative approaches may be necessary to increase the rate of envelop return.     

Regulations vs. ideals: a case history of a hospice closure.

The cost of health care and health insurance and the increasing number of Americans without access to basic health services has become a primary issue in today's society. Leading politicians, economists, planners, and private individuals recognize the essential need to re-design the system and provide coverage to all Americans. However, the history of programs strangling in the red tape created by inflexible regulatory efforts to set standards, monitor performance, and control costs, thereby denying access to individuals they were specifically designed to serve, points to the need for an equally new approach to planning such a system. The authors have attempted to illustrate, through the case history of the closure of a hospice serving a poor socioeconomic area of New York City, the need for government regulators, program planners, and caregivers to recognize and define common goals and develop flexible and cooperative working relationships.     

A local health department's journey to the summit: a case study of a decade of quality improvement

As the interest in quality improvement (QI) efforts in public health agencies gathers momentum, organizations looking to initiate or strengthen QI processes may benefit from learning about existing programs. This article serves as a case study for other agencies to consider as they embark upon their QI journey. Specifically, this article reviews more than a decade of QI efforts in a mid-sized local health department and highlights areas of success (including an annual QI summit), barriers to implementation of QI, and areas needing improvement.     

The marketing decade: a desktop view

The authors challenge health care marketers to put into perspective the brief history and development of the health care marketing function and process. They advocate closing the gap between strategy development, operations management, and strategy implementation, and suggest that "strategic management" may be the way to organize for marketing. Marketers' roles and readiness for strategic management are discussed.     

The significance of lifeworld and the case of hospice

Questions on what it means to live and die well are raised and discussed in the hospice movement. A phenomenological lifeworld perspective may help professionals to be aware of meaningful and important dimensions in the lives of persons close to death. Lifeworld is not an abstract philosophical term, but rather the opposite. Lifeworld is about everyday, common life in all its aspects. In the writings of Cicely Saunders, known as the founder of the modern hospice movement, facets of lifeworld are presented as important elements in caring for dying patients. Palliative care and palliative medicine today are, in many ways, replacing hospices. This represents not only a change in name, but also in the main focus. Hospice care was originally very much about providing support and comfort for, and interactions with the patients. Improved medical knowledge today means improved symptomatic palliation, but also time and resources spent in other ways than before. Observations from a Nordic hospice ward indicate that seriously ill and dying persons spend much time on their own. Different aspects of lifeworld and intersubjectivity in the dying persons’ room is presented and discussed.     

Lessons learned from a decade of partnership between PEPFAR and the Global Fund: a case study from Tanzania

The President's Emergency Plan for AIDS Relief was intended to be complementary to existing US work to fight HIV/AIDS through the broader multilateral efforts of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This article explores the history of this collaboration, highlighting lessons learned through a case study of Tanzania and challenges overcome through ongoing improvements, such as ensuring reliable access to antiretroviral drugs. Improved communication and a more formalized partnership between PEPFAR's bilateral efforts and the Global Fund have been key to improving health outcomes in Tanzania, and this case can be used as a model for other countries. If PEPFAR is reauthorized in 2013, its partnership with the Global Fund should be further formalized and expanded.     

The hospice volunteer: a person of hospitality.

Volunteers are integral members of the hospice interdisciplinary team. They are distinguished from other members of the team only by role, not by expectation. The distinction is not between "volunteer" and "professional," because every team member is to be professional in the best sense of that word. If a distinction is to be made, it is that some hospice staff members are salaried while others donate their services. Volunteer staff members are expected to be as responsible and accountable as every other member of the team. ALL staff members must realize the importance of taking care of personal needs in order to be able to care for others. Even though the following article deals primarily with the volunteer hospice staff member, the points outlined can just as easily be applied to the salaried staff member.