First Hospital-Based Pain and Palliative Care Program in Hawaii

Abstract

variations in programs and generalizing back to theorized relationships with the organizational environment (healthcare system), service technology (interdisciplinary palliative care), and implementation process factors. IV. Results. Implementation barriers include staffing deficits, organizational culture, futile care, resistance, knowledge deficits, stigma, difficulty communicating, disciplinary tension, and turf issues. Implementation facilitators include executive support, innovation champion, micro and macro observability, strategic planning, and communication networks. V. Conclusion. Palliative care challenges the dominant culture of the hospital because of a perceived conflict with curative care. Moreover, the interdisciplinary nature of palliative care transgresses traditional hierarchies. Executive support and a physician champion, in addition to including users in the implementation process, and increasing opportunities for observability of outcomes, are among the best ways to overcome resistance to palliative care. VI. Implications for Research, Policy, or Practice. Capitated financing mechanisms (or global budgets) provide an incentive to implement palliative care. These findings should be considered in shaping healthcare reform efforts to accommodate the aging population and the concurrent increases in chronic illness, disability, and unpredictable disease trajectories. The conceptual model was useful in understanding the implementation of this health services innovation within multiple levels of context.