Hospital Executives’ Perceptions of End-of-Life Care

Kimberly K Garner,Joann E Kirchner,Leanne L Lefler,Patricia M Dubbert,Jean C Mcsweeney,Dennis H Sullivan

doi:10.1177/2158244015590610

Kimberly K Garner, Joann E Kirchner + Show 4 more

Open Access

https://doi.org/10.1177/2158244015590610

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Abstract

Hospital executives are key stakeholders in the hospital setting. However, despite extensive medical and nursing literature on the importance of end-of-life (EOL) care in hospitals, little is known about hospital executives’ perceptions of the provision of EOL care in their facilities. The objective of this study was to capture hospital executives’ perceptions of the provision of EOL care in the hospital setting. This descriptive, naturalistic phenomenological, qualitative study utilized in-person interviews to explore executives’ opinions and beliefs. The sample consisted of 14 individuals in the roles of medical center directors, chiefs of staff, chief medical officers, hospital administrators, hospital risk managers, and regional counsel in Arkansas, Louisiana and Texas. An interview guide was developed and conducted utilizing a global question followed by probes concerning perceptions of EOL care provision. Hospital executives acknowledged that EOL care was a very important issue, and more attention should be paid to it in the hospital setting. Their comments and suggestions for improvement focused on (a) current EOL care, (b) barriers to changing EOL care, and (c) enhancing provision of EOL care in the hospital setting. The findings of this study suggest that hospital executives although key change agents, may have insufficient EOL information to implement steps toward cultural and infrastructural change and should therefore be included in any EOL discussions and education.

Highlights

Hospital executives are key stakeholders in the hospital setting because of their considerable “administrative knowledge, clinical experience, and authority to effect change” (Song et al, 2010)
Despite extensive medical and nursing literature on the importance of EOL care in hospitals, little is known about hospital executives’ perceptions of the provision of EOL care in their facilities
The responses of hospital executives indicated that there is a need for focusing efforts on EOL care, and they identified some potential strategies to overcome barriers that were identified

Summary

Introduction

Hospital executives are key stakeholders in the hospital setting because of their considerable “administrative knowledge, clinical experience, and authority to effect change” (Song et al, 2010). With the aging of the population, provision of end-of-life (EOL) care has become a critical issue for these executives. 40% (~ 1,000,000/year) of all deaths occur in acute care settings, and 20% (~500,000/year) involve intensive care services prior to death (Angus et al, 2004; Lin, Farrell, Lave, Angus, & Barnato, 2009; Nelson et al, 2006). Many older adults experience prolonged hospital stays and invasive procedures before death, and these numbers are likely to increase. Without a better understanding of these key stakeholders’ views, effective implementation and management of EOL care in the acute care setting is not likely

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