Rooted in the power of storytelling and fueled by a desire to improve health equity and foster meaningful connections, Johns Hopkins Bayview Medical Center’s innovative palliative care approach has earned industry-wide acclaim.
“We take care of folks who are seriously ill, sometimes at the end of life … and the way I see it is we enter into their stories, we help bring peace and presence in a time of suffering,” David Wu, the program’s director, told Palliative Care News.
Spanning inpatient, acute rehabilitation and outpatient settings, Bayview’s program recently received a Circle of Life Award at the American Hospital Association Leadership Summit in Seattle for making “significant advances to become a creative, substantive program that is deeply engaged in its community while pursuing excellence on several fronts.”
According to Wu, the hospital sees about 1,000 patients a year across the spectrum of serious illnesses; some of the most common diagnoses include sepsis, heart failure, Chronic Obstructive Pulmonary Disease, cancer and dementia.
Wu added that with only 10 members, the palliative care team is “small but mighty” and includes physicians, a nurse practitioner, a nurse social worker, a pharmacist, a chaplain and an administrator. In addition to seeing adult patients amongst the hospital’s roughly 450 acute beds, including adult rehab, the team has providers embedded in Bayview’s thoracic oncology clinic and ALS Center at Hopkins, Wu said.
To become a distinguished program, Bayview implemented the 3-Act Model, a narrative approach to goals-of-care conversations, developed the Palliative Interprofessional Collaborative for Action Research, a team designed to improve health equity, and launched a comprehensive staff wellness program called Thrive by Design.
While medical models traditionally center on doctors, Bayview’s 3-Act Model — led by Wu and inspired by Aristotle — focuses on understanding patients’ stories and the goals and outcomes they hope to achieve in their remaining time or through the course of their illnesses. Additionally, providers share medical opinions in “big picture terms,” Wu said, and work with patients to make shared decisions that align with their values and wishes.
“[Our program] is fiercely narrative and really focuses as much on the art of listening as the art of what we say,” Wu said.
The 3-Act Model has been woven into various other programs across Johns Hopkins, including medicine residency at Bayview and multiple fellowship programs, spanning geriatrics to oncology. Courtesy of funding from the Cambia Health Foundation Sojourns Scholar Leadership Award, the 3-Act Model is also being integrated into the Medical ICU at Hopkins Bayview.
Despite the program’s efforts, disparities remain among some groups within Baltimore’s community — namely Black residents who have long experienced structural racism and health inequities — and Johns Hopkins’ providers, Wu indicated.
“I saw that as a recurring theme in my work in a way that made me think, you know, ‘I think there’s a big gap here, and we need to understand that better,’” he said.
In 2019, leaders set up a collaborative with researchers from the Johns Hopkins School of Nursing and the Bloomberg School of Public Health to diversify patient-care perspectives.
The Palliative Interprofessional Collaborative for Action Research, or PICAR, partners with community members through various funded projects to integrate patients’ voices more effectively into palliative care using co-design methods.
One ongoing project seeks to better understand community members’ experiences with goals-of-care conversations and how the palliative program can redesign its methods to incorporate their input. A powerful theme to emerge from these conversations has been Black community members in particular underscoring the importance of having an advocate present in family meetings, Wu said.
“Now we’re trying to understand how to integrate that into our training and in our workflow so that we’re thinking about that,” he said.
While Bayview’s program continues to improve patient care strategies, a pervasive workforce shortage driven by clinician burnout looms in the palliative care industry, sparking investment in staff wellness programs.
To help combat the issue of burnout, Wu and his team met with a facilitator in 2019 and co-designed a wellness program called Thrive by Design. Wu said the program, which continually changes, addresses wellness as it relates to systems effectiveness, the team and the individual.
As part of this initiative, team members are encouraged to speak up if they must leave work early to attend a child’s sporting event, for example, Wu said, or if they’ve hit their limit of how many patients they can see in a day without feeling tipped over.
The wellness program also funds professional development opportunities for all interprofessional team members and includes a monthly session called Thrive by Arts, where team members switch off bringing in arts-based activities.
“This is where connecting at a heart level runs through everything we do,” Wu said.