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Learning from the Closure of Clinical Programs: A Case Series from the Hospital Elder Life Program
Author(s) -
SteelFisher Gillian K.,
Martin Lauren A.,
Dowal Sarah L.,
Inouye Sharon K.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12274
Subject(s) - medicine , closure (psychology) , geriatrics , restructuring , documentation , revenue , staffing , nursing , medical education , finance , psychiatry , computer science , economics , market economy , programming language
Clinical programs in geriatrics face a challenging fiscal environment. Although recent research offers lessons from successful programs to help others like them sustain operations, it is not clear whether these lessons apply to programs that are beginning to fail. This study takes an approach that is frequently recommended, but rarely applied: examining failed programs to develop guidance for those at risk. It uses the example of an evidence‐based, cost‐effective geriatrics program that has been successfully implemented at more than 200 sites: the H ospital E lder L ife P rogram ( HELP ). Data come from 14 in‐depth interviews conducted between J anuary and M ay 2011 with staff and hospital administrators affiliated with the six fully operational sites that closed between 2006 and 2011. Using the constant comparative method, researchers identified major themes suggesting that former HELP sites closed because of two interrelated problems centered on a major financial crisis or restructuring at the hospital or health system level. First, the crisis created challenges, such as the removal of program champions and a new focus on revenue‐generating programs. Second, there were on‐going vulnerabilities that the crisis revealed but that had not previously posed a threat to program viability. These included problems such as insufficient support from physicians and nursing leaders and limited documentation of program outcomes. Results suggest that, to protect against closure, clinical programs need to prepare for major crises at the hospital or health system level by ensuring support from multiple senior champions, with a special emphasis on nursing and physician leaders.