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In this report clinicians at nine hospitals describe how they and their colleagues established formal programs of palliative care. Clinicians and managers at each of these institutions negotiated innovative clinical and institutional arrangements and made effective use of the reimbursement policies of public and private payers. Each of these programs of palliative care is a product of the organizational culture of the institution in which it operates.

The nine stories also have common themes. Christine K. Cassel, Professor and Chair of the Henry L. Schwartz Department of Geriatrics and Adult Development at Mount Sinai School of Medicine, who helped to initiate and lead the process that produced this report, describes lessons from the short history of these programs in her introduction. We share her opinion that the success of this report depends on whether it “encourages clinicians who are starting, or who hope to start, palliative care programs in their own institutions.”

The report is one result of an ongoing collaboration between two foundations that have similar missions and complementary operating styles. The Milbank Memorial Fund works with decision makers in the public and private sectors to develop better policy for the care of patients, the health of populations, and the organization, financing, and governance of health services.

The Robert Wood Johnson Foundation (RWJF) has as its mission improving the health and health care of all Americans through funding for demonstration projects, training, educational and communications activities, policy analysis, and research. One of its goals is to improve care at the end of life; to that end, RWJF has funded the Center to Advance Palliative Care at the Mount Sinai School of Medicine in New York. The Center’s purpose is to serve hospitals and health systems interested in developing palliative care programs at their institutions.

The authors of the studies are identified below. G. Robert D’Antuono, Deputy Director of the Center to Advance Palliative Care, and Beth Demel and Grace Moon, both health policy analysts in the Henry L. Schwartz Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, assisted in the preparation of these stories and in compiling the data that follows each of them.

Daniel M. Fox
President
Milbank Memorial Fund

Rosemary Gibson
Senior Program Officer
Robert Wood Johnson Foundation