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July 24, 2003 Mindy Carlson Rallying Points A program of Last Acts 1620 Eye Street NW Washington, DC 20006
Dear Mindy:
The Vermont ExCEL (Excellent Care at the End of Life) Coalition would like to utilize our statewide special certificate as outlined below. Our short term goal is to expand the coalition, clarify its operational, financial and governance structure and begin to accomplish components of our strategic plan.
We are applying for the certificate titled Strategic Planning, led by Kathy Brant. We would like to host this strategic planning summit on September 26th and 27th – with planning beginning in July and implementation running into December. The summit would last for one-and-a-half days, with the coalition steering committee meeting for the evening on the 26th and the entire coalition invited for the full day on the 27th. Estimated total attendance is 50 people. |
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Background:
ExCEL is a statewide coalition with a mission to ensure that excellent end-of-life care is available in all settings and all regions of the Vermont. Initially it was established as an expansion of the Vermont Medical Society (VMS) Ethics Committee. That committee developed a policy on physician assisted suicide in 1997. Because the primary component of that policy was educating physicians and others about end of life care, the committee added members from hospice, hospitals, the ethics network and nurses from around Vermont. ExCEL then identified a number of priority tasks and established task forces to work on those tasks, including:
In the 6 years since ExCEL formed, the coalition has made significant progress toward each of these goals, yet more needs to be done.
Earlier this year, ExCEL, to bring new energy and perspectives to the ongoing work of the coalition, began an initiative to expand the coalition to include broader representation from all regions of the state and to add representation from additional government entities, associations and private entities. In addition to the core membership of physicians, hospice, hospitals, regional coalitions, the Ethics Network and the Vermont Program for Quality, the group is in the process of adding representatives from the Office of the Attorney General, Agency of Aging and Disabilities, Department of Health, CDC, pharmacists, schools of nursing and medicine, religious communities, funeral directors, and nursing homes.
At the last statewide meeting held on June 12 and 13th of this year, the coalition, joined by many new members, identified five key functions and tasks that it wanted to work on. Education on end-of-life care topped the list. Coalition building, legislation, fundraising, and developing standards for evaluation/quality improvement were also identified as current goals. The members then spent time discussing concrete objectives to help reach those goals.
In the course of the discussion in the legislation group, it became clear that that the group felt that it would be important to take positions on behalf of ExCEL on current pending legislation, including bills on medical marijuana, the reorganization of the Agency of Human Services and for and against physician-assisted suicide. Because of ExCEL’s current structure as a part of the VMS Ethics Committee, there is no way for ExCEL to take positions separate from those of the Vermont Medical Society. This led to a discussion of the appropriate structure and governance for the coalition, as it further expands and refocuses. Issue to Address
ExCEL proposes to examine and if appropriate, redesign a fitting operational, governance, and financing structure and strategic plan for the expanding coalition.
Objectives
ExCEL would identify an appropriate sponsoring organization for the expanded coalition or would identify the specific steps necessary to establish an independent non-profit tax exempt organization.
ExCEL would identify monetary and in-kind funding sources sufficient to operate the coalition, or develop an interim and long term plan to secure those resources.
ExCEL would meet as an expanded group to develop or confirm a strategic plan based on the work done at the Lake Morey Conference held on June 12 and 13 of this year.
ExCEL would assign responsibility to members and task forces for accomplishing the above objectives in agreed-upon timelines.
While ExCEL could engage in this planning process on its own, it would benefit greatly from the expertise of the consultant in identifying models that would be successful for our coalition and brainstorming and guiding the process. We expect that representatives of groups for and against physician assisted suicide may attempt to steer the process and we need to be mindful of our core mission as we proceed.
ExCEL would establish a leadership structure and elect an interim steering committee to guide the organization through the transition.
Ability to Accomplish the Objectives
ExCEL has operated on a shoestring since its inception. The in-kind contributions of committed members, particularly the VMS, the Ethics Network and the Hospice Council have enabled it to accomplish a great deal. With this core of committed members who have strong statewide credibility, considerable experience working together and a an impressive track record of accomplishments, ExCEL is poised for future success, but would benefit from guidance and direction during this transition period.
Short term and long term impact of proposal
The short term impact of the proposal would be to expand the coalition, clarify its operational, financial and governance structure and begin to accomplish components of its strategic plan.
The strategic plan should be based on the five key goals identified at the statewide meeting in June, including: education, coalition building, legislation, fundraising, and developing standards for evaluation/quality improvement. Short-term objectives based on those goals include: clarifying the mission of ExCEL and creating a brochure to reflect that mission and to educate the greater Vermont population about ExCEL; continuing to identify and invite key parties to meetings and follow-up on interest; if deemed appropriate by the membership, taking a position on key bills pending in the legislature; sharing samples of evaluation tools that coalition members around the state are already using; and making sure we are pursuing available resources, such as grants from Rallying Points. The strategic plan should also take into account ongoing goals and projects previously identified by ExCEL, including: out-of-institution DNR orders, guidelines/standing orders in hospitals; palliative care certification; pain as a fifth vital sign; institution mission statements; and Vermont Ethics Network regional groups.
Long term, with a clear structure, and strategic plan, the coalition would be well positioned to continue its work identifying leaders in end-of-life care and educating groups to improve palliative care in all regions of the state. A clear strategic plan will help the coalition prioritize and accomplish the ongoing goals mentioned above. The coalition would expand work on broader statewide projects such as ensuring quality palliative care in the mental health and corrections systems. More concretely, the coalition also envisions maintaining a website to share best practices in pain and symptom management and examples of advance directives and advanced care planning from around the state.
How we will maintain the activity from the program
The coalition has strong and active membership from key players around the state. The Vermont Medical Society, the Hospice Council, and the Vermont Ethics Network are dedicated to ExCEL and the continuation of the coalition’s work. In addition, many regional partners from hospitals, hospices and other facilities are dedicated to the coalition. New partners who have just joined the coalition have brought new energy and enthusiasm. The coalition has a history of creating task forces that accomplish identified goals and objectives and a dedicated “steering committee” that will make sure the task forces are working effectively. However, the coalition is at a point to step back and decide the best location, structure and priorities for the coalition. Once the coalition has had help in the activity clarifying its operational, financial and governance structure, the members of the coalition are ready to implement these ideas and use this opportunity to help enhance the coalition’s ability to improve end-of-life care around Vermont.
Our anticipated expenses for this program include:
We look forward to hearing back from you soon regarding our application. Thank you for the opportunity to participate in this exciting program to strengthen our coalition.
Sincerely,
Madeleine Mongan Jessa Block
Vermont Medical Society P.O. Box 1457 Montpelier, VT 05601 802-223-7898 / 800-640-8767 802-223-1201 (fax) mmongan@vtmd.org / jblock@vtmd.org
Transition letter | Steering Committee | Policy: Position on Oxycontin, VMS Statement on Physician-Assisted Suicide | Funding | Minutes | Newsletters| Opportunity Awards | Rallying Points Application | Regional Reports | Articles | Links | 2006 Meeting Dates
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Email: mail@vpqhc.org
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Vermont
Program for Quality in Health Care, Inc. |
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