A local Southern California hospital serving 5.5% of Los Angeles County’s population recently conducted a triennial community needs assessment and some of the significant community health needs identified were:

■ obesity/overweight,

■ diabetes,

■ cardiovascular disease,

■ hypertension, and

■ cholesterol.

Hospital leadership identified an opportunity to better serve the community, particularly patients with chronic illnesses, and prevent medical readmissions. A private foundation was approached about funding a project to improve patient and family decision-making about health issues and medical crises. The primary grant deliverable was to increase the number of patients (over baseline) who completed advance care planning. The ultimate goal was to reduce unnecessary readmissions for persons with chronic illness by leveraging 24-hour community support for them at home.

The DNP-prepared nurse practitioner (NP) hired to the palliative care team is having successful advance care planning conversations with patients about their chronic conditions, setting goals for overall wellness, and teaching them how to manage a declining chronic disease trajectory. T he patients and families are responsive and express gratitude that someone is talking with them about quality of life.

However, the NP is worried that he may not be able to meet the grant deliverables.

After the multiyear grant was awarded, some unanticipated issues arose during the project execution phase, including turnover of key hospital personnel who were grant team members, delays in onboarding additional NPs, difficulty obtaining patient-level and aggregate data from the hospital’s data systems, conflict over patient care goals between attending physicians and the project medical staff, and lack of willing/able 24-hour–response community resources, such as home health agencies to respond to the patient’s home rather than using an on-call phone-triage service.

The first-year grant report is due in a few months, and the DNP is unable to tell whether efforts have been successful in reducing readmissions; he is concerned about the resistance of the medical staff and lack of 24-hour response community resources.
He makes an appointment to discuss this with the grant project manager and hospital administrator, who is the project’s executive sponsor.

a. In your opinion as a DNP, is this grant-funded project salvageable?

b. What steps should the DNP take to get the project on track and what resources at the hospital can he employ to assist with this project?

c. Who are the key stakeholders that the DNP needs to engage, what should be expected of them, and what does the DNP need from his executive sponsor and the project manager?