title: Productivity in Pediatric Palliative Care: Measuring and Monitoring an Elusive Metric.
abstract: Workforce productivity is poorly defined in health care. Particularly in the field of pediatric palliative care (PPC), the absence of consensus metrics impedes aggregation and analysis of data to track workforce efficiency and effectiveness. Lack of uniformly measured data also compromises the development of innovative strategies to improve productivity and hinders investigation of the link between productivity and quality of care, which are interrelated but not interchangeable.
  
  
  
  To review the literature regarding the definition and measurement of productivity in PPC; to identify barriers to productivity within traditional PPC models; and to recommend novel metrics to study productivity as a component of quality care in PPC.
  
  
  
  PubMed®and Cochrane Database of Systematic Reviews searches for scholarly literature were performed using key words (pediatric palliative care, palliative care, team, workforce, workflow, productivity, algorithm, quality care, quality improvement, quality metric, inpatient, hospital, consultation, model) for articles published between 2000 and 2016. Organizational searches of Center to Advance Palliative Care, National Hospice and Palliative Care Organization, National Association for Home Care & Hospice, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, National Quality Forum, and National Consensus Project for Quality Palliative Care were also performed. Additional semistructured interviews were conducted with directors from seven prominent PPC programs across the U.S. to review standard operating procedures for PPC team workflow and productivity.
  
  
  
  Little consensus exists in the PPC field regarding optimal ways to define, measure, and analyze provider and program productivity. Barriers to accurate monitoring of productivity include difficulties with identification, measurement, and interpretation of metrics applicable to an interdisciplinary care paradigm. In the context of inefficiencies inherent to traditional consultation models, novel productivity metrics are proposed.
  
  
  
  Further research is needed to determine optimal metrics for monitoring productivity within PPC teams. Innovative approaches should be studied with the goal of improving efficiency of care without compromising value.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. Electronic address: erica.kaye@stjude.org.
authors.forename: Erica C
authors.initials: EC
authors.lastname: Kaye
authors.affiliation: Department of Radiology, Baptist Hospital, Memphis, Tennessee, USA.
authors.forename: Zachary R
authors.initials: ZR
authors.lastname: Abramson
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Snaman
authors.affiliation: Division of Pediatric Palliative Care, Akron Children's Hospital, Akron, Ohio, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Friebert
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Justin N
authors.initials: JN
authors.lastname: Baker
mesh_terms: D017598:Efficiency, Organizational / Q000145:classification / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000458:organization & administration; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D010166:Palliative Care / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration*; D011787:Quality of Health Care; D016526:Workload / Q000706:statistics & numerical data*
keywords: Palliative care; indicator; metric; pediatric; productivity; quality