Palliative Care Transformational Project – Project Manager

Background

Médecins Sans Frontières (MSF) provides life-saving emergency relief and longer-term medical care to some of the most vulnerable and excluded communities around the world. As an independent medical humanitarian organisation, we deliver care based only on need, regardless of ethnic origin, gender, religion or political affiliation. Around 40,000 patients die in MSF’s projects every year. Despite the valuable efforts of Palliative Care clinicians working with MSF, we have not yet been able to address quality of death and dying for most of these. The success of a first phase of a multiphase transformational investment project has confirmed a need to introduce best practices around palliative care within MSF. These include an emphasis on quality of care at the end of life; the non-exclusivity between active and palliative care; the need for a holistic approach surrounding the dying process; the consequent importance of multidisciplinary work, as well as the risk of medical paternalism, and conversely, the importance of patient self-determination.

After successful development of a decision-making algorithm for medical managers, we have a good foundation to address the quality-of-care improvements for those dying in our facilities to transform to a decentralised capacity to tailor end of life care and support to all patients, their families and health worker staff.

The substantiated critical need and urgency for holistic palliative care of children, who constitute 75% of deaths in MSF health facilities, will be addressed. We also aim to solve the separation between active and palliative care, with uncertainty about when to initiate the latter. Multidisciplinary work will be developed, addressing the central role of doctors in the patient decision-making process, leading to an excessive sense of responsibility and a sense of exclusion by other health practitioners. In general, the perception, especially among doctors/clinicians, is that death is a failure and the result of therapeutic defeat, with the poor involvement of the patient and their family in decisions they make we hope to change.

Gap analysis/Assessment of current need

In previous years, MSF developed extensive guidelines, toolkits, and training materials for our medical managers. Despite these efforts, and a few successful pilot projects, palliative care needs remain unmet in most projects.

Pilot projects to date, required high intensity specialist input and produced poorly adaptable tools which are non-user friendly. We need high-standard tools to support our medical staff to prioritise quality of death services.

MSF wishes to integrate palliative care services in more structural and sustainable ways in all its projects to improve quality of death and dying.

Objectives

1. To guide and manage project team and stakeholders ensuring everyone aligns with project purpose.
2. To further refine, adapt, pilot, and endorse decentralised high-quality palliative care in MSF projects globally in line with decision making algorithm and holistic model of palliative care – minimum viable product (MVP).

Key Responsibilities

1 – Coordinate the activities of the project, including project design, developing methodology, overseeing implementation and change management.

• Ensure clear direction, coherence and good cooperation within the project team and alignment of the different stakeholders:
• Manage the budget, accountability and project progress through formal six-monthly status update reports: (to MSF UK, and to the MSF Transformational Investment Capacity (TIC) project and steering teams).
• Manage and report project risks in line with six monthly project status updates.
• Manage applications to ethics boards as needed.

2 – Collaboration on the development of a decentralised holistic Palliative Care model

• Oversee data engineer, design expertise and palliative care consultants to co-develop (further refine/design) the user-friendly decision-making algorithm and holistic model, (MVP) for palliative care, ensuring it is:
• Practical and feasible from a medical management and multidisciplinary team perspective.
• Adapted to the realities and unique field challenges of MSF programs considering level of services (home base, primary and secondary health care).
• Implementable in various care settings while aligning with the goals of Palliative care for patients with advanced illnesses.
• Evaluated, (MEAL) of improvement of Palliative care approach and provision.

3 – Networking and Collaboration for Palliative Care Support

• Create a network of collaboration and relationships with other organisations and providers to integrate quality of palliative care tailored support in MSF projects.
• Engage with external stakeholders to ensure shared learning, support, and resources that benefit the MSF palliative care – mentorship etc.

4 – Communication, dissemination and adoption of decentralised palliative care approach

• Direct and coordinate the creation of materials that can help raise awareness and communicate this unique approach to integrating patient centred palliative care:
• A film about MSFs approach to death and dying in humanitarian projects which aims to raise awareness around how suffering and dignity is included in our approach to quality of health care for patients and their families
• The stages of pre-production, making and editing of the film, and postproduction are optimised to ensure utility of the communication product
• Advice on communication planning and implementation is timely and informative to optimise investments in a potential next phase.

Expected Results/Outcomes

• Project leadership and management, in collaboration with nurse consultants, data engineer consultants and designers to provide to the Palliative Care Transformational project.

• With data engineer and eHealth team, steer and work together to design and develop the user-friendly application capacity, (decision making algorithm and MVP) accessible to MSF medical project leaders and multidisciplinary teams to help decentralised a holistic model of Palliative care.

• Development of models to clarify the requirements to decentralise and tailor Palliative Care MSF projects, focusing on multidisciplinary health programme staff.

• Partnerships created internal and external to MSF ensuring the availability of specialised support for projects.

• Work specifically with MSF UK and Manson Unit communications team for film production and other communication support and materials.

• Integration of evaluative measures, (MEAL) using project cycle routine metrics and indicators to measure improvement of Palliative care approach and provision.

Methodology

The consultancy will:

• Provide strategic leadership and management of the Palliative Care TIC Project aimed at designing, prototyping, implementing, and evaluating adapted and customisable solutions to integrate Palliative Care in all MSF Projects.

• Utilise all existing MSF capacities useful for the development of the project: eHealth, MSF UK communications team, audio visual and editorial and design capacities, Palliative Care working group, Health Advisors, Social Scientists, etc.

• Represent MSF with associations and institutions specialised in Palliative Care, particularly those located near MSF projects.

• Ensure specialised clinical support for all existing projects providing palliative care.

• Ensure we can evaluate improvement of Palliative care approach and provision.

Assumptions made / areas of uncertainty

MSF is a complex and ever-changing organisation, composed of a variety of medical and operational structures. The consultant will be required to navigate this complexity while creating and sustaining generalised buy-in for the project implementation.

In / out of scope

The initial focus of the project concerns patients who are dying and their families. Broader aspects of palliative care, although very important, are out of scope at this stage.

Deliverables and Deadlines

This second phase of this multiphase project deadline is 12 months, with six key outcomes:

1. Phase 2 Palliative Care Project concept and objectives are delivered with clear direction for phase 3 application established

Deadline 12 months

2. User-friendly application, (decision making algorithm and MVP) is designed, developed and accessible to MSF medical project leaders and multidisciplinary staff to help to decentralise holistic model of Palliative care.

Deadline 6 months

3. Models to clarify the requirements to decentralise and tailor Palliative Care in MSF projects, focusing on multidisciplinary health programme staff are tested, validated and embedded and communicated.

Deadline 12 months

4. Specialised Palliative Care support network prototypes developed for projects.

Deadline 12 months

5. Evaluative measures, (MEAL) using project cycle routine metrics and indicators to measure improvement of Palliative care approach and provision integrated.

Deadline 12 months

6. Using film and other resources, a communication and dissemination plan for marketing and further uptake of approach developed for phase 3 application.

Deadline: 12 months

Profile required:

• Medical or paramedical qualifications with expertise in palliative care.

• Excellent strategic planning and project management skills with ability to direct diverse activities and people.

• Prior experience working and collaborating with partners within cross cultural settings and humanitarian settings.

• Proven strategic and analytical thinking skills.

• Ability to lead a project through teaming approach.

• Ability to complete work within specific timescales.

• Proven networking and representation skills

• Prior work experience leading medical palliative care projects / activities.

• Clinical or managerial experience in a variety of palliative care settings (hospice, ambulatory, home-based, etc).

• Ability to develop and maintain relationships with high profile stakeholders in professional manner and in accordance with MSF principles.

• Strong communication and interpersonal skills with the ability to motivate and influence change.

• Fluent English language abilities

• Research experience is advantageous.

• Commitment to the aims and values of MSF.