With regard to our issues, health care professionals have a special obligation to take action to improve care for people dying with serious and complex illness. After all, no one defends present practices as the best that we can do. And professionals bear special responsibility to regulate their own practices and set standards.
On a few occasions, I have given a presentation that I call "Beyond Whining." I get my audiences of professionals to list the routine, repeated problems they see in the care of very sick patients. Usually, listeners fill a blackboard or an overhead transparency within a few minutes. Then, I take a clean blackboard or transparency and label it, "Solutions Already Tried." Remarkably, the audience has great difficulty stating anything they have tried, "beyond whining."
Obviously, this exercise gives way to a third list of "Improvements We Could Try." Responses come slowly at first, but then groups tend to pick up the pace. Audience members really get enthused in tossing out ideas for what to do. Next comes the hard work: "What We Will Do." This step requires a quicker, ad hoc assessment of what can be done, might work, and is important.
Often, I help break down the challenge to smaller tests: A few patients, one floor, a few nurses, this week. And I help the group postulate how they might measure and guide effects and what they might do to build upon the first work.
Teaching quality improvement is beyond the scope of this column. (For that, see our forthcoming book! Improving Care for the End-of-Life: A Sourcebook for Clinicians and Health Care Managers, from Oxford University, in early 2000.) However, the point that I really want to press is that most people in my audience have not really been seeing themselves as responsible for how their system works: or for its improvement. Somehow, a whole array of doctors, nurses, social workers and others have come to think of themselves as having done enough if they have complained. The time has come to get beyond whining and to learn how to engender and guide reform.
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