Improving Care for the End of Life, Online Edition The Palliative Care Policy Center

Sourcebook : Improving Care for the End of Life : 2.4 Importance of Interdisciplinary Teams

Essential areas of expertise in a good team.Improving end-of-life care requires interdisciplinary action. Teams need expertise of three types: system leadership, technical expertise, and day-to-day leadership. System leaders, such as vice presidents, need not be on the team, but they do need to care about and support the team's work. More than one person on the team may fit each dimension, and one individual may fill more than one role.

Improvement teams usually include five to eight key participants in a care delivery issue. This number provides representatives from many disciplines, and enough people to share the work. However, there are not so many involved that meeting and decision making become difficult. Some programs seek ideas and input from patients and families, but including them on the team is usually not practical. Instead, teams have solicited ideas from patients by inviting 8 or 10 patients (or surrogates) to participate in a group discussion focused on improvements they would make in the organization's programs, services, and style.

The following table highlights the key reasons for including different staff from all levels of the organization, and the skills and resources they can bring to improvement projects. Assisted living facilities, which may not have on staff all of the people needed to create change might look to communities for links to pain clinics, hospice programs, or care managers.

System Leadership Vice President for Patient Services, Director of Palliative Medicine
  • Enough clout to institute change
  • Authority to allocate the necessary time and resources
  • Power in all areas affected by the change
Technical Expertise Physician Champion
  • Knows the subject intimately
  • Understands the care process
  • Has expertise in improvement methods to help the team determine what to measure, assist in the design of simple, effective measurement tools, and provide guidance on the collection, interpretation, and display of data.
Day-to-Day Leadership Nurse Manager, Pharmacist, Clinical Social Worker
  • Drives the project
  • Assures that tests are implemented and data are collected
  • Understands the details of the system and the effects of making change(s) to it.
  • Works effectively with the physician champion(s) and the system leader(s).

A physician may be the team leader but usually is not. Having a physician to explain to other physicians the work and toals of the improvement efforts can generate wider support and acceptance for the project.

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ ].

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