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

Sourcebook : Improving Care for the End of Life : 2.12 Making and Keeping Promises: Satisfaction Guaranteed?

At first glance, this new approach to change and improvement may seem daunting-- - or it may appear to be too far from the kinds of change institutions usually practice. But because care of the dying is known to be so poor, and has been so for many years, teams might find solutions just by taking a fresh look at an old problem. One way to do this is to consider making promises to patients and families, promises about how a patient dying in the health care system can expect - and therefore demand - to be treated.

A Vision of a Better System

A better health care system for the end of life would follow through on these seven promises:

  1. Good medical treatment:You will have the best of medical treatment, aiming to prevent exacerbations, improve function and survival, and ensure comfort.

  2. Never overwhelmed by symptoms: You will never have to endure overwhelming pain, shortness of breath, or other symptoms.

  3. Continuity, coordination, and comprehensiveness: Your care will be continuous, comprehensive, and coordinated.

  4. Well-prepared, no surprises: You and your family will be prepared for everything that is likely to happen in the course of your illness.

  5. Customized care, reflecting your preferences: Your wishes will be sought and respected and, whenever possible, followed.

  6. Use of patient and family resources (financial, emotional, and practical): We will help the patient and family to consider their personal and financial resources, and we will respect their choices about the use of their resources.

  7. Make the best of every day: We will do all we can to see that you and your family will have the opportunity to make the best of every day.

This sourcebook is full of examples of how others improved practice by reconsidering what they were doing, having a vision of how to do it better, and promising themselves, if no one else, that they would do a better job.

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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 [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

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

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