Setting institutional standards for continuity is a basic step in bringing the issue to health care providers' attention. Standards may be very basic, such as ensuring that no more than two or three nurses ever visit one hospice patient at home, or guaranteeing that all patients will know who their primary health care providers are and how to contact them.
Another route to setting standards is to make promises to patients and families. Chapter 2 describes the promises some organizations are committed to making to patients and families. Early in the course of caring for dying patients, health care providers should aim to make promises to patients about the overall system of care: promises about a level of performance that all providers agree to maintain. Patients and families should feel confident that they will encounter few crises or emergencies which are not quickly resolved through the health care team and that when emergencies occur, those who attend to the patient will know and respect the patient's preferences.
What can you promise patients? Try some specifics. Can your organization make any of these promises to a seriously ill patient?
Making and keeping promises is a way to start making care more reliable for patients and their caregivers.
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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 ].