Sourcebook : Improving Care for the End of Life : 17.0 Conclusion

Do, or do not. There is no “try.”
- Yoda, The Empire Strikes Back

I think I can, I think I can . . .
- The Little Engine That Could

Getting Started

Between the guiding principles of Yoda and the Little Engine That Could, organizations dedicated to improvement will find reality: Improvement can happen, no matter where a group begins. Most Breakthrough Series teams found that opportunity abounded - and that the need for improvement was irrefutable. Many innovators in end-of-life care work for large organizations and institutions, in which change is under way - albeit at a relaxed or even glacial rate. For innovators intent to improve quality quickly and in ways that patients and families can experience almost immediately, this chapter describes proven methods for launching improvements or for accelerating the rate of change. The basic steps are these:

Find out where the problems are - name them!
Find colleagues willing to engage in improvement projects.
Inform institutional leadership.
Set an aim.
Choose a simple measure.
Start with small-scale changes most likely to be effective.
Start to test changes with small numbers of people.
Ask for help and support whenever necessary.

Innovators Need to Know
Do not be daunted by a few obstacles. The system we have created is the one in which the people we love - and we ourselves - will come to die. That alone should be reason enough (selfish or self-serving though it might seem) to do a better job. Establish a vision of a better system of care for people at the end of life, and continue to work toward it, even if that work seems incremental or inconsequential. Care for individual patients can be improved quickly - but the better system in which to provide the care will not appear overnight. Cultural change might take a generation to complete. But that change can begin today, one person at a time and one family at a time, until excellent and reliable care becomes the norm, not the result of some strange luck in which one happens to become gravely ill in the right city, with the right doctors, at the right time. Luck should not be the standard by which we measure health care - and organizations dedicated to improving that care soon discover that when luck runs out, patients suffer.

Innovators Need to Know

Do not be daunted by a few obstacles. The system we have created is the one in which the people we love - and we ourselves - will come to die. That alone should be reason enough (selfish or self-serving though it might seem) to do a better job.

Establish a vision of a better system of care for people at the end of life, and continue to work toward it, even if that work seems incremental or inconsequential. Care for individual patients can be improved quickly - but the better system in which to provide the care will not appear overnight. Cultural change might take a generation to complete. But that change can begin today, one person at a time and one family at a time, until excellent and reliable care becomes the norm, not the result of some strange luck in which one happens to become gravely ill in the right city, with the right doctors, at the right time. Luck should not be the standard by which we measure health care - and organizations dedicated to improving that care soon discover that when luck runs out, patients suffer.

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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 ].