Teams in any Breakthrough Series quickly learn that they need not engage in long and arduous studies to gather evidence that an organization needs to improve some aspect of the care it provides. What is more important is to be able to pinpoint why change is needed and to name or define the need quickly and in simple terms.
Teams find that there are two ways to avoid additional research and to demonstrate why change is needed: Either use existing information or gather a limited amount of new information.
Examples of existing information include:
Some teams find that they really have no readily available data - and that national data and studies are not sufficient evidence for change in their own organizations. In such situations, teams collect a limited amount of information to describe how their organizations care for the dying. Chapter 2 describes many tools and strategies for collecting limited data on patients or in areas in which problems are likely. Teams can conduct basic chart reviews or arrange postdeath interviews with families and loved ones. For instance, a team might interview five family caregivers and ask them about their loved ones' deaths: Were patients in pain? Did families know where to turn or whom to call for help? What was the worst thing that happened? What was the best?
Teams can also interview health care providers to learn more about their experiences in caring for dying patients. Can they describe the system from a patient's perspective? Do they believe that the care given is the best possible? How would they describe an ideal system? What would need to change to make their own system ideal?
Another way to identify opportunities for improvement is to compare an organization or community to programs that are widely viewed as being examples of superlative care. This book is full of stories about organizations that excel in some aspect of care for the dying. How far would one's organization have to push to provide a similar level of care? Breakthrough Series teams frequently found that the gap between what they believed to be true about their organizations and what was actually true was quite stark and pointed to an immediate need for change.
This kind of information should be summarized in a one-page document that can be used to convince others that change is essential - and that it will improve the way the organization cares for the dying.
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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 ].