The Common Sense Guide to Improving Palliative Care > 1.1 An Orientation

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

An Orientation

Healthcare is changing for the better for patients nearing the end of life. Changes being tested and tried by organizations nationwide demonstrate that we can and must make life better for people with advanced, and eventually fatal, illnesses. Using a rapid-cycle approach to quality improvement (QI), hundreds of teams have found that straightforward approaches to complex problems can actually lead to improvements for patients and families. In the midst of the physical and emotional suffering that often accompany dying, these teams have found that they can comfort the sick; that pain and a score of other symptoms can be managed; that advance care plans can be located and honored; that transfers can be almost seamless; and, certainly, that human relationships can be strengthened. Although it may take some time to design and implement a program of one's own, the process is easy to understand and follow; it is simple enough to try one or two changes with one or two patients and then go on from there, as other groups have. For instance, consider the following examples.

These groups sound so good, you might think that we made them up. But in fact, people like you, eager to improve how palliative care is done, created these stories with hard work and dedication. Like them, you too can use rapid-cycle QI methods to make substantial changes. You can use these methods in any healthcare setting, and you can do so quickly, effectively, and efficiently. This manual shows you how to jump start QI, no matter where you work, so as to improve your organization's practices. We focus on patients with advanced illness and those coming to the end of life, though the QI method works in other populations as well.

Everyone wants to improve healthcare, and many even have great ideas for doing so. Sometimes, the toughest part can be figuring out where to start and forging the will to get changes underway. We will show you how to develop a QI project, measure what you are doing, figure out whether what you have tried really leads to improvement, and sustain the improvements that you achieve.