The Common Sense Guide to Improving Palliative Care > 1.5 The Power of Promises

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

The Power of Promises

In the care of very sick people, the error is not that we never provide good care; it is that we do not always provide good care. One particularly strong way to envision a really good care system is to imagine a clinician sitting down with a patient and family who face a serious, and eventually fatal, condition. What would the patient and family want the clinician to be able to promise, right through to the end of life? You can cover most of what people in the last phase of life want from their healthcare in these seven promises (Lynn, 2004, p.22):

  1. evidence-based, appropriate medical treatment;
  2. no overwhelming symptoms;
  3. continuity of comprehensive care;
  4. planning ahead for complications and death;
  5. care customized to the patient's preferences;
  6. care adapted to serve the patient's family;
  7. help to live as fully as possible.

In deciding on their improvement priorities, many teams find it useful to ask, "What keeps us from making these promises?" The idea of keeping promises is highly motivating, and it targets all goals toward high reliability.

Others have done it, and you can, too. As you improve the ways in which your organization cares for patients and families, we ask you to take action to change the larger system of care, not only in your community but nationally, too. As you know, the care system too often fails patients and families. This guide will enable you to become a force for change in how we care for people with advanced chronic illness and near the end of life.

Figure 1.1. Diagram showing what good care systems should promise.

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Figure 1.1. What good care systems should promise