The Common Sense Guide to Improving Palliative Care > 1.9 Looking for Improvement Everywhere

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

Looking for Improvement Everywhere

Improvement in care for advanced illness and the end of life will ultimately require multiple perspectives, many approaches to change, and the joint efforts of biomedical researchers, policymakers, healthcare professionals, and the public. However, reform will almost certainly begin with you: a healthcare professional, paraprofessional, administrator, or chief executive oficer, someone who realizes that what is going on should not go on, and someone who is willing to take a chance on change.

Most of us alive today — you, and those you love — are lucky. Unlike previous generations, the majority of us will grow old and die late in life of chronic illness. As we age, we will turn to the healthcare system for information, care, and support. In its current setup, that system will fail. Those with advanced chronic illness or near the end of life suffer from pain and other physical symptoms, from fear and confusion, from isolation and uncertainty. We know that this is so, and we know that we can change it. We should start now, with four or five patients in our care, by picking something we can make better. We promise that you can and will and that your efforts will lead to better care — and better lives and deaths for your patients. We have an unprecedented opportunity to improve the system, to make a difference in how people die, not only in the next decade, but in the next year. Such opportunities to make a difference are rare, and if we do not make the most of them now, we will find ourselves dying in the wasteful and unreliable system we allowed to drift along.

Give Them Something to Talk About

Better care for advanced chronic illness and the end of life demands profound changes in how we design, finance, and deliver healthcare for people with advanced chronic and life-threatening illnesses; first, it demands leaders who can envision better care and take steps to achieve it. Dividing the "dying" from the living and providing palliative care only to those who clearly are dying is an approach that prevents us from developing comprehensive systems of care for all seriously ill patients as they move from health to disability and eventual death.

Rapid-cycle changes for QI can create real and lasting improvement in most organizations in less than one year. Many healthcare organizations have used this approach to make significant strides in how they care for patients with advanced chronic illness and near the end of life. You will, too, so let us get started.