The Common Sense Guide to Improving Palliative Care > Assuring Comfort > 5.4 Choosing a Team

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

Choosing a Team

Based on your project's focus, try to include knowledgeable providers who can help patients and their families cope with the array of symptoms that people face at the end of life. To be manageable, your core group should include five to seven stakeholders, people who are really invested in your aim and project.

Our hospital-based teams often report that success usually hinges on a physician "champion" who can provide clinical expertise and a link to senior management. Your champion need not be a physician, but it should be someone who knows the field, who has the clinical and administrative authority to implement a QI project, and who is going to be around for a year (or more) to see the work through. Beyond this, your team should be made up of those who "own the process" and "make things happen." Your team could be enriched with input from many experts: a geriatric psychiatrist, a palliative care physician, a hospital pharmacist, a nutritionist or dietitian, or a family member would each be able to offer insights and suggestions that your team could use.

Team Breathe-Easy

Team Breathe-Easy included two physicians and two nurses who had responsibilities in the hospital, home health care, and the COPD clinic. Once the core team had its aim, they sought support from others who worked with their patient population. Eventually, the team expanded to include a nurse from the community health program, a respiratory therapist, and a social worker. The group also turned to staff from the Ask-a-Nurse hotline, which served the entire suburban area, and others from pulmonary rehabilitation, smoking cessation, and the IT group. As its work progressed, the core team kept senior administrators posted on what was happening and what had yet to be done. A few months into their work, the team expanded to include a particularly engaged patient, a man who had been a construction engineer. His presence (while on oxygen) turned out to be quite motivating and kept the team focused on the patient perspective.

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