Organizations that make change happen are those that value innovation and provide the time and other resources needed to test and learn from changes. An important assumption of rapid quality improvement is that "frontline" providers and others are familiar with the "nuts and bolts" of a particular care system--and that they already know a good deal about what might work better. Often, by encouraging frontline staff to solve long-recognized problems, teams find solutions.
With an aim in place, teams can begin to recruit others to help accomplish their goals. Obviously, teams need to have the right clinical and administrative people involved to make change happen. But this team will require the support of a backup team—senior leaders and upper management can charter the team and approve of its aim, while the backup team needs to support the improvement team's effort, creating organization-wide support for the endeavor.
Improving end-of-life care requires interdisciplinary action. The physicians, nurses, social workers, chaplains, pharmacists, administrators, and others who care for patients must work together to achieve improvement aims. Teams need representatives from three different levels of the organization: system leadership, technical expertise, and day-to-day leadership. System leaders, such as vice presidents, need not be on the team, but they do need to care about and support the team's work. More than one person on the team may fit each dimension, and one individual may fill more than one role.
Improvement teams usually include the five to eight key participants in a care delivery issue. This number provides representatives from many disciplines, and enough people to share the work. However, there are not so many involved that meeting and decision making become difficult. Some programs seek ideas and input from patients and families, but including them on the team is usually not practical. Instead, teams have solicited ideas from patients by inviting eight or ten patients (or surrogates) to participate in a group discussion focused on improvements they would make in the organization's programs, services, and style.
This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.