Sourcebook : 2.3 How to avoid common problems

In health care, we have come to accept some very troubling practices. Think, for instance, about patients in the last phase of life who receive futile CPR or doctors who keep prescribing meperidine. Some aspects of the status quo never set off the alarms that they should. If a team cannot think of anything to improve about the way it cares for dying patients, team members are not looking critically at the status quo. Sometimes, under scrutiny, the status quo actually becomes shocking. Sometimes, just measuring the dysfunction in the status quo is so embarrassing that it motivates a readiness to change.

• Find the horrible stories. Ask two or three nurses or physicians to tell a terrible experience in end-of-life care and identify the arrangements in the organization's systems or routines that allowed the catastrophe to happen.
• Find the ideal. Ask staff members what would be their ideal for care at the end of life, and discuss what would have to change to make this happen in the organization.
• Ask the patients how it could be. Interview two or three families of patients who died in the system and ask what they thought of the care provided: What was helpful? Upsetting? Good? Bad? What could have made it better?

This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.