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January 15, 2015
End-of-Life Care And How Communities Can Become “Conversation Ready”
Dial In: 877.668.4493 Code: 661 876 023
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Dial In: 877.668.4493 Code: 665 524 975
3Madge KaplanDirector of Communications
Institute for Healthcare Improvement
For resources & slides, visit IHI.org/WIHI
Dial In: 877.668.4493 Code: 665 524 975
Madge Kaplan, IHI’s Director of Communications, is responsible for developing new and innovative means for IHI to communicate the stories, leading examples of change, and policy implications emerging from the world of quality improvement ― both in the U.S. and internationally. Prior to joining IHI in July 2004, Ms. Kaplan spent 20 years as a broadcast journalist for public radio – most recently working as a health correspondent for National Public Radio. Ms. Kaplan was the creator and Senior Editor of Marketplace Radio's Health Desk at WGBH in Boston, and was a 1989/99 Kaiser Media Fellow in Health. She has produced numerous documentaries, and her reporting has been recognized by American Women in Radio and Television, Pew Charitable Trusts, American Academy of Nursing and Massachusetts Broadcasters Association.
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Kate DeBartoloInstitute for Healthcare Improvement
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Dial In: 877.668.4493 Code: 665 524 975
Kate DeBartolo is the National Field Manager at the Institute for Healthcare Improvement (IHI). She designs and executes national field operations for IHI’s hospital-based work and for The Conversation Project. In this role, Ms. DeBartolo manages and cultivates relationships with statewide organizations that provide support to hospitals across the country working to improve health care and patient safety. She built and manages a similar field structure to support the many different regions and communities working on The Conversation Project as part of their end-of-life care efforts. Ms. DeBartolo started at IHI in 2007 as the Eastern Region Field Coordinator for the 5 Million Lives Campaign. Prior to joining IHI, Ms. DeBartolo worked as a grant analyst at The California Endowment.
You can reach Kate at [email protected]
Conversation Ready Principles1. Engage with our patients and
families to understand what matters most to them at the end of life
2. Steward this information as reliably as we do allergy information
3. Respect people’s wishes for care at the end of life by partnering to develop shared goals of care
4. Exemplify this work in our own lives so that we understand the benefits and challenges
5. Connect in a manner that is culturally and individually respectful of each patient
Connect
Engage Steward Respect
Exemplify
Additional resourcesMonthly Community Calls
– Next call on 1/21 from 3-4 pm ET– Email [email protected] for more information
Conversation Project Speaker Training Call– Offered quarterly– Next call on 1/28 from 3-4:30 pm ET– Email Mandy Ferguson at [email protected] for more information
Conversation Project Newsletter– Email Mandy Ferguson at [email protected] to receive our
newsletter
Jean AbbotUniversity of Colorado Hospital
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Jean Abbott, MD, is a Professor Emerita in Emergency Medicine and Attending Physician at University of Colorado Hospital for the past 29 years. She is a faculty member in the Center for Bioethics and Humanities at UC Denver and is a 15-year member of the University Hospital Ethics Committee and manages the Ethics Consult service. Dr. Abbott lectures locally and nationally on end-of-life and palliative care issues, “difficult” patients, and decision-making as well as a number of other issues related to clinical ethics in the hospital setting. A 39-year resident of the Boulder County community, Dr. Abbott became interested in The Conversation Project after its founder, Ellen Goodman, spoke about the initiative in Boulder County in May 2013. Dr. Abbott is now a co-founder of The Conversation Project in Boulder County, with a goal of encouraging meaningful conversations about our values and wishes when we approach our own deaths. The idea is to make all of us more comfortable with talking about these things, so that our values can be expressed and honored at the end of our lives.
You can reach Jean at [email protected]
Jean Abbott, MD, MH & Constance Holden, Rn, MSN
A GRASSROOTS ADVANCE CARE PLANNING EXPERIENCE:THE CONVERSATION PROJECT IN BOULDER COUNTY
Challenges• Funding for: Starter kits, Website, Administrative and
website support
• Requires volunteers with time, sustained interest
• Relationships with multiple hospices can be difficult to
negotiate
• Development of coaching resources slow
• Difficulty measuring success
• TCP is challenging to link to health care providers; pilots
underway
Lessons Learned• Don’t use slides or videos. Use stories, discussions,
sharing among participants. • 2 facilitator/speakers is helpful to balance backgrounds • Don’t lecture: encourage conversation, “playing” with
Starter Kit • Fiscal umbrella for tax-exempt donations very helpful. • A well-crafted website can be imperative; need to keep it
updated • Focus on getting the conversation started: Starter Kit is
helpful in starting the conversation…it is not the end.
Kimberlie FlowersElder Services of Merrimack Valley
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For resources & slides, visit IHI.org/WIHI
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Kimberlie Flowers, MSW, LICSW, is the Senior Outreach Social Worker at Elder Services of the Merrimack Valley (ESMV), a federally funded Area Agency on Aging (AAA) in Northeastern Massachusetts. She has been at ESMV for over 10 years, providing in-home counseling services and program development. Kimberlie was the primary developer of “Making Life Care Choices," a program designed to educate and activate elders to develop their End of Life Care plans. This program was developed as ESMV’s project in the IHI Conversation Ready collaborative. Kimberlie is a fellow in the Zelda Foster Fellowship in Palliative and End of Life Care at NYU.
You can reach Kimberlie at [email protected]
Key Changes
1. Our case managers and nurses are required now to ask about and document the HCP. This will be very helpful for our agency, but also facilitates information to the hospital for discharge purposes if a rehab is needed and the client is unable to communicate who their HCP is.
2. The personal experience for the staff to actually go through thinking about their own health care choices enhanced their understanding of what clients go through, and also gives them an appreciation for how difficult it can be to choose a trusted person, as well as to choose one family member over another.
3. The capacity to do individual counseling for people who do not feel prepared to make such decisions on their own has enhanced the agency’s ability to help our clients feel supported and educated, and provides the staff the peace of mind to know that if a client needs extra help processing these very important decisions, the staff member has a second level of response they can utilize. This has made people more receptive to engaging in the conversation at routine visits, because they are not concerned that they will hit a challenge they are not prepared to deal with.
Aim going forward
• Our original project plan was focused on client and community education, and we did not plan to also engage staff. This changed as a result of our participation with this CR program, where we heard about and saw the importance of staff involvement and understanding. This was a very good decision for our program, and will greatly extend the outreach, as staff is more comfortable with the process now.
• Over the next year we will implement the community education program and also the individual referral/counseling process.
• Our intention is to use existing staff and interns for the community and individual counseling, and implementation of this will be ongoing.
Helping peers: Area Agency on Aging or other community agencies
• Get Agency Leadership support. • Identify the reasons that this is a compelling need in your population.
– For ESMV the lack of rehab availability when a person does not have a HCP makes this a benefit to agency case managers and nurses .
• Train your staff first – They need 1st hand experience with it to understand the challenges and benefits of
Conversation Project and 5 Wishes.– Measure what you want to be done – monitor and audit.
• Use a pilot group for both the training and implementation to make sure the new process addresses how your business really works – people may be using your software in ways you don’t know.
• Allow for plenty of time to adapt – the training should allow time to think, talk and process on their own before the second session where you will talk about how to use this with clients.
• Be available to assist with speaking with clients/consumers if your staff person needs some back-up.
• People want to talk about this and the community agancies are the best ones to open up the conversation!
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Diana SilveyWinter Park Health Foundation
For resources & slides, visit IHI.org/WIHI
Dial In: 877.668.4493 Code: 665 524 975
Diana Silvey currently serves as Program Director for the Winter Park Health Foundation, a position she has held since 2007. In this role, Silvey is responsible for identifying best practices that promote one of the Foundation’s three focus areas: older adults. With a lofty goal of creating the healthiest elders by promoting physical and mental health and well-being through an elder-friendly environment, Silvey works with Central Florida non-profit organizations to support critical issues including falls prevention, chronic disease self-management, brain health, mobility, and aging in place. Silvey had over 20 years of health care and grant making experience prior to joining the Foundation. Silvey is active on many local boards, councils and advisory committees including the Senior Resource Alliance, Central Florida’s Area Agency on Aging.
You can reach Diana at [email protected]
Population of WPHF’s service area:
Winter Park 29,203Maitland 16,464Eatonville 2,229
47,896
Orange County 1,225,267
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The Human Thread
Thanks to everyone who makes WIHI possible!
Next up on WIHI:
January 29, 2015: When Everyone Knows Your Name:
Identifying Patients with Complex Needs
February 12, 2015: The Ups & Downs of Health Care
Costs and Reform. A discussion with Don Berwick and
David Cutler.
For more information, visit IHI.org/WIHI
