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L24 - Learning Lab: Coaching the Conversation about End-Of-Life Care
Harriet Warshaw, MSW
Jessica McCannon, MD
Kelly McCutcheon Adams, LICSW
December 8, 2013
Welcome!
These presenters have no disclosures
Disclosures
Please note that these presenters have nothing to
disclose.
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Objectives
Understanding the importance of Having The Conversation
from the Personal, Professional and System Perspectives
Review The Conversation Project/Conversation Ready
Project Initiatives
Identify the barriers to having end-of-life care conversations
and the strategies and tools available to promote action
Develop a conversation action-plan that includes both a
personal and professional conversation
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Today’s Speakers
Harriet Warshaw, MSW
Executive Director, The Conversation
Project
Kelly McCutcheon Adams, LICSW
Director, The Conversation Ready Health Care Community
Jessica McCannon, MD
Faculty, The Conversation Ready Health Care Community and Medical Director, The Conversation Project
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Agenda
1:00-1:15pm Welcome, Review of Agenda, Introductions
1:15–1:45pm The Conversation Project Overview
1:45-2:30pm Going Deeper: Having The Conversation In
Your Own Life
2:30-2:45pm BREAK
2:45-3:30pm Overcoming Professional Barriers
3:30-4:00pm Conversation Ready Overview
4:00-4:30pm Questions, Final Reflections, Evaluations
The Conversation Project
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The Conversation Project
Public Engagement Campaign
Expressed and Respected
Co-Founded by Ellen Goodman
Rooted in Personal Stories
Double Helix of Change
Change in Cultural Norm: from Not Talking to Talking
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Social Change 8
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TCP’s Strategy for Creating Cultural Change
Awareness: National media campaign
Accessible: Tools to help people get started
Available: Bringing TCP to people where they work, where
they live, and where they pray
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Media Coverage to Date
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Our Tools
Conversation Starter Kit
How to talk to your Doctor guide
Conversation Group Coaches guide
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New! New!
Field Strategy:
Working with the States, Counties and Cities
Monthly newsletter and call for Conversation Project
Communities
Identify and share best practices among regions
Design new business opportunities with regions
(currently: Atlanta, Hawaii, Portland…)
Boston Faith-Based Initiative
Death Over Dinner – Jan.1-7, 2014
A Catalyst for Change
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Picture of Boulder Team 13
Learning to Date
Universality of issue
Starter kit is very accessible
Having the conversation makes a major difference in
peoples’ lives
Not every conversation is perfect, need to start…..
Not everyone wants to have the conversation
Major impact on health care providers
It always too early until it is too late!
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The Gap
90% of people think it is important to talk about their loved
ones’ and their own wishes for end-of-life care.
27% of people have discussed what they or their family wants
when it comes to end-of-life care.
Source: The Conversation Project National Survey (2013)
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Going Deeper: Having the Conversation in your Own Life
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I want mine to be…
“I want to say goodbye to everyone I love, have one last look
at the ocean, listen to some 90’s music, and go.”
“A tingling sensation of sadness combined with gratitude
and overflowing love for what I leave behind.”
“Paced (and with enough space and comfort so that I can
make it a ‘quality chapter’ in my life.) I want time and help to
finish things.”
“Without suffering and without reproach.”
“Peaceful, pain-free, with nothing left unsaid.”
“In the hospital, with excellent nursing care.”
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The Starter Kit: Get Set 20
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The Starter Kit: Go 21
Debrief
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The Starter Kit: Keep Going
Overcoming Professional Barriers
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A memorable conversation
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How did you learn how to do this?
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How does this compare?
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Pie in the sky
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Conversation Ready
Perspective From the Field
"When you talk about dealing with people who are nearing the end of
their life and their family members, the work that we do stays with them
forever. It's the same way that people tell stories about the birth of their
children, they also tell stories about the death of a loved one. And I just
feel like you have one chance to do it right, and if we can work harder
and harder to get it right on each patient and family, then that's what we
have to do. People in the hospital recognize that, even people who may
not like working with patients at the end of their life, they understand
that when that's their task they have one chance and they need to get it
right that time. That's important.”
Julie Knopp, NP, Palliative Care, Beth Israel Deaconess Medical Center
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Conversation Ready
IHI is working with leading health care organizations in
the US and internationally to ensure the health care
delivery system is prepared to receive, record, and
respect patients’ wishes
The Pioneer Sponsor year spanned from October 1,
2012 to September 30, 2013
Pioneers collaborated with IHI to design and test the
Conversation Ready principles for use in their own
systems and for possible adoption across the US and
internationally
Now we are ready for Phase 2
Pioneer Sponsors
Beth Israel Deaconess Medical Center (Massachusetts)
Care New England Health System (Rhode Island)
Contra Costa Regional Medical Center (California)
Henry Ford Health System (Michigan)
Mercy Health (Ohio)
North Shore‒Long Island Jewish Health System (New York)
St Charles Health System (Oregon)
UPMC (Pennsylvania)
Virginia Mason Medical Center (Washington)
Contributing Sponsor: Gundersen Lutheran
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Current Conversation Ready Principles
1. 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. Partner with our patients to develop appropriate 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
Engage Steward Partner
Exemplify
Connect
Examples from the Field
1. Engage with our patients and families to understand
what matters most to them at the end of life:
• St Charles – Heart Failure University
• Mercy and Contra Costa – Primary Care appointments
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2. Steward this information as reliably as we do allergy
information
• Virginia Mason – Advance Directive Note Type
• BIDMC – IT revision
• NSLIJ – MOLST work with skilled nursing facilities
Examples from the Field
Examples From the Field
3. Partner with our patients to develop appropriate goals of
care
• Care NE – Conversation Nurse
• UPMC – Partners Program
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Examples From the Field
4. Exemplify this work in our own lives so that we
understand the benefits and challenges
• UPMC – Day of Conversation
• Mercy – Employee Focus Groups
• BIDMC – Talk Turkey and Story database
Examples From the Field
5. Connect in a manner that is culturally and individually
respectful of each patient
• Henry Ford – faith community summit
• Contra Costa – medical interpreters
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Conversation Ready Health Care Community:
Schedule
Nine month learning and innovation community with
approximately 35-40 organizations
Schedule:
– Pre-work: January 2014
– Virtual Learning Session 1: February 2014
– In-person Learning Session 2: Spring 2014 (Boston – dates TBD)
– Virtual Learning Session 3: October 2014
Ongoing support through faculty, listserv, extranet, change
package, measurement strategy
What Participants Can Expect
Participation in a vigorous and innovative learning
community
Coaching to accelerate rapid-cycle testing of the change
package
Peer-to-peer learning with colleagues around the country
(and hopefully around the world)
Teaching from expert faculty
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How to Learn More
http://www.ihi.org/offerings/MembershipsNetworks/collab
oratives/ConversationReadyCommunity/Pages/default.a
spx
Call or email:
Kelly McCutcheon Adams, LICSW, Director, IHI
Ph: 802-879-2905
Next Steps: Leaving in Action
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Next Steps…
What can you do by next Tuesday?
Have the Conversation: Personally & Professionally
Share Starter Kit & other tools with family and loved ones.
Share your stories on our website.
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Discussion Reflections Questions?
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