WIHI - A Podcast from the Institute for Healthcare Improvement
Health & Fitness:Medicine
Date: January 26, 2012
Featuring:
Most of us, if asked, say we care a great deal about will happen to us when we’re at the end of our lives. And yet, because we’d also rather focus on just about anything but death and dying, especially if we’re young and healthy or aging well, we’re all vulnerable to what can transpire by default: spending our last few days in an ICU, even if that’s at odds with our needs and preferences. The reasons for this disconnect are complex but often stem from the fact that individual and family decisions come late, are hashed out during a crisis, and in the very setting — a hospital — that promises high-tech and high-intervention cures for just about everything.
This scenario is slowly starting to change. There are now numerous efforts, some medically-based and many more that are grassroots, successfully promoting alternative perspectives and practices so that people who’d prefer to die at home can do so, and benefit from pain management and comfort over costly and heroic measures. But when you get right down to it, “dying well” is quite personal and, as such, needs to start in a personal place: by having a conversation with the people you’re closest to about how you want to die and how they, surviving friends and family members, can feel okay carrying out your wishes. Equally important: initiating or being open to that conversation, perhaps several conversations, when the circumstances aren’t so fraught and there’s time to digest and reflect and integrate the information.
All of this and more are what’s behind a new initiative getting underway in 2012 called The Conversation Project (TCP), which will be discussed on the January 26 WIHI. In collaboration with IHI, award-winning columnist and founding member Ellen Goodman and the project’s team members seek to create a cultural movement with one basic goal: to help every American say what they want at the end of life so that family members and medical providers have the guidance they need to respect those preferences. To get there, TCP wants to normalize discussions that can at times feel “too big to broach” by encouraging loved ones to talk to one another when circumstances aren’t so charged — when everyone is healthy — and the environment is more conducive to a good exchange. Around the kitchen table, for instance, rather than the hospital bed.
To launch a national campaign to bring about this change, Ellen Goodman and members of TCP have turned to many, many experts on death and dying, palliative care, and successful partnerships with patients and families, including two outspoken champions of change on the clinical and community side: Dartmouth’s Ira Byock and Gundersen Health System’s Bud Hammes. With IHI’s Martha Hayward also on board, WIHI host Madge Kaplan invites you to get an early look at a unique initiative in the making from the architects themselves. Increasingly, that’s going to become all of us —having “The Conversation” and telling others how it went and what we learned in the process. It’s hoped that many will benefit, including health professionals who often find themselves at a loss for words, brought up short by their training, and caught in the cross hairs of their own and others’ conflicting emotions and wishes.
WIHI: Harnessing Improvement to Reduce Diagnostic Errors and Delays
WIHI: Medicare Reimbursement and Meaningful Conversations about End-of-Life Care
WIHI: Accelerating Improvement: The Enduring Value of Collaboratives
WIHI: How Health Care Organizations Can Create Equity in the Community
WIHI: Relationships Count: Community Health Workers and Team-Based Care
WIHI: Getting Right Care, Right!
WIHI: What Students in the Health Professions Can Do for You... and Improvement
WIHI: Saving Lives by Design: Lessons for All from Ghana's Project Fives Alive!
WIHI: The Echo Effect of Project ECHO's Access to Specialty Care
WIHI: The IHI Triple Aim: Lessons from the First Seven Years
WIHI: Disability Competent Care
WIHI: Now What? Best Practices for Newly Diagnosed Cancer Patients
WIHI: Leaning In: Oregon's Coordinated Care Organizations
WIHI: Reducing Risks and Defects with Help from the Front Lines
WIHI: All Hands on Deck to Reduce C. Difficile
WIHI: The Managers and Management We Need to Improve Care
WIHI: Bundles and Buy-In for Value-Based Care
WIHI: Topping the Charts in Pediatrics and Adverse Events Reporting
WIHI: The Ups and Downs of Health Care Costs and Reform
WIHI: When Everyone Knows Your Name: Identifying Patients with Complex Needs
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