The Institute of Healthcare Improvement (IHI) promote six leadership actions to honour preferences of patients with advanced illness

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 2 May 2011




(2011), "The Institute of Healthcare Improvement (IHI) promote six leadership actions to honour preferences of patients with advanced illness", Leadership in Health Services, Vol. 24 No. 2.



Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited

The Institute of Healthcare Improvement (IHI) promote six leadership actions to honour preferences of patients with advanced illness

Article Type: News and views From: Leadership in Health Services, Volume 24, Issue 2

Keywords: Health care, Strategic leadership, Medical ethics

In its recently revised Ethical Policy Statement “Decisions Near the End of Life,” the American College of Healthcare Executives (ACHE) urges healthcare leaders to address the ethical dilemmas and care issues surrounding death and dying and to promote public dialogue that will lead to awareness and understanding of end-of-life issues.

The National Priorities Partnership, convened by the National Quality Forum, estimates that more than one million people in the United States die each year without important palliative care services, and many patients and families endure prolonged and needless suffering and costly or ineffective treatments.

The alternative, according to the Partnership, is “healthcare capable of promising dignity, comfort, companionship, and spiritual support to patients and families facing advanced illness or dying, fully in synchrony with all of the resources that community, friends, and family can bring to bear at the end of life.”

Healthcare executives play a crucial role in making this vision increasingly a reality for more patients.

The IHI offers six specific recommendations to help executives more effectively honor the preferences of patients with advanced illness and their families.

These recommendations are built on ACHE’s Ethical Policy Statement and equally draw from the work of the Institute for Healthcare Improvement and the findings of the Expert Panel on End-of-Life Care in the Commonwealth of Massachusetts:

  • Action 1: Know your organization’s current performance. Understanding the realities of current practice in your organization concerning advanced illness is essential to charting a course forward. Some questions leaders might ask include: In what ways and how often do staff members inform patients with advanced illness and their family members of the full range of options for care, including the availability of palliative care?

  • Action 2: Set bold and measurable aims. Governance and executive leadership should set a bold aim to always honor a patient’s preferences at the end of life, providing no more care than desired and no less. Communicate this aim clearly to all staff members and explain why it is important, not only for patients and families but also for the organization.

  • Action 3: Prepare people for success. With the expectation set, leaders need to position their staffs (including all physicians) to be knowledgeable, competent and compassionate about the preferences of patients with advanced illness.

  • Action 4: Establish systems to support effective care delivery. Training, while important, is insufficient to support respectful practices 100 percent of the time. Patients, families and staff need a system they can rely on to reinforce what has been learned.

  • Action 5: Create measures and accountability. Establish specific measures for palliative care programs, and have your organization’s leadership team and the board review the data for these measures periodically.

  • Action 6: Remove external barriers. Barriers to effective, respectful care for patients with advanced illness include reimbursement systems that don’t cover hospice or palliative care and the absence of systems that enable clinicians to seamlessly address the palliative care needs of patients also receiving curative therapy. As healthcare executives experiment with accountable care organizations, medical homes, episode- or global-based payments, and other care and payment reforms, they should seek to identify mechanisms that support advanced illness planning and care delivery.

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