Hospital personnel engaged in end-of-life care understand the importance of honoring patients' wishes.

But all too frequently, this critical aspect of care suffers from shortfalls in communication and documentation. Trying to ascertain the wishes of dying patients sometimes may seem like a frantic race against time.

In an effort to improve this scenario, the Florida Hospital Association has partnered with the Institute for Healthcare Improvement to provide hospitals and communities with training designed to generate end-of-life care discussions early on.

Known as the Conversation Project, the program aims to prevent patients from dying in circumstances and surroundings they would not choose.

"As part of the work we are doing to improve quality and patient safety, a key piece of this is to ensure that the care we provide is patient- and family-centered, and that it honors patients' and families' wishes," says Kim Streit, the FHA's vice president for health care research and information services.

The Conversation Project began in 2010 when Pulitzer Prize-winning columnist Ellen Goodman joined with colleagues and concerned media, clergy and medical professionals to share stories of “good deaths” and “bad deaths.”

Kate DeBartolo, the IHI's national field manager for the Conversation Project, says the program is working around the country to attain a "cultural shift" that will encourage more people to talk about the kind of care they wish to receive in their final days. The effort includes spreading the word throughout communities, "where people live, work and pray," she says. 

The "flip side," DeBartolo says, is making sure the health care system is ready to receive that information. "It doesn't do us much good if we get people knowing what they want, and then they present in the emergency room and nobody can figure that out."

The Florida program includes hospital training that began in May and community training that will get underway later.

The hospital portion is being funded by Mission to Care, an initiative of the FHA's Hospital Improvement Innovation Network, and it is open to network-participating hospitals and other FHA members.

Those receiving the training participate in a six-part series of call-ins and webinars. The material includes five conversation-ready principles for improving end-of-life care:

  1. Engage with patients and families to understand what matters most to them at the end of life.
  2. Steward information about each patient's end-of-life care wishes as reliably as we do allergy information.
  3. Respect people's wishes for care at the end of life by partnering to develop a patient-centered plan of care.
  4. Exemplify this work in our own lives, so that we fully understand the benefits and challenges.
  5. Connect in a manner that is culturally and individually respectful of each patient.

"We have a diverse team of individuals from our system who are participating in the webinar," says Phyllis Baum, vice president and chief quality officer for Central Florida Health Alliance, which includes Leesburg Regional Medical Center and The Villages Regional Hospital. "We're looking to set our goals and encourage those conversations."

DeBartolo says IHI is planning a national call series on end-of-life care training in the fall. "I think a lot of health systems are realizing that there's a growing need to address this. This is something that everybody is going to be working on in the coming years."