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Innovations in End-of-Life Care: Where the Chart Meets the Heart

By Kimberlydawn Wisdom | Thursday, March 24, 2016

Innovations in End-of-Life Care

It can be daunting to make improving end-of-life care a high priority with all the challenges of the current health care environment. But there are many reasons to do so.

For example, are people getting quality care if most of them spend their final days in the hospital, when they’d rather be at home? Estimates suggest that 15 to 20 percent of Medicare patients spend their last days in intensive care units, which can cost $10,000 or more per day. Medicare data indicates that the US spends billions of dollars in health care costs in the last two months of life.

Henry Ford Health System just celebrated our 100th anniversary. As our name implies, we have a long history of innovation. It’s part of our DNA. In the last few years, some of our innovations have focused on improving end-of-life care, and becoming Conversation Ready.

At Henry Ford, we’ve taken an approach to improving end-of-life care that some may consider unconventional.

Wellness as a Lifelong Journey

At Henry Ford, we try to ensure our health care services promote our patients’ broader life goals. This approach requires we address not only the treatment of disease but also the promotion of health and wellness. Through our Henry Ford LiveWell Center of Excellence, we often describe wellness as a lifelong journey and end of life as an important part of that journey.

This means giving all of our health care professionals the license to think outside of the box — or outside of the bed (as I heard John Bufford, the former CEO of Truman Medical Center, once say) — to find ways to make the patient experience as positive as possible given the circumstances.

One example of how we put this into practice involved a terminally ill woman who expressed her wish to see her grandchild before she transitioned. But the grandchild had not yet been born. A very astute nurse arranged for this dying woman’s daughter to come to the hospital for an ultrasound so the patient could “meet” her grandchild virtually. It was a profound experience for all involved. Just imagine the memories that family will have forever because that nurse understood her patient’s wishes beyond medical care in the midst of an emotional time for this family.

When medical interventions have reached their limits, there are many ways we can still provide a meaningful experience for the patient and their family and friends. To do this, we have to shift our thinking about what it means to care for patients once a cure is no longer possible.

Engaging the Faith Community

Another way that we promote wellness for patients and families is through faith. We invite representatives from the many faith traditions in our local community to join us in a dialogue around end-of-life, palliative, and hospice care.

Henry Ford Health System has worked for decades with the faith community, and, of course, we have offered palliative and hospice care for a long time as well. But before the IHI Conversation Ready program challenged us, we had never brought the two communities together.

Initially, we were not at all sure these groups would find value in talking to each other about end-of-life care. We were delighted to learn that they not only wanted to have “the conversation,” but they wanted to have it over and over again and put their new knowledge into practice.

We bring health professionals together with representatives from the five largest faith traditions in the Detroit area. Sometimes, the faith leaders present and the clinicians listen. Other times, the clinicians present to the faith leaders. 

This partnership has been invaluable. We are always learning from each other — about the intersection of medicine and spirituality, how to be even more compassionate experts at that intersection, and how to ensure that our patients have an experience that fosters wellbeing. It’s truly where the chart meets the heart.

We’ve had five sessions to date, and the feedback has been overwhelmingly positive. We now have waiting lists for every session. In fact, on the snowiest day in decades in Detroit, we had well over 200 people attend!

As a result of this effort, we’ve developed many free tools to help support open communication about end-of-life issues. We have a number of resources, including videos to help Christian, Muslim, Sikh, or Jewish faith leaders facilitate discussions around end-of-life planning. We also have online user-friendly Advance Care Directive planning documents in English, Arabic, Bengali, and Spanish.

Putting Patients at the Center

When a person has a terminal illness, health professionals must do their best to provide a psychologically and emotionally healing experience for patients and their families.

Bringing faith leaders and faith traditions into our organization has given us the tools and experience to achieve our mission: to improve people’s lives through excellence in the science and art of health care and healing.

It’s part of a culture shift toward better patient-centered care that has evolved over many years. We’re delighted to continue on this wellness journey for those we are privileged to serve. We hope that wellness is not a destination for just a few, but a lifelong journey for all – no matter how long or short that journey may be.

Kimberlydawn Wisdom, MD, MS, is Senior Vice President of Community Health & Equity and Chief Wellness & Diversity Officer at Henry Ford Health System (HFHS) in Detroit, Michigan. HFHS was a Conversation Ready Pioneer Sponsor.

 

You may also be interested in:

IHI White Paper – "Conversation Ready": A Framework for Improving End-of-Life Care

IHI Virtual Training: Is Your Organization Conversation Ready?, one of the benefits included in the Passport to IHI Training membership.

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