WIHI: Who’s Conversation Ready? How Health Care Can Respect End-of-Life Wishes

Date: October 24, 2013


  • Kelly McCutcheon Adams, LICSW, Director, Institute for Healthcare Improvement
  • Lauge Sokol-Hessner, MD, Attending Physician, Beth Israel Deaconess Medical Center (BIDMC)
  • Kate Lally, MD, Medical Director of Palliative Care, Kent Hospital and Medical Director, VNA of Care New England
  • Donna L. Smith, MD, MBA, Medical Director of Virginia Mason Clinics at Virginia Mason Medical Center

For over a year, building on others’ great work, IHI has been engaged in two groundbreaking initiatives to reduce the confusion and improve the circumstances that surround end-of-life care for most Americans in the US. The Conversation Project, founded in collaboration with IHI, is a grassroots effort to encourage and enable every one of us to discuss our wishes regarding end-of-life care with our friends and loved ones, long before there’s a medical crisis. The second initiative, Conversation Ready, is designed to capture the ways in which health care organizations can effectively respect and respond to these wishes. Ten organizations have been working with IHI to share and refine their best practices, and this WIHI checks in on what they’ve learned so far. 

Three clinical leaders from notable health care systems were on hand for this WIHI, along with IHI’s Kelly McCutcheon Adams. You’ll hear about an effort underway at BIDMC to embed a system of “4 Rs” into all patient engagements: Reaching out to learn a patient’s end-of-life preferences and values, followed by processes to Record and reliably Retrieve and Respect the information. Care New England has a number of innovations underway, including the designation of a “conversation nurse” who ensures that the goals of patients and families stay at the forefront of all end-life decision making. At Virginia Mason Medical Center in Seattle, the electronic medical record is becoming an effective home base for important and visible information about preferences regarding end-of-life care.



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