Background Kaiser Permanente Colorado (KPCO) is a nonprofit, integrated health care delivery system providing comprehensive health services to > 600,000 members. Regional data reveal only 1 in 6 members have documented advance directives in the medical record. The quality of conversations is inconsistent and poorly understood.
Aim Implement a systematic approach to ACP across all KPCO departments and care settings to better ensure patient-family values and treatment preferences are reliably known, documented, and followed.
Methods In 2014, KPCO initiated implementation of a nationally recognised, evidence-based and staged approach to ACP. Initial steps included: casting vision and leveraging leadership support; building critical infrastructure; engaging and training teams; and measuring progress.
Results To date, KPCO has built preliminary infrastructure and completed two waves of training. Faculty have certified 108 facilitators who have had nearly 800 conversations. Surveys show members are highly satisfied. Early shortcomings include: competing organisational priorities, time barriers, and inconsistent uptake of training. Successful teams share common features: an enthusiastic champion; ownership by the entire delivery team; middle management support and accountability; and a desire to learn and adapt.
Discussion Early implementation of systematic ACP shows great promise. Speed of spread is largely governed by the organisation’s willingness to invest in critical infrastructure, teams’ commitments to work reprioritization, and the cultivation of a learning environment.
Conclusion Adoption of an evidence-based, systematic approach to advance care planning in a large integrated health system is feasible. Success and speed of spread depend on widespread organisational commitment and adaptability.
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