Background Honouring Choices Wisconsin (HCW) is an initiative of the Wisconsin Medical Society whose mission is to promote the benefits of and improve processes for advance care planning (ACP) across the state of Wisconsin.

Aim To depict the process of implementing a systematic ACP approach in a large health region, and to make the experiences made available to other regional teams.

Results HCW now includes 23 hospital, clinical and health system participants, from large integrated systems to small rural hospitals. These organisations have trained over 250 facilitators through the Respecting Choices First Steps® model, facilitated more than 5000 conversations, and are moving toward advance care planning as a standard and routine part of care. HCW provides training, workflow assistance, consultation and support to ensure that ACP conversations are routinely offered, scheduled, conducted, documented, and entered consistently into the medical record. Participants share common documentation, measures, education materials and vocabulary, and collaborate across competitive lines. HCW has also developed community engagement strategies to improve and promote ACP across cultures, faiths and identities. Outreach includes ambassador programs, local facilitator pools and media, as well as video production with Wisconsin Public Television.

Discussion Recruiting strategies, fundraising, staffing, uniform vocabulary, appropriate messaging, the creation of collaborative learning communities, and culture change are all necessary to regional ACP implementation. With a comprehensive plan in place, leadership will emerge to help make implementation a success.

Conclusion Implementing ACP systems in multiple organisations across a large geographic area is a difficult but replicable process.