Background The most effective efforts to implement advance care planning (ACP) have been systematic approaches. An ACP system is one in which there is an intentional design that addresses: 1) how and when patients are engaged in ACP; 2) how materials are designed; 3) who is capable to provide ACP services; 4) how to document care plans so that written care plans can be uniformly created and retrieved; and 5) how to hold health professional accountable so that care plans are used thoughtfully and correctly.

Aim Designing and implementing such an ACP system is complex and challenging. Once established, such ACP systems also need to be managed and re-evaluated in order to maintain their quality and effectiveness. This presentation will address what is necessary to maintain a high quality, ACP system once it has been established.

Discussion One of the main keys to maintaining the integrity and quality of an ACP system is to create a position of an “ACP Coordinator/Manager” who is responsible for managing and maintaining these systems. This person should have needed support from a multi-disciplinary, oversight committee and be a direct report to a senior administrator of the health organisation. This Coordinator needs to have an adequate budget to carry out the work as well as support from staff in medical records, information technology, and quality improvement. In addition the coordinator needs to have the capacity or resources to train staff to provide advance care planning and to maintain the skills and competency of these specialised staff.

Conclusion It is only through such ongoing management of such an ACP system that high quality outcomes can be maintained over time.