Improving end‐of‐life care for non‐cancer patients in hospitals: description of a continuous quality improvement initiative

Abstract

Aim and objectives. To describe a continuous quality improvement initiative that aimed to improve the quality of end‐of‐life care for non‐cancer patients. Background. In spite of the importance given to improving end‐of‐life care for non‐cancer patients in the context of national health policies as well as guidelines of various professional bodies, there is a gap between articulation of the need for better care and the actual care patients receive. By analyzing this gap, a better understanding of potential barriers to improving care may contribute to planning of services. Design. A continuous quality improvement initiative was developed in 2008 to document barriers encountered to quality end‐of‐life care for people with non‐cancer conditions and measures to overcome them were implemented. Method. The continuous improvement initiative consisted of a culture change in a hospital setting and development of guidelines and care protocols, with continual feedback to plan the next step, constituting in a series of incremental changes. Results. There was a reluctance to talk to relatives and patients about death. Staff held perceptions that such communications are mainly concerned with psychological, spiritual or religious matters that are best left to ‘trained’ personnel and that it equated with terminal care. The need to create an opportunity for patients and relatives to express their wishes regarding end of life situations was not well understood. Conclusion. We have demonstrated that this approach of continuous improvement through incremental change with feedback and continuing education is feasible. To achieve improvement, a culture change is needed in addition to distributing pathways and guidelines. Relevance to clinical practice. This integrative approach may be the way forward for the organisation of end‐of‐life care for patients with non‐cancer chronic diseases, rather than the setting up of many specialised palliative care teams.