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Outcomes 1. Describe the iterative process by which 2 interdisciplinary palliative care teams developed a quality improvement (QI) dashboard 2. Identify common facilitators and barriers to conducting QI work Background Quality improvement (QI) is recommended by multiple national palliative care guidelines. However, little guidance exists on how to execute this work in clinical settings. Aim Statement To assess the impact of a QI dashboard for interdisciplinary palliative care teams. Methods Two palliative care teams, one outpatient and one inpatient, at distinct academic medical centers, identified the need for a QI dashboard that was easily accessible by team members and promoted continuous, collaborative improvement. We modeled the dashboard after the “True North Board” from Lean methodology. After a series of brainstorming sessions, teams voted on improvement priorities and metrics that were meaningful and feasible. With the emergence of COVID-19 and physical distancing, both teams transitioned from a physical to an electronic dashboard that was shared virtually at team meetings. To refine the approach to QI after implementation of the dashboard, focus groups and individual semistructured interviews were conducted with eight outpatient and five inpatient interdisciplinary team members about the dashboard and barriers and facilitators to QI. Results Benefits of the dashboard included increasing awareness of QI work: “It makes explicit what matters most.” Regularly seeing data encouraged participation and a “growth mindset.” Facilitators of QI work included identifying a QI champion, aligning team priorities with those of the institution, and systematic integration of QI work into schedules. Common barriers at both sites were lack of dedicated time for QI, inadequate training, and difficulty measuring important aspects of care: “The ability to measure what matters most, and improve on that, feels like a juggernaut.” Additionally, changes in providers week to week lead to shifts in “what we care about and how things are done.” Conclusions and Implications Palliative care teams can use dashboards to promote engagement in QI in outpatient and inpatient settings. However, challenges in doing QI in palliative care persist, such as lack of time and training.
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CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S. METHODS: UW Medicine developed a strategy to implement a palliative care response for a multihospital health care system that incorporates conventional capacity, contingency capacity, and crisis capacity. The strategy was developed by our palliative care programs with input from the health care system leadership. RESULTS: In this publication, we share our multifaceted strategy to implement high-quality palliative care in the context of the COVID-19 pandemic that incorporates conventional, contingency, and crisis capacity and focuses on the areas of the hospital caring for the most patients: the emergency department, intensive care units, and acute care services. The strategy focuses on key content areas, including identifying and addressing goals of care, addressing moderate and severe symptoms, and supporting family members. CONCLUSION: Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.