For Change You Need a Roadmap: An Implementation Model to Improve Serious Illness Communication Across Health Systems (S860)

Abstract

1.Describe the three phases of a novel implementation model designed to achieve system-level improvement in serious illness communication.2.Apply incremental milestones derived from implementation science and organizational change to primary palliative care programs. Programs that aim to improve clinician-patient communication about values and goals (‘serious illness communication’) often focus on skills-training while neglecting the system in which communication takes place. Driving measurable improvements in communication requires organization-level change. Develop a novel implementation model for improving serious illness communication across a health system with practical steps for palliative care leaders. Researchers and implementers with the Serious Illness Care Program (SICP) at Ariadne Labs (AL) conducted a four-stage process: 1) Assembled an expert panel (n=10) to draft a theory of change. 2) Reviewed the implementation science and organizational change literature. 3) Synthesized learnings into key implementation features and engaged a designer to create a “roadmap.” 4) Refined the roadmap with feedback from its application in three systems. The ‘Implementation Roadmap’ has three phases: Prepare; Train/Coach; Sustain. Phase one creates a supportive environment for implementation. Actions include engaging leaders and colleagues to gain buy-in, assembling and training a team of champions (trainers + implementation team) with dedicated resources, selecting levers to support practice change, choosing pilot sites, and customizing the program (clinician training/coaching; workflow; EHR template; metrics for monitoring/evaluation). Phase two launches the program in pilot sites with rapid-cycle-improvement. The team trains early-adopter clinicians in serious illness communication who initiate the workflow, resulting in documented conversations with patients. The team uses metrics to track conversations, get feedback, and provide support to frontline clinicians. Phase three expands the program to new sites and plans for evaluation and sustainability, e.g. dashboards, automated triggers. An Implementation Roadmap provides incremental milestones and practical steps to support palliative care leaders interested in organization-level, measurable improvements in serious illness communication across populations and settings.