“We received few consults from the cardiology department. And the ones we were getting from the cardiac coronary care unit were really challenging cases. Patients were very sick and at the end of life. [It] made me think, ‘This is an opportunity to expand our relationship with each other and identify areas where we can prevent palliative care from getting involved so late in the game for patients who are so sick.’”
—Palliative care lead
Moving from needs assessment to implementation requires changes in current practices combined with time, patience, and receptive partners who recognize the need for improvement and are willing to implement the changes. The following implementation resources are based on the experiences of nine California public health care systems that participated in a California Health Care Foundation (CHCF) initiative to pilot generalist palliative care interventions in 2020–21. Through this initiative, the teams learned that change happens when highly motivated partners work together to solve a shared problem and implement processes that set clear goals, start small, and build on what works well.
Although each implementation process is unique, some common findings about structures and processes that can effectively support integration emerged from the CHCF initiative. The following information represents the collective experiences of these nine teams and can provide valuable insights to others regarding successful approaches for strengthening palliative care skills and approaches among all clinicians that care for people with serious illness.
- Creating the Plan: Describes how teams can go from needs assessment to making an implementation plan, including a template for defining specific objectives, activities, and approaches to evaluating impact.
- Key Ingredients: Describes five key elements that help teams successfully implement generalist palliative care programs or interventions.
- Resources Required: Describes what teams need from their health systems to implement these approaches.
- Measuring Impact and Making the Case: Describes approaches to evaluating impact and success, including sample measures, tools to assess progress, and strategies for engaging leaders to support the work.
