Leadership for better end of life care in current · PDF fileLeadership for better end of...
Transcript of Leadership for better end of life care in current · PDF fileLeadership for better end of...
Hong Kong Hospital Authority Convention: May 2016
Leadership for better end of life care
in current times
Professor Bee Wee
National Clinical Director for End of Life Care, NHS England
Consultant in Palliative Medicine, Oxford, UK
www.england.nhs.uk
Changing
demographics
Rising
expectations
Diminished
financial
resources
Changing
workforce
Frequently
changing
‘system’
Subspecialisation
www.england.nhs.uk
Changing
demographics
Rising
expectations
Diminished
financial
resources
Changing
workforce
Frequently
changing
‘system’
Subspecialisation
Increasingly
complex
world
www.england.nhs.uk
Changing
demographics
Rising
expectations
Diminished
financial
resources
Changing
workforce
Frequently
changing
‘system’
Subspecialisation
Desire and commitment
to provide dignified and
compassionate care
www.england.nhs.uk [email protected]
www.england.nhs.uk [email protected]
www.england.nhs.uk
What enables transformational change?
1. People – question the norm: ‘rocking boat’ but staying on board
2. Leading from the edge – moving change processes to, and from, ‘the edge’
3. From ‘diagnostic’ to ‘dialogic’ – changing conversation and mindset
4. Curators of knowledge – greater focus on ‘tacit knowledge’ (know-how)
5. Bridge building to connect the disconnected
www.england.nhs.uk
Quality improvement
• Quality improvements – look through the patient’s
eyes
26/05/2016
www.england.nhs.uk
Patient and Family Centred Care
Select a care experience
Establish a guiding council
Evaluate current situation – through eyes of patients and families
Develop PFCC care experience working group
Creating shared vision through written ‘ideal experience’
Identify PFCC improvement projects and form project improvement teams
http://www.kingsfund.org.uk/projects/pfcc
https://www.pointofcarefoundation.org.uk/our-work/patient-family-centred-care/
www.england.nhs.uk
Quality improvement
• Quality improvements through the patient’s eyes
• Review evidence – revise what we do
26/05/2016
www.england.nhs.uk
Quality improvement
• Quality improvements through the patient’s eyes
• Review evidence and revise what we do
• Take all evidence into account
www.england.nhs.uk
0%
10
%20
%30
%40
%50
%60
%70
%80
%90
%10
0%
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
~~
~C
AN
CE
R~
~~~
Hig
gin
son
et a
l. 20
10
Ingle
ton
et
al. 2
00
4
Koe
kko
ek e
t a
l. 2
01
4
McC
all a
nd R
ice
200
5
Pea
cock e
t al. 2
011
Th
om
as e
t a
l. 2
004
Wa
gho
rn,
You
ng
an
d D
avie
s 2
01
1
We
ir e
t a
l. 2
011
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
~~
MU
LT
IPLE
~~~
~
Arn
old
et
al. 2
013
Ca
pe
l et
al. 2
01
2
Co
x e
t al. 2
011
De
pa
rtm
en
t o
f H
ea
lth 2
01
2
Fis
he
r an
d D
uke
20
10
Fra
me
et
al. 2
01
2
Ge
rra
rd e
t a
l. 2
011
(2
00
7)
Ge
rra
rd e
t a
l. 2
011
(2
00
9)
Gra
nde
et a
l. 20
09
Ha
ll 2
00
7
Ho
ldsw
ort
h a
nd F
ishe
r 20
10
Hu
nt
an
d A
ddin
gto
n-H
all
201
2
Hu
nt,
Shlo
mo
an
d A
ddin
gto
n-H
all
201
4a
Hu
nt,
Shlo
mo
an
d A
ddin
gto
n-H
all
201
4b
(O
ver
85
)
Hu
nt,
Shlo
mo
an
d A
ddin
gto
n-H
all
201
4b
(U
nde
r 8
5)
Joh
nso
n e
t a
l. 2
012
Koff
ma
n a
nd H
iggin
son 2
004
Ne
wto
n
Ne
wto
n e
t al. 2
00
9
Off
ice f
or
Natio
na
l S
tatistics
20
13
Oxen
ha
m e
t al. 2
01
3 (
200
5-0
6)
Oxen
ha
m e
t al. 2
01
3 (
201
2-1
3)
Pea
rse
et a
l. 2
005
Sw
ind
lehu
rst e
t a
l. 20
06
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~N
ON
-CA
NC
ER
~~
~~
Ashto
n e
t al. 2
01
3
Bajw
ah e
t a
l. 2
01
2
Baxte
r et
al. 2
01
3
Bru
ni e
t a
l. 2
01
0
Ga
nd
y 20
10
Joh
nso
n a
nd
She
rwe
n 2
01
0
McK
eow
n e
t a
l. 2
008
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
NO
T S
TA
TE
D~
~~~
Ahlq
uis
t an
d N
ew
ton 2
00
8
Akin
tad
e,
Lis
k a
nd D
ua 2
01
2
Bow
ers
et a
l. 20
10
Da
ley a
nd
Sin
cla
ir 2
00
6
Do
rman
an
d K
irkha
m 2
01
0
Evan
s et
al. 2
01
4 (
Pre
fere
nce r
ecord
ed
on
ce)
Evan
s et
al. 2
01
4 (
Pre
fere
nce r
ecord
ed
tw
ice
1st)
Evan
s et
al. 2
01
4 (
Pre
fere
nce r
ecord
ed
tw
ice
2n
d)
Gra
nde
et a
l. 20
08
Kin
g e
t al. 2
00
0
Siv
es, C
orn
ble
et
an
d M
urr
ay 2
00
8
Th
om
pso
n-H
ill e
t a
l. 2
009
Wa
lker
et
al. 2
01
1
Wo
od e
t al. 2
00
7
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
~~
~~P
UB
LIC
~~
~~
Dyin
g M
att
ers
Go
me
s e
t al. 2
01
2
Hic
key a
nd
Qu
inn 2
01
2
Hig
gin
son
200
3
Ipsos M
OR
I 20
10
Le
ad
be
ate
r a
nd
Ga
rber
20
10
NH
S P
ub
lic H
ealth
No
rth E
ast (n
ation
al d
ata
)
NH
S P
ub
lic H
ealth
No
rth E
ast (o
n s
tre
et)
NH
S P
ub
lic H
ealth
No
rth E
ast (o
nlin
e)
No
rfo
lk H
ea
lth O
ve
rvie
w a
nd
Scr
utiny C
om
mitt
ee
20
05
Shu
cks
mith,
Ca
rle
ba
ch a
nd
Whitta
ker
201
3
Wo
od a
nd S
alter
201
3
A. Preferences for place of death by patient condition
Home Hospice Hospital Care Home
Multiple choices Other No preference/Don't mind Unsure/it depends
Unwilling to express preference Median
Source: Hoare et al, PLOS One 2015
0%
10
%20
%30
%40
%50
%60
%70
%80
%90
%10
0%
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
~~
~C
AN
CE
R~
~~~
Hig
gin
son
et a
l. 20
10
Ingle
ton
et
al. 2
00
4
Koe
kko
ek e
t a
l. 2
01
4
McC
all a
nd R
ice
200
5
Pea
cock e
t al. 2
011
Th
om
as e
t a
l. 2
004
Wa
gho
rn,
You
ng
an
d D
avie
s 2
01
1
We
ir e
t a
l. 2
011
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
~~
MU
LT
IPLE
~~~
~
Arn
old
et
al. 2
013
Ca
pe
l et
al. 2
01
2
Co
x e
t al. 2
011
De
pa
rtm
en
t o
f H
ea
lth 2
01
2
Fis
he
r an
d D
uke
20
10
Fra
me
et
al. 2
01
2
Ge
rra
rd e
t a
l. 2
011
(2
00
7)
Ge
rra
rd e
t a
l. 2
011
(2
00
9)
Gra
nde
et a
l. 20
09
Ha
ll 2
00
7
Ho
ldsw
ort
h a
nd F
ishe
r 20
10
Hu
nt
an
d A
ddin
gto
n-H
all
201
2
Hu
nt,
Shlo
mo
an
d A
ddin
gto
n-H
all
201
4a
Hu
nt,
Shlo
mo
an
d A
ddin
gto
n-H
all
201
4b
(O
ver
85
)
Hu
nt,
Shlo
mo
an
d A
ddin
gto
n-H
all
201
4b
(U
nde
r 8
5)
Joh
nso
n e
t a
l. 2
012
Koff
ma
n a
nd H
iggin
son 2
004
Ne
wto
n
Ne
wto
n e
t al. 2
00
9
Off
ice f
or
Natio
na
l S
tatistics
20
13
Oxen
ha
m e
t al. 2
01
3 (
200
5-0
6)
Oxen
ha
m e
t al. 2
01
3 (
201
2-1
3)
Pea
rse
et a
l. 2
005
Sw
ind
lehu
rst e
t a
l. 20
06
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~N
ON
-CA
NC
ER
~~
~~
Ashto
n e
t al. 2
01
3
Bajw
ah e
t a
l. 2
01
2
Baxte
r et
al. 2
01
3
Bru
ni e
t a
l. 2
01
0
Ga
nd
y 20
10
Joh
nso
n a
nd
She
rwe
n 2
01
0
McK
eow
n e
t a
l. 2
008
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
NO
T S
TA
TE
D~
~~~
Ahlq
uis
t an
d N
ew
ton 2
00
8
Akin
tad
e,
Lis
k a
nd D
ua 2
01
2
Bow
ers
et a
l. 20
10
Da
ley a
nd
Sin
cla
ir 2
00
6
Do
rman
an
d K
irkha
m 2
01
0
Evan
s et
al. 2
01
4 (
Pre
fere
nce r
ecord
ed
on
ce)
Evan
s et
al. 2
01
4 (
Pre
fere
nce r
ecord
ed
tw
ice
1st)
Evan
s et
al. 2
01
4 (
Pre
fere
nce r
ecord
ed
tw
ice
2n
d)
Gra
nde
et a
l. 20
08
Kin
g a
nd M
ack
enzie
et a
l. 2
000
Siv
es e
t al. 2
00
8
Th
om
pso
n-H
ill e
t a
l. 2
009
Wa
lker
et
al. 2
01
1
Wo
od e
t al. 2
00
7
~~
~~
~~
~~
~~
~~
~~~
~~
~~
~~
~~
~~P
UB
LIC
~~
~~
Dyin
g M
att
ers
Go
me
s e
t al. 2
01
2
Hic
key a
nd
Qu
inn 2
01
2
Hig
gin
son
200
3
Ipsos M
OR
I 20
10
Le
ad
be
ate
r a
nd
Ga
rber
20
10
NH
S P
ub
lic H
ealth
No
rth E
ast (n
ation
al d
ata
)
NH
S P
ub
lic H
ealth
No
rth E
ast (o
n s
tre
et)
NH
S P
ub
lic H
ealth
No
rth E
ast (o
nlin
e)
No
rfo
lk H
ea
lth O
ve
rvie
w a
nd
Scr
utiny C
om
mitt
ee
20
05
Shu
cks
mith,
Ca
rle
ba
ch a
nd
Whitta
ker
201
3
Wo
od a
nd S
alter
201
3
B. Preferences for place of death by patient condition including 'missing'
Home Hospice Hospital Care Home
Multiple choices Other No preference/Don't mind Unsure/it depends
Unwilling to express preference Missing Median
Source: Hoare et al, PLOS One 2015
www.england.nhs.uk
Take home thoughts
• Are we using the optimal balance of leadership
approach?
• Are we making changes that improve care and
experience for patients?
• Are we open-minded about seeking all evidence and
brave enough to consider what it means?