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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
http://media.nhsiq.nhs.uk/
whitepaper/index.html
Leadership for complex times
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
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
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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
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~~
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UB
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~~
~~
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g M
att
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01
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key a
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inn 2
01
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gin
son
200
3
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OR
I 20
10
Le
ad
be
ate
r a
nd
Ga
rber
20
10
NH
S P
ub
lic H
ealth
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rth E
ast (n
ation
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ata
)
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ub
lic H
ealth
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rth E
ast (o
n s
tre
et)
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S P
ub
lic H
ealth
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rth E
ast (o
nlin
e)
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rfo
lk H
ea
lth O
ve
rvie
w a
nd
Scr
utiny C
om
mitt
ee
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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?
www.england.nhs.uk
For every complex problem
there is an answer that is clear, simple……..
and wrong
HL Mencken
