This presentation tells an engaging story of discovery, occasional failure and growing success in improving care for patients with advancing serious illness while achieving triple aim improvement. Dr. Shulman and her colleagues’ strategy combines data, education and workflow optimization to dramatically improve advance care planning. In order to take the next step and engage providers, patients and families in difficult conversations, Dr. Shulman and her colleagues teamed up with the Serious Illness Conversation Project to provide a structured tool and coaching for their teams to push their organization closer to providing goal-concordant care for their patients with serious illnesses. Their results are measurable and dramatic, and while they still have a long way to go, they are seeing a change in their practice that goes beyond metrics.

During this webinar, Dr. Schulman allows participants to identify the importance of conversation as part of comprehensive advance care planning and how challenging this can be for providers. She also allows participants to understand the need for a multifaceted approach to education and training of primary care teams and the importance of a team-based approach, with diversity of skills, for advance care planning.