Respecting Choices® (RC) has pioneered a unique, multi-modal implementation strategy for organizational and cultural change. Through testing and evaluation of educational and consultation approaches, RC has learned that successful implementation and sustainability occurs only when an organization is committed to a long-term strategic plan to create person-centered workflows and processes. This strategic plan includes the development of supporting systems and accountability, education of staff about how to effectively work in this new system, and engagement of individuals and the larger community.
The strategic plan further requires leadership commitment to provide critical resources that include 1) a person to coordinate and manage the change (project manager or ACP Coordinator), 2) the mentoring and certification of an RC Organization Faculty (OF) as a leader and local expert for ongoing program dissemination, 3) the creation of a multi-disciplinary oversight committee, and 4) the allocation of resources for long-term sustainability and continuous quality improvement.
RC offers organizations and communities a wide-ranging menu of implementation services that can begin with one stage of planning (First Steps®, Next Steps, or Last Steps®), Shared Decision Making in Serious Illness (SDMSI), or the creation of a plan for implementation of multiple services over time. These implementation services are intended for large and small health systems, individual health organizations, and conveners (such as community groups and medical associations). RC implementation services include a core set of principles that are customizable to each unique customer.
I am a former pediatrician, retrained in adult palliative medicine, and working full time in that capacity. I have the Respecting Choices conversations on this campus with adult patients and have been very happy with it.
In the unexpected turn my life has taken in the past couple of years (from pediatrics to geriatrics), I am now having these conversations with families of adult patients with dementia, COPD, CHF, and renal failure. We use Respecting Choices with our adult patients extensively and very effectively.
I’m amazed, even after many years of experience honing communication skills with families, how useful this tool has been to help me explore the tough questions with patients and families.
Jennifer Cohen, MD, Palliative Care
Kaiser Permanente, San Jose, CA