Key messages

  • Help and support is available to health services to implement advance care planning.
  • Robust systems, an evidence base, workforce capability and enabling conversations are the cornerstones of effective advance care planning.

As part of the advance care planning strategy, four key priority action areas have been identified to guide organisations with implementation.

Priority 1: Establish robust systems so your organisation can have the conversation

Successful implementing of advance care planning requires robust systems and processes within the organisation.

Health service priorities

  • Create a shift in organisational culture, coordinate and monitor advance care planning within the health service setting through:
    • policies
    • governance
    • alerts
    • documentation
    • quality improvement.
  • Promote advance care planning with key external stakeholders.

Actions

  • Develop an organisation-wide advance care planning policy that is endorsed by executive and clinical leaders.
  • Work towards creating alert systems for advance care plans and provide readily accessed documentation.
  • Use quality audits to inform and improve advance care planning systems.
  • Establish mechanisms that support the mutual recognition of advance care plans developed in other settings or services.

Priority 2: Ensure you have an evidence-based and quality approach to have the conversation

Ensure your health service takes an evidence-based and quality approach for the advance care planning conversation.

Health service priorities

  • Review and improve advance care planning to suit local needs.
  • Base advance care planning practice on the best available evidence.

Actions

  • Inform advance care planning practice through review of activity, quality and patient experience data.
  • Shape advance care planning practice with available evidence.

Priority 3: Increase your workforce capability to have the conversation

Increase your work place capabilities to have advance care planning conversations.

Health service priorities

  • Enable workforce to deliver advance care planning through:
    • targeted education, training and mentoring
    • position descriptions and induction programs that emphasise a person-centred care approach
    • access to training programs
    • strong mentoring and support.
  • Deliver advance care planning in the context of person-centred practice.
  • Provide an individualised approach that considers and is responsive to the illness trajectory.
  • Provide clients with opportunities to discuss and record their wishes and preferences at clearly identified points in their care.

Actions

Inform and educate staff about their role through:

  • position descriptions and induction programs that emphasise a person-centred care approach
  • access to training programs
  • strong mentoring and support.

Priority 4: Enable the person you are caring for to have the conversation

Enable the person in your care to have the conversation.

Health service priorities

  • Deliver advance care planning in the context of person-centred practice.
  • Provide an individualised approach that considers and is responsive to the illness trajectory.

Actions

  • Provide people with opportunities to discuss and record their wishes and preferences at clearly identified points in their care.

Priority Action Areas

Diagram: The four key priority action areas for implementing advance care planning across organisations: 1. Establishing robust systems 2. An evidence-based and quality approach 3. Increasing your workflow capacity and 4. Enabling the person to have the conversation.

For more information on each of these priorities, please see Advance care planning - have the conversation: A strategy for Victorian health services 2014-­18 (Part 4: Getting your organisation ready to have the advance care conversation).