How health care systems shape end-of-life care—A step toward transparency

How health care systems shape end-of-life care—A step toward transparency
JAMA Network Open; by Jacqueline M. Kruser, Gordon D. Rubenfeld; 7/25
Our health care systems, in all their multifaceted complexities, are more influential in shaping the delivery of care than individual human effort or error. Influential system-level factors span many different domains: how we are paid, the buildings we work in, the technology around us, who and how many we have on the team caring for patients, our workload, and our local social networks of influence. One pragmatic first step in addressing the problem of invisible, inaccessible, and/or inflexible patterns of end-of-life care is to build awareness of and foster transparency about the current patterns and their default orientation. Building from this deeper understanding of how our everyday routines and practice patterns influence care, we can then take the bigger step of intentionally designing our routine clinical practice patterns to be systematic yet flexible in their support of patients with serious illnesses.