Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Fairview Health Services
Mark Leenay, MD
Director of Palliative Medicine
Office of Medical Affairs, Room 668
2450 Riverside Avenue
Minneapolis, MN 55454

Fairview Health Services has the distinction of being one of the largest integrated health systems in the Twin Cities (Minneapolis) area. The network of clinical services that make up Fairview includes seven hospitals (one of which is Fairview-University Medical Center, a premier research and education institution), a physician network, 31 clinics, 25 long-term care facilities, retail pharmacies, rehabilitation services, a home care division and a hospice division. In an ambitious effort to improve the care of dying patients and their families, Fairview has assembled a multidisciplinary end-of-life care team to overcome barriers within the entire health services system. The End-of-Life Care Initiative has successfully introduced changes in end-of-life care across a broad array of services and disciplines.

Fairview Health Systems participated in The Institute for Healthcare Improvement's "End-of-Life Initiative" in 1997. Subsequently, Fairview began to make technical and humanistic changes in the areas of surrogate decision making, bereavement services, pain management, and hospice, to the benefit of its patients, physicians, and healthcare community. Specifically, staff at Fairview has focused on pain and symptom managment; has integrated holistic therapies and spiritual counseling into treatment, and has encouraged patients and families to choose surrogate decision makers before the need arises. Involvement and support from the highest levels of management have contributed largely to this program's success by providing leadership in policy, management and funding. Operational support and recognition led to the creation of a director of palliative medicine.

A thirteen-member interdisciplinary team, made up of leaders in their own areas of the health system, functions as a quality improvement team across all sites at Fairview. This team is comprised of: a geriatrician, who is a long-term care medical director and palliative medicine physician; nurse managers representing critical care, medical surgery and bone-marrow transplant units; a social worker from a rural hospital; a social worker and marketing director from Fairview's long-term care division; nurses representing other portions of the Fairview system, including home care and hospice, child-family and performance improvement; and chaplains. The Fairview initiative implemented a continuous quality improvement (CQI) effort to collect data and feedback every two weeks on the various change efforts. Using these methods, Fairview piloted more than forty separate interventions across the health system in the initial eight-month phase of implementation.

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