System Wide Goals of Care Implementation: A Podcast with Ira Byock, Chris Dale, and Matt Gonzales
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
50 min
4 speakers
8 chapters
transcribed 9 hours ago
Transcript
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Transcript generated automatically by AI and may contain errors.
What is the overall goal of the system‑wide goals‑of‑care implementation project?
This episode of the JerryPal Podcast is CME eligible.
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Welcome to the JerryPal Podcast. This is Eric Wadera. This is Alex Smith. And Alex, who do we have on with us today?
We are honored and delighted to welcome back Ira Bayak, who is a palliative care doctor and author and founder of the Institute for Human Caring, and he is joining us from Missoula, Montana. Ira, welcome back to the JerryPal Podcast.
Truly a pleasure to be back with you.
And we're delighted to welcome Matt Gonzalez, who is a palliative care doc and friend and chief medical officer of the Institute for Human Caring and Providence. And he is joining us from Southern California. Matt, welcome. Thanks. Nice to be with you, friends. And we're delighted to welcome Chris Dale, who is an intensivist ICU doc and is the medical director of clinical innovation and virtual care and digital health at Providence. Chris, welcome to the Jerry Powell podcast.
Hey,
thanks for having me. Awesome to be here. So we're going to be talking about a New England Journal catalyst article that we will have on our show notes this podcast. I'm basically creating a goals of care initiative in a large healthcare system and what the results of those initiative are. But before we jump into this topic at hand, Ira, I think you have a song request for Alex.
Yes, indeed. Uh Alex, I'd like you to play just dropped in to see what condition my condition is in. Who sings that again? Kenny Rogers.
Kenny Rogers. Ira, why did you pick this song?
Well, you know, we're talking about goal alignment as uh key to people's quality of care, quality of life, uh with illness. And I just thought that this kind of evoked a sense of really looking at one's condition and what the what life holds.
Mm-hmm. And uh this is a fun song. This is not the Kenny Rogers many of you may know. This is before that Kenny Rogers. Here's a little bit.
Yeah, yeah, oh yeah. I woke up this morning with the sun down shining here. I found my mind in a brown paper bag within I tripped on a cloud and fell eight miles high. I tore my mind on a jagged sky. I just dropped in to see what condition my condition was in. Yeah, yeah, oh yeah.
I never would have guessed that was a Kenny Rogers song. Uh a hundred million years.
It's like a guaranteed earworm too.
Yeah, it is.
Yeah.
Yeah, yeah. Oh yeah. Psychedelic for Kenny Rogers, I feel like.
Yeah, I think our first podcast with Ira was on psychedelics. It's
shocking.
Totally
shocking.
Yeah, yeah. But this is not a psychedelic podcast. We're going to be talking about New England Journal Catalyst uh again article on Goals of Care Conversations, a system-wide innovation. Really great study. Um, and we will put it again in the show notes. Encourage all of our readers to talk about it. But I'm gonna take a big step back because I heard something that I saw in the article, something called the Institute of Human Caring. Ira, I'm gonna go to you first. Y what is the Institute of Human Caring? So it's the Institute
for Human Caring. For human caring. Uh and it is a effort within Providence to align um what we do with what people want and to improve uh whole person caring. Um, w we saw an opportunity back in 2014, frankly, to get in front of the leadership of this large Western health system and use the knowledge, attitudes, and skills of palliative care to embed within the healthcare system writ large to really turn focus from solving medical problems only. Only to caring well for people as whole persons. Now, just to take you back, in 2014, we all thought that uh Obamacare or the ACA was about to uh be the new model of health care across the country. And what I had the opportunity to do in speaking to the the uh leadership, executive leadership, and board of directors of Providence was to make a big
Business case for making sure that what we're doing for our patients is what they desire and that they're making informed decisions. The idea being that there's a business case to avoid highly burdensome and ineffective treatment and also treatments that informed patients simply do not want.
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Chapters
8 chapters
1
What is the overall goal of the system‑wide goals‑of‑care implementation project?
0:00–5:39
2
How did the Institute for Human Caring originate and what role does it play in the initiative?
5:39–12:37
3
What strategies were used to secure leadership buy‑in and align the project with the health system’s mission?
12:37–19:33
4
How were the electronic health record (Epic) and documentation workflows redesigned to simplify goals‑of‑care recording?
19:33–25:19
5
What communication‑training methods (e.g., Serious Illness Conversation Guide) were employed and who were the primary trainees?
25:19–31:11
6
What metrics and dashboards were created to track documentation rates and quality across the 51‑hospital system?
31:11–37:24
7
How did the program address barriers such as clinician time constraints, gaming the system, and code‑status inconsistencies?
37:24–43:10
8
What are the next steps and future directions (e.g., AI tagging, expansion beyond ICU) for sustaining and scaling the initiative?
43:10–50:03
Speakers
4 identifiedMore from GeriPal - A Geriatrics and Palliative Medicine Podcast
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