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Formative evaluation of an employee-driven approach to improve care in the dying phase in hospitals

Year: 2025

Type: article

Abstract: OBJECTIVES: The hospital setting is often perceived as slow to change. While employee-driven approaches offer a promising alternative to traditional top-down methods, guidance is limited. This study provides a description and formative evaluation of an employee-driven working group (WG) approach to tailor ward-specific measures to improve care in the dying phase. The aim is to evaluate the WG process and offer practical insights for transferability to other hospitals. METHODS: was applied. Data included baseline evaluation (medical record analysis, staff survey and focus groups, informal caregiver interviews), WG protocols, and an online survey with WG participants. RESULTS: Multiprofessional WGs were established on all hospital wards, with an average of 7 meetings per ward within 1 year and 4 participants per meeting. Adapting the process to participants' wishes and needs were crucial, particularly regarding the desired degree of external input. We identified 4 barriers (e.g. declining participation, institutional limits) and 7 facilitators (e.g. involvement of staff in leading positions, multiprofessional composition). The WGs tailored 34 measures, e.g. team meetings to improve communication within the team. Participants' views were generally positive: 91% felt able to share their thoughts, 66% were satisfied with the outcome, and 77% would participate again. SIGNIFICANCE OF RESULTS: The employee-driven approach was feasible and useful for tailoring ward-specific measures. However, integrating top-down elements proved to be beneficial. The identified barriers and facilitators provide insights for transferring an employee-driven approach to other hospitals to improve care in the dying phase outside specialized palliative care settings. CLINICAL TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS00025405).

Source: Palliative & Supportive Care

DOI: 10.1017/s1478951525100400