Table 3.

Overview of learning session objectives and activities

ObjectivesDidactics and Activities
Learning session 1
 Understand Pathways Project best practices, including identification of patients who are seriously illIntroduce Pathways project best practices
Describe the surprise question as a prognostication tool
Kidney Innovations Café; tabletop discussions
 Enhance communication skills for shared decision making and advance care planningGoals-of-care conversation training using Veterans Affairs faculty and curriculum based on VitalTalk (8 h total)
Communication skills: responding to emotion, eliciting patient’s goals, establishing plans to meet goals
Skill practice and role play of common nephrology communication scenarios
Responding to patient values
 Integrate supportive care into kidney care setting using incremental changes and PDSA cycleDescription of IHI Breakthrough Series, including PSDA cycles
Each team plans initial change project with faculty input
Develop team charter, including implementation goals
 Understand and be prepared for data collection and submission of data for projectDescription of data-collection processes
Demonstration of data-collection tools
Learning session 2
 Demonstrate steps to conduct advance care planning, shared decision making, and goals of care with patients seriously ill with kidney diseaseEnhanced Communication Skills Training: using Ask-Tell-Ask; responding to emotion, empathy
Advance care planning discussion with palliative medicine physician
Patient panel discussion
 Describe approaches to providing MMWDVideo interview with physician leader in MMWD in Australia
Breakout session: MMWD for CKD teams
Breakout session: palliative dialysis for dialysis center teams
 Identify ways to implement Pathways best practices for supportive care of patients who are seriously illCollaborative sharing through storyboards
Idea sharing between sites
Discipline-specific conversations to address shared concerns
Implementation strategies
 Apply appropriate steps of IHI Breakthrough model of healthcare improvement techniques to implement small tests of changeSmall tests of change; the PDSA cycle
Team working time: fishbone diagram for root cause analysis
Learning session 3
 Share successes and challenges in implementing supportive careVisual storyboard presentations
Interdisciplinary panel of successful project teams
 Foster momentum for implementing Pathways best practicesDiscuss implementation challenges
Plans to overcome challenges; collaborative discussions
Data collection
 Use frameworks for sustainability planning to anchor changes to existing processes and “holding the gains”“Fostering-sustainability” lecture
Developing a sustainability plan
Fishbowl discussion: case study on sustainability plan with one site
 Identify opportunities and resources for spread within organizationPanel of innovative US models transforming the kidney care system
How to “nudge” organization culture
  • PDSA, Plan-Do-Study-Act; IHI, Institute for Healthcare Improvement; MMWD, medical management without dialysis.