At The Conversation Project, we’ve always tried to reach people where they live, work, pray, and learn to talk about what matters to them. Today, we wanted to dive into the “work” aspect a little bit more. Two TCP partners in Colorado, Mindy Rickard of the Health District of Northern Larimer County and Amanda Meier of The Conversation Project in Boulder County, take this seriously. In their own words, here is the work they do.

Workplace environments are a perfect place to introduce advance care planning (ACP) conversations — about discussing and documenting people’s health care wishes — as normal activities. Both of us are committed to offering employer-based ACP education in a variety of settings. The programs are well-received; employees tell us they view this work as signal that the employer cares about work-life balance.

Normalizing ACP work means providing education and opportunities for every generation. The sooner ACP is seen as a life-long process, the better each of our wishes can be respected.

Adapting for the needs of different organizations
The team at Larimer [where Mindy works] has been involved in employer ACP campaigns for many years. The program, called Get Around TUIT (Think, Understand, Implement, and Tell Others), has worked with over 20 employers in manufacturing, government, health care, and higher education. The topic does well as both a virtual and in-person “lunch and learn” opportunity that introduces the idea of ACP and motivates employees to sign up for the program. This has translated into thousands of people learning about ACP and completing advance directives.

Employees can sign up for an online self-paced program. It lasts 3 weeks and is filled with resources around choosing your health care proxy — someone who could speak on your behalf if you can’t make your own health care decisions — and completing the Conversation Starter Guide with that person. The employees have in-person signing days with a notary with witnesses available and have the option of having their documents shared with both major health systems in northern Colorado. The team promotes the program in newsletters and offers “Wellness Points” toward incentives like time off with pay depending on the employer.

The Larimer ACP program customizes the campaigns to fit the culture and needs of each organization. For example, the program has trained Spanish translators and materials in multiple languages. When working with a county government or the manufacturing sector, some events happen at 6:00 AM before employees head to work on roads and bridges in various locations. For “rounding” in hospitals, the team takes a cart with materials to each department, including dietary, housekeeping and medical records. Across these efforts, the final signing day helps people feel like they have accomplished an important task.

Helping health care staff help patients — and themselves
That program was so well organized and successful, that it inspired a similar program in next door Boulder County [where Amanda works]. The Conversation Project in Boulder County (TCPBC) has focused efforts on educating employees within their parent organization, TRU Community Care. TRU offers a continuum of services to older adults in Colorado, including hospice, palliative care, grief services, and PACE. TCPBC serves patients and families as well as the broader community.

Clinical staff working in all areas provide ACP encouragement to enrolled patients and families. However, the team knows that not all staff come to TRU with personal ACP experience. TCPBC starts educating them immediately by presenting during employee orientation. Each year, TCPBC also offers ACP education to all staff and volunteers during open enrollment season. This program is called Get Around TRUIT (with the addition of R to align the name to the organization). In addition to completing the Conversation Starter Guide, participants are encouraged to watch “Who Will Speak for You” and “Practice Makes Perfect.” These are perfect short videos with the right mix of humor and messaging.

110 employees — about half of the TRU staff — have participated over the last 3 years. Staff with real ACP experience have not only completed important personal work, but also are better able to encourage and assist others. Clinical staff in hospice and palliative care are focused on encouraging advance care planning in their day-to-day work with patients. Across age groups, these professionals appreciate the opportunity to learn about how the process applies to their own lives.

When health care workers participate in personal advance care planning, they develop empathy and connection points to improve work skills. It’s a win-win experience! One Get Around TRUIT participant gave the following feedback: “I am always encouraging patients to complete advance directives and I think my education around that process will be more effective because I have actually done it for myself now. I have a different appreciation and understanding of what it means to have those conversations with our loved ones.”

Keys to success
Locally, health care organizations are often a large employer. If each employee talks about this with someone in their lives, it further normalizes in the community that these conversations are a regular part of life.

There are a few key components to a successful employer-based ACP program:

• Organize the content into logical steps. We suggest offering most of content online using a mix of written and video materials. Strategic in-person events and assistance provide a great way to connect with those that have questions or prefer live learning.
• Send regular email reminders (1–2 per week) to encourage participants to make progress. Allow enough time for program completion; 3–4 weeks is usually sufficient.
• Provide incentives for a strong motivator. Small gift cards, “Wellness Points” that can be redeemed for vacation time, and other prizes have been successful for these Colorado programs.

ACP in the workplace is a powerful way employers can help normalize the process and offer employees tangible benefits at low cost. The results can literally be life changing, like it was for the individual helped by the Larimer ACP Program through the City of Fort Collins:

“One young (20 something) city employee shared with me that in the year after our first employee campaign he had suffered a heart attack while driving which led to a very damaging car accident. He was thankful to have his directives on file with the local emergency room and his health care proxy was prepared to speak for him and make his wishes known. He expressed that he was grateful that he had the conversations and had done his documents.”

Want to keep connected to The Conversation Project for more ideas from other communities? Sign-up for our community engagement newsletter, follow us on social media (Twitter, Facebook, Instagram, and YouTube), and feel free to reach us at ConversationProject@ihi.org.