Implementing institutional change: an institutional case study of palliative sedation.

Palliative sedation is used in the rare patient who has intractable distress at the end of life. Implementation of palliative sedation, however, may meet resistance from various clinicians and other hospital staff. To ensure that our patients had access to this important treatment modality, we found it necessary to engage in a process of institutional change that resulted in acceptance of the use of palliative sedation in the non-ICU setting.* In this paper, we will review the processes we found to be successful in hopes that they will also be efficacious for others wishing to produce similar change within their institutions. We first will review the theoretical foundations described in organizational development and change management literature. Next we describe our implementation strategies (including education, multidisciplinary alliances, and the development and approval of a practice guideline). Finally, we discuss in detail the role of interpersonal interactions. Three clinical cases are used to demonstrate the change in attitudes, processes, and outcomes.