Providence sees dramatic rise in goals of care conversations after implementing system-wide changes

Enhanced clinician education, EHR tools lead to more than 1,100% increase in GOC documentation for ICU patients in 8 years, says newly published manuscript

RENTON, Wash. [May 21, 2025] – Providence, one of the nation’s leading health care systems with 51 hospitals across seven western states, documented and tracked more than 8,500 goals of care conversations in its electronic health record for critical care patients in 2024, marking a seismic increase in the total number of GOC conversations had across the organization over the last decade. The health system released its findings in a paper published today in the New England Journal of Medicine Catalyst.

Driven by Providence’s Institute for Human Caring, an arm of the health system focused on advancing person-centered care, Providence witnessed a roughly 1,100% increase in GOC documentation in eight years.  These marked gains were the result of tying goal-aligned care to targeted quality thresholds, implementing clinician education and skill-building activities, and making improvements to the EHR interface to make it easier for clinicians to document and retrieve GOC conversation notes.

Within the recently published manuscript, Providence detailed that in 2024:

• 8,533 out of 10,063 (84.8%) patients who were in an ICU for five or more days had a documented GOC conversation, compared to 555 out of 8,143 patients (6.8%) in 2016
• 102,066 GOC conversations were documented within patient health records associated with an adult admission, representing 27% of all non-obstetric admissions

“We knew from the start that if we were to successfully improve the frequency and quality of GOC conversations, we’d need to reinforce it as a strategic priority for the organization,” said Matthew Gonzales, MD, chief medical and operations officer, Institute for Human Caring and lead author of the study. “Instituting goal-aligned care is essential for clinical teams to properly understand what matters most to patients and their overall whole-person well-being, so it wasn’t difficult to get top-to-bottom buy-in for needed system-wide changes. 

“What we learned early on, however, is that if we were going to make meaningful progress toward these ends, we would need to find ways to better equip caregivers with the proper knowledge and skills to hold GOC conversations with patients and reduce documentation burdens in the EHR.”

After adopting the Ariadne Labs Serious Illness Conversation Guide and accompanying training to address perceived gaps in clinician knowledge and skill, Providence launched a successful pilot program in 2015 starting with two acute care hospitals in Southern California. The team enrolled 91% of active nursing staff in training and worked with its informatics team to develop a unique GOC note in the EHR. At the close of the two-year pilot, 5,141 GOC conversations were documented for 19,972 adult non-obstetric admissions. 

After the pilot, the team began to scale the model across the health system focusing on critically ill patients and targeting a 65% threshold — by year five — for those in the ICU for at least five days. In 2024, of the 45 hospitals with ICUs, 38 hospitals exceeded the target with 20 hospitals surpassing 90%, which was designated as outstanding performance.

"These results reflect our collective commitment to our Mission and our dedication to providing holistic, compassionate care," Dr. Gonzales said. “While more research is needed to better understand the impact GOC conversations have on patient- and family-centered outcomes, we’ve laid a solid foundation to expand this work to more patient populations and tap into leading-edge tools, such as generative AI, to further advance goal-aligned care.”