Fostering Locally Led Palliative Care Innovation: A Qualitative Evaluation of the SPHERE-Stanford Collaborative...

Australia is recognized internationally for high-quality palliative care, yet inequities in access, variable service models, and workforce pressures limit safe, effective, and person-centered care. Quality Improvement (QI) approaches offer a practical method for addressing these gaps. To build local QI capability, the Sydney Partnership for Health, Education, Research and Enterprise partnered with Stanford Medicine to implement an evidence-based QI program in seven Australian palliative care services.

To evaluate clinicians' experiences implementing QI projects through the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)-Stanford Medicine Collaborative QI Program and identify barriers and facilitators influencing successful implementation.

Twenty-five participants were interviewed, including team leaders, team members, mentors, and a service director from seven participating teams.

Teams completed a 6-month structured QI curriculum combining virtual workshops, a 2-day in-person intensive, and ongoing mentor support. Semi-structured interviews explored experiences with QI capacity building and implementation. Guided by the Consolidated Framework for Implementation Research, qualitative content analysis identified determinants of implementation success.

The program developed clinicians' QI knowledge and confidence, enabling teams to identify root causes of service challenges, design targeted interventions, and achieve meaningful improvements, including increased palliative care referrals, enhanced care integration, and more consistent documentation practices. Multidisciplinary collaboration, strong team cohesion, and dedicated mentorship were central facilitators. Executive sponsorship and proactive communication promoted stakeholder buy-in and supported adoption of new practices. Key barriers included varying service models, limited resources, workforce turnover, and insufficient awareness of palliative care across partnering services. Despite these challenges, participants viewed the program as a catalyst for ongoing QI work and identified opportunities for scaling and sharing outcomes.

The program strengthened QI capability within Australian palliative care services, generating transferable solutions to improve equity, access, and service quality. Further work is needed to support sustainability, disseminate learning, and expand QI capacity across the broader palliative care sector.