Great things are not done by impulse, but by
a series of small things brought together.

~ Vincent Van Gogh

The work of improving care at the end of life is only at the beginning stages. The Commission has identified issues and made recommendations and strategies. Minnesota now has a framework on which to build a better kind of care. However, the work of the Commission will result in change only if both public and private sector leaders endorse the recommendations and commit to putting them into action within their own organizations.

Each organization concerned with improving care needs to study the recommendations and decide on those that can be incorporated into their overall strategic plan. This could mean that the Minnesota Department of Health integrates the Five Guiding Principles into its survey process to assure that patients and families receive adequate teaching, symptom management, or bereavement follow-up. This could mean that home care agencies identify patients who have a life-limiting illness and begin to discuss advance care planning. This could mean that social service organizations who provide information and referral to aging populations are familiar with the end of life resources in their area.

Next steps also involve engaging the public in understanding that they have choices and options for care at the end of life. This needs to happen on a personal and family level as well as a community level. For all who read this report and ask, "What can we do?" remember the words of Mahatma Gandhi: "We must become the change we want to see."