Clinician perspectives of an improvement bundle to improve integrated palliative care: a qualitative study

Improving the quality of hospital-based palliative care remains a persistent challenge. Patient-reported experience measures (PREMs) offer a mechanism to centre improvement on what matters most to patients. Yet, there is limited evidence on how PREM data can support meaningful change. The Listen, Empower and Act to improve Hospital Palliative care (LEAHP) bundle is a facilitated, PREM-informed intervention designed to support hospital-based multidisciplinary teams to co-design and implement locally relevant improvements. This study explored clinicians’ perspectives on the acceptability and feasibility of the LEAHP bundle. An exploratory qualitative study was conducted following pilot implementation of the LEAHP bundle across three acute Australian hospital wards. Semi-structured interviews with multidisciplinary clinicians and managers were informed by the Theoretical Framework of Acceptability, with additional prompts to explore feasibility. Data were analysed using practical thematic analysis. Twenty-seven interviews were conducted (nursing ( n = 20); medicine ( n = 6); and allied health ( n = 1)), with a median duration of 27 min (range 17 to 40 min). Six themes were identified: 1). Clinicians valued PREM data to guide improvement; 2). Clinicians valued authentic engagement and collaboration; 3). Collaborative improvement required a new way of working; 4). Facilitation enabled collaboration; 5). Representation, power and workload realities were a challenge to collaboration; and 6). Building and maintaining gains is challenging. Participants valued PREM data as a credible driver for change and described the process as meaningful and engaging. Facilitation was critical in enabling collaboration, interpreting data, and sustaining momentum. Feasibility challenges included workload pressures, staffing variability, and reliance on sustained facilitation. The LEAHP bundle was perceived as acceptable and meaningful, supporting a shift toward collaborative, patient-centred improvement. However, operationalising the bundle was contingent on skilled facilitation, organisational support, and integration into routine workflows. Future implementation should address sustainability and support balanced participation across disciplines and roles.