Building on the success of the DECIDE and iDECIDE (DECIsion-Making about Goals of Care for Hospitalized MeDical Patients) projects, the Canadian Frailty Network study will use quality improvement methodology to create a toolkit for hospital medical wards. The toolkit will help guide hospital efforts to implement a multi-faceted intervention aimed at improving the quantity and quality of goals of care discussions with patients who have serious illness, and their families. The data collected will then be used to show the impact of the intervention across the participating sites.