For patients and their families facing chronic, serious illnesses, conversations about goals, preferences, and prognosis are an essential part of care. Particularly in a hospital setting, when complex decisions need to be made about health care, goals of care conversations are essential. However, these conversations often do not occur or occur too late to impact care. In this proposed DIHI project, we will use an innovative combination of Maestro Care alerts, “just in time” conversation cues, and 1:1 coaching to increase and improve how hospitalists discuss goals of care with patients and their families.