Leading Changes at Your Healthcare Site?

I am sure that many of you have encountered				they are allowed to do so in your state. By doing
individuals who are very resistant to change. Many				so, physicians will have more time to address
believe that physicians are the hardest individuals				issues such as the diet of a patient with
as a group to convince to go along with changes				hypertension.
being planned at a healthcare site or with changes				Another category of data to use is data which
that are already underway. In fact, some who				demonstrates that by adopting changes the
are in charge of change management at a site will				bottom line of the practice improves. For instance,
avoid any changes that require physician				you might demonstrate that if the staff at a site
cooperation as they see accomplishing any change				make sure that their female patients have an
with physicians as impossible.				annual breast exam then the site would benefit
I believe that with the right approach almost				from pay for performance revenue. Many pay
anyone can be convinced to go along with efforts				for performance plans offer this benefit. The
to improve the delivery of healthcare at a site				physician is not necessarily responsible for this
and to work well with others at the same time. In				activity. A medical assistant with the use of a
fact, many can be convinced to work with teams				registry could be responsible for carrying out this
that plan changes. I am currently working with				task.
several physicians in a team effort to design and				I think that in most circumstances using data can
bring to West Michigan a center that will help local				convince staff resistant to change to go along
primary care offices adopt the Advanced Medical				with the planned changes and at some point
Home; it is a good example of a variety of				become involved with planning changes. After all,
healthcare professionals working well together as				those involved directly with the care of patients
a team. A well-respected physician ably leads the				use data all the time to monitor the health of
group and the other physicians offer valuable				patients and to have patients change their
contributions. The team includes individuals from				behavior to improve their health-whether it be
various areas of healthcare--insurers, nurses,				diet changes or taking medication. However, some
primary care administrators and more-and is				may refuse to change when shown data that
steadily and successfully advancing towards its				convincingly demonstrates the benefits of
goals.				changes; some may even be those who use data
Some possible reasons to resistance to change				often in direct patient care. The excuse of those
by individuals at healthcare sites is that the team				refusing to change may be that the data doesn't
effort required to make changes has not been				apply to them; it doesn't fit their circumstances. In
practiced in the past. You will find at many of				the face of such refusals you might try some
these sites the silo mentality-leave me alone and				alternate approaches. One would be the
let me do my job. In fact there will rarely be				testimony of a respected colleague. You can ask
team meetings, which is a more common practice				someone on staff who has benefited from
in businesses in general. Another reason that there				changes and quality improvement to talk to
is little cooperative effort to accomplish change is				another staff member who is reluctant to go
that the training of healthcare professionals often				along and to share how by adopting the desired
does not address the methods of team				changes that he/she has personally benefitted.
cooperation in quality improvements. I have				This testimonial approach is effectively used in
encountered quite a few students in college				business and marketing; advertising on television
business courses who are taught the concepts of				and the internet amply demonstrate this.
continuous quality improvement through leadership				If data and testimonial don't work, you might
and team building. Yet even many in healthcare				want to try slipping changes slowly and
administration do not encounter such content.				unobtrusively into the routine of a staff member
Overall, if an individual is immersed in a culture				who refuses to change. I recently heard of such
which resists cooperative efforts to address				an approach from a local physician. This physician
changes then that individual will likely resist change.				was leading changes at his site. After a meeting
Let me suggest to those of you who are				of staff to address planned changes which were
interested in getting most everyone in your				necessary to advance the concept of the
organization positively involved in planning and				Advanced Medical Home he related that one of
executing beneficial changes ways to accomplish				the physicians went to the office manager and
this. I think that the first approach to use in				said that the changes were fine as long as he
approaching an individual resistant to change is to				didn't have to change how he practiced medicine.
use data that supports changes. For the				So, rather than confront him the other staff at
healthcare environment I believe that there are				the office slowly started changes around him. For
basically three categories of data that would be				instance, his medical assistants started taking
useful. One would be data that demonstrates that				charge of updating patients with their tetanus
the planned changes lead to improved patient				shots. The recalcitrant physician did not object.
health. For instance, suppose you want a physician				Other changes were instituted slowly and the
in a primary care practice to use a registry				physician eventually adopted the concepts of
consistently but the physician refuses to do so.				planned changes through teamwork.
Then, I would collect data with physicians onsite				Of course, some staff, just like patients, may
who do use registries well and demonstrate that				resist change for a long time. It may be
using it does lead to improved patient health. For				impossible to overcome the resistance to
instance, you should be able to demonstrate that				teamwork and change put up by some. Although
those who do use registries are more consistent				this will impair the improvement process, better
in getting A1c measures of their diabetic patients				not to waste time and effort in a futile effort, in
and that by doing so these patients have				my opinion. Much more good can result by
improved outcomes.				spending effort on other projects with willing
Another category of data to use would be data				participants. However, there may be hope in the
that demonstrates that by adopting changes the				long run; those who are recalcitrant may find
physician or other staff person would have more				themselves somewhat isolated as others change
time to accomplish other important tasks that				and may eventually join their colleagues.
otherwise cannot be done. For instance, you				Change is difficult; some embrace it and some
might want to show that letting medical assistants				resist it. With the help of appropriate data, the
in an office do tasks that normally a physician				testimony of trusted colleagues and the slow but
does leaves the physician more time to				steady pulling of staff and physicians into the
accomplish more complex tasks that only he can				stream of change most personnel can be enlisted
do. For instance, why not have the medical				to support change and, in some cases, become
assistant update patients with tetanus shots if				innovators themselves.

Integrail

Leading Changes at Your Healthcare Site?