5 Tips on Engaging Physicians in Major Process Changes
Managing change at CTCA: Case study
An example of engaging clinicians in a major change is the development of a Certified Quality Breast Center of Excellence at the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Ill. To receive designation as a center of excellence from the National Quality Measures for Breast Centers Program, the breast cancer team had to meet 36 quality standards on a variety of breast care measures. The hospital needed to redesign its data collection system to effectively track and report the hospital's performance on these 36 measures.
The process of developing a new data collection system was one of the biggest challenges of this initiative, according to Stephen Ray, MD, medical director of the breast center and medical director of oncoplastic and reconstructive surgery. Besides people's natural aversion to change, gaining buy-in for changing the data collection process was made more difficult by the nature of clinicians' schedules. Clinicians had to learn a new workflow in addition to maintaining their normal responsibilities. "It was taking people who were already working extremely hard and asking them to work harder, and convincing them the effort we were engaging them in was worthwhile," Dr. Ray says.
However, by keeping the emphasis on the patient, focusing on small steps and providing feedback, the hospital successfully engaged clinicians and received certification as a Quality Breast Center of Excellence in October.
Here are five tips on engaging clinicians in a major process change such as changing data collection processes.
1. Support bottom-up change. Successfully implementing widespread changes that affect physicians' and staff members' day-to-day work often relies on leadership from these physicians and staff members. Driving change from the bottom-up, as opposed to the top-down, with administration mandating certain changes, is crucial for engaging people in the project.
"One of the things we learned is you need to find a small group of people who have a passion for the vision that you're trying to manifest," Dr. Ray says. "This isn't something that can be readily dictated from above. It has to be something that's driven by the passion of the people who work with patients daily."
CTCA at Midwestern formed a multidisciplinary leadership group including medical oncologists, surgical oncologists, radiation oncologists, radiologists, registered dietitians, pathologists, mind-body therapists, naturopathic oncology providers and pastoral counselors. This group led the creation of the breast cancer center, including the redesign of the data collection process. While these projects were also supported by hospital leaders, the implementation of the changes was led by clinicians who work with breast cancer patients.
2. Focus on the patient. To gain clinicians' buy-in for any initiative, hospital leaders need to keep the focus on how the initiative will help patients. "One thing that drives everybody here at CTCA is that we're all about the patient," says Lana Poirier, director of quality at CTCA at Midwestern. "If we can derive a better treatment, better outcomes for patients, we're all going to do it."
The breast cancer care leadership group at CTCA at Midwestern emphasized how accurate and effective data collection can help patients. Being able to track the hospital's performance on key metrics helps providers identify opportunities for improvement of patient care. Hospital leaders can identify not only performance trends within the hospital, but also performance compared to other breast cancer centers. Collecting and analyzing data can thus help drive quality improvement.
Importantly, hospital leaders should emphasize the impact on patients not only when pitching the process change and gaining initial buy-in, but throughout each step of the project to maintain people's motivation and engagement. When challenges may cause some clinicians to question the project and resist the change, refocusing on patient care and quality can get people back on track, according to Ms. Poirier.
Furthermore, keeping the patient at the center of the change helps clinicians focus beyond their personal challenges and frustrations to the end result for patients. "As [the project] gathered momentum, people felt they were something much bigger than themselves," Dr. Ray says.
3. Break the project into smaller pieces. Hospitals can gain clinicians' buy-in for a large project by breaking the project into smaller pieces, which makes the initiative seem more manageable. Dr. Ray compares this strategy to a strategy he used when mountaineering, which is one of his passions. "Sometimes the only way was to literally focus on one step at a time, and not look ahead because [you would get] scared," he says.
When CTCA began the data collection project, the breast cancer program leaders wanted to get a consensus from team members on the new strategy for collecting data. However, as the team was a large group with people from multiple disciplines, reaching a consensus was difficult.
To address this challenge, the breast care leadership team broke down the data collection change into small elements and discussed with individual physicians the elements that would affect them. Then, leaders would try to get physicians to agree to these elements of change. By going through this process with all physicians, leaders would gain buy-in for the entire project. Dr. Ray likens this effort to putting pieces of a puzzle together to form a whole — each clinician focuses on the parts of the change that affect him or her so that together, clinicians support the entire change.
4. Conduct a trial. Once clinicians buy in to the change, hospital leaders should conduct a trial to test the new processes. "Chunk it down into small pieces, be persistent and get people to agree to a trial," Dr. Ray says. While the trial can initially result in slowed processes and frustration, persisting with the change will eventually result in a smooth workflow.
5. Provide positive feedback. Hospital leaders can encourage clinicians to persevere when facing challenges in process changes by providing positive feedback for incremental improvement. Dr. Ray suggests providing specific positive feedback on relatively small successes to demonstrate to the physician that his or her contribution is important for the overall project.
Similarly to framing the project in small steps, feedback on small parts of the larger change can keep physicians motivated when challenges arise. "We kept them focused on one step we were asking them to change, not the whole journey," Dr. Ray says. "We tried to keep the journey in context, but we would reward the step."
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