by Dr. Trina Dorrah MD, MPH
At the Society of Hospital Medicine’s 2015 conference, I had the privilege of hearing Dr. Peter Pronovost speak. He is a leader in the field of quality and safety, but the part of his talk that struck me the most was his advice on leading change.
During his discussion on change strategies, he accurately noted: People don’t fear change, they fear loss. As I reflected on his statement, I realized he was absolutely correct. We all know change is hard, but Dr. Pronovost identified the fundamental reason why – we’re all afraid of loss.
One of my roles as a hospitalist is that of “physician champion” for the patient experience. I’m constantly trying to promote change by asking clinicians to focus on the patient experience. This idea is often met with resistance even though my colleagues intuitively believe the patient experience is important.
When working with providers, I always try to focus on the why – why the patient experience is important; why it matters to our patients; why we should work to improve it. However, as Dr. Pronovost pointed out, simply focusing on the why may not be enough to promote change. We must also understand our colleagues’ and providers’ fears. More specifically, the fear that change will lead to loss.
When I consider change from their perspective, there are three things providers fear they will lose as a byproduct of change, and these three things must be considered when engaging providers on the patient experience: autonomy, time, and respect.
Autonomy
One thing clinicians love is autonomy. Throughout our training, we are encouraged to think independently and we feel a great deal of responsibility for our patients’ outcomes. Patient experience initiatives often require team buy-in and some level of standardization.
For example, let’s say your hospital installs white boards in all patient rooms and your medical director asks the hospitalist group to make sure they complete the pertinent information during each patient encounter. Surprisingly, some of the team refuses to participate. Why? Are they fundamentally opposed to patients knowing what the care plan is for the day? Of course not!
Going back to Dr. Pronovost’s explanation, it’s not the white boards the doctors fear, it’s the loss of autonomy. Providers have no fundamental problem with the white boards, but when its use is mandated, many providers view this as an attack on their autonomy. In these situations, you’ll have a greater adoption of the new patient-centered practice if the provider can see how the change directly benefits their patients instead of simply mandating the change.
Time
All hospitalists are short on time. Thus, providers are hesitant to embrace new improvement initiatives if they fear they will add more tasks to complete in the limited amount of time they have. Conversely, providers will gladly embrace solutions that save time. Both of these elements of time are important to keep in mind when considering patient experience improvement initiatives.
Consider the example of physician/nurse rounding. Many hospitals want to implement some version of care team rounds, but those initiatives have been met with resistance. Why? The change that providers are resistant to is an additional demand on their time. When you ask hospitalists to take on a new or different responsibility, you must understand the numerous demands on their time, and in this particular example, show providers how physician/nurse rounding actually saves time. When everyone taking care of the patient hears the plan at the same time, meetings are reduced, pages are decreased, and provider efficiency increases. Once providers see that the change benefits them, resistance dissipates. However, you will never get to this point without understanding the providers’ true fear – not fear of change but fear of lost time and productivity.
Check back on Thursday for Part 2 where I will explore the third feared loss, respect, and how to read and address providers’ fear of losing the esteem we’ve earned over years of hard work and dedication.
Dr. Trina Dorrah MD, MPH is a board-certified internal medicine physician who currently practices at Baylor Scott & White Health in Round Rock, TX. After earning her medical degree from Vanderbilt University School of Medicine, she completed her residency in internal medicine and her master’s degree in public health from the University of Alabama, Birmingham.
While in residency, Dr. Dorrah realized a passion for quality improvement. She enrolled in and completed a fellowship in quality improvement through the VA National Quality Scholars program. Dr. Dorrah then moved to Round Rock, TX, where she accepted a position as a hospitalist and entered her role as medical director of quality for the Baylor Scott & White Health hospital in Round Rock, TX. It is there where she has led numerous improvement initiatives and honed her passion for improving the patient experience.
Dr. Dorrah loves teaching providers and health care organizations how to improve the patient experience. She is excited to share her passion and expertise in an effort to create a better health care experience for all. She is the author of two books on the patient experience: Physician’s Guide to Surviving CGCAHPS & HCAHPS and CGCAHPS & HCAHPS Breakthrough: Coaching Health Care Providers for Success with the Patient Experience.
You can follow Dr. Dorrah on Twitter: @drtrinadorrah
[…] In Part 1, we discussed the fact that providers are often resistant to change not because they fear change itself, but because they fear loss. In my work as a patient experience physician champion, I am constantly encouraging providers to change. […]