Do Providers Fear Change or Do They Fear Loss? Part 2

by Dr. Trina Dorrah MD, MPH

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.

At the Society of Hospital Medicine’s annual meeting in March, Dr. Peter Pronovost challenged us to recognize that resistance to change comes from a fear of loss as opposed to a fear of change. In Part 1, I talked about provider resistance to patient experience initiatives due to a fear of lost autonomy and time. In Part 2, we will discuss the fear of losing professional respect.

Respect

Historically, physicians have enjoyed a great deal of respect. Although this is still the case, many physicians feel that respect has decreased over time. We devote years to education and training, so we want to be respected for our clinical knowledge and skills. Unfortunately, many patient experience initiatives leave providers feeling at odds with their patients, and they feel their expertise is ignored in favor of patient desires. Given this perception, it is unsurprising that providers are suspicious of patient experience initiatives.

Consider the example of resident bedside rounding. Historically, residents present the patient’s case to the attending outside of the patient’s room. The team then enters the room for a quick physical exam and announcement of the plan. When focusing on the patient experience, the traditional bedside rounding routine is redesigned so that rounding occurs in front of the patient at the bedside instead of in the hallway. The patient is invited and encouraged to participate in the conversation. As expected, some providers oppose this approach because they fear the loss of professional respect. With bedside rounds, patients now have a voice. They can ask questions and express their thoughts and concerns. Providers become frustrated when they feel that patients are being encouraged through patient experience initiatives to question our knowledge and expertise. Knowing this, it’s important to focus on the value that a collaborative relationship brings. However, even in collaboration, there are things in which the physician remains the expert (i.e. clinical knowledge and decision making) and things in which the patient is the expert (i.e. personal thoughts, feelings, and preferences). When these two levels of expertise combine, everyone benefits, and both the physician and patient feel respected.

When developing patient experience initiatives, you will be much more successful in gaining provider buy-in if you remember your providers’ fear of losing autonomy, time, and professional respect. Until we internalize Dr. Pronovost’s point (it’s not change we fear, it’s loss), we will continue to mislabel providers as difficult, obstructionist, and resistant to change. If you can mitigate providers’ fear by addressing their perceived loss, your providers will be much more willing to change. After all, as a hospitalist, I can tell you we overwhelmingly support an improved patient experience; it’s just the approach that is often used to promote patient experience initiatives that we find questionable.

Many of you reading this article are also physician champions for the patient experience. As you know, this is difficult work. Very few of our colleagues are excited to see us coming, and some are downright hostile. After attending Dr. Pronovost’s talk at SHM, I plan to change my practice by paying closer attention to my providers’ underlying concerns. It takes no leadership skill to announce a change, make it immediately effective, and penalize for noncompliance. However, initiatives announced in this manner are often unsuccessful. True leadership involves taking the time to solicit your colleagues’ opinions and consider/address their underlying issues and fears. With the first approach, your improvement initiative is bound to fail. With the second approach, your chances of success are much greater.

Healthcare’s focus on the patient experience is not going away, so as leaders, we must find effective ways to engage our colleagues. Dr. Pronovost suggested one approach, and I agree with him that addressing our providers’ fears is key. When we take time to explore the negative effects that our improvement initiatives have on our providers, we may have to adjust our approach slightly. However, in the end it is worth it because you’re more likely to have a group of providers who actually support your patient experience initiative.

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