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February 08, 2017

Change Management: Saving Money, Saving Lives

3 mins read

killer-care_blogLately, I’ve been reading Killer Care, a review of the prevalence of medical error and efforts to improve patient safety. It’s an exhaustively researched work, and it contains great advice for anyone about to receive medical care. I was most surprised by how often safety improvements came down to cultural and process changes, not new technologies or scientific breakthroughs, and how doctors and researchers have implemented them with many of the same change management techniques we bring to our clients.

The Inevitable

You might think it would be easy to build support for efforts to reduce medical errors – after all, patient safety is on the line. But resistance to change is inevitable. To manage it, set expectations and justify the need for change by communicating early and throughout the implementation of a change. Dr. Peter Pronovost, rolling out processes designed to reduce hospital-acquired infections (HAIs), emphasized the data supporting the changes at the outset, and then assessed whether the new process had its intended effect afterward.

Communicate the WIFM

It’s only natural for those impacted by change to be uncertain if it’s unclear how their skills will translate or if they fear being blamed as individuals. By communicating the “what’s in it for me”, the value of the individual’s contributions, and how their participation impacts the success of the initiative, you can reduce resistance and create a more sustainable environment for the change to be successful. As Dr. Lucian Leape noted in the Journal of the American Medical Association, “Errors result from faulty systems, not from faulty people, so it is the systems that must be fixed. Errors are excusable; ignoring them is not.”

Get Buy-In and Commitment

The next step is to get people to buy in and commit to the initiative. In 2003, Dr. Carolyn Clancy of the Agency for Healthcare Research and Quality lamented that “there’s more double-checking and systematic avoidance of mistakes at Starbucks than at most health-care institutions.” This model is most successful in a safe environment where individuals feel their voice is heard and their contributions are valued. To build a culture of shared responsibility, hospitals have broken down silos between doctors, nurses, and epidemiologists, empowering everyone to speak out in support of patient safety. When necessary, they’ve designated change “champions” who help push the culture forward. This works from the top down, with respected senior physicians advocating for the change, and from below, with staffers tasked with nudging their peers toward compliance. You may still encounter what the Joint Commission on Accreditation of Healthcare Organizations termed “constipators,” those who oppose the change and refuse to budge. A targeted effort may convert them into great allies – but if not, be prepared to find ways to work around them.

Keep It Simple

Even those already on board might find their conviction wavering if the change is too great. When making an ask, keep it simple. When Pronovost set out to fight HAIs, he found that the CDC and WHO had already published comprehensive guides on the subject. But at more than 100 pages long, doctors found them impenetrable, and the guides were rarely followed. Pronovost managed to distil the protocols down to a five-point checklist and made sure necessary supplies were within doctors’ reach. Compliance shot up, infections plummeted, and thousands of lives and millions of dollars were saved. This success has been replicated with other types of HAIs, proving that infections that had long been considered unavoidable could be all but eliminated.

Since 1999, when the report To Err Is Human brought the issue to national attention, America’s healthcare system has made great strides in patient safety. But by and large, the improvements weren’t due to new technologies or miracle drugs, but with changes in attitudes and behaviors. Change can be as hard at a hospital as in any other organization. But with the right change management approach, it can be accomplished.

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