Turning Skeptics into Allies
Dr. M. G. Maharaj
Chief of Surgery
NSQIP Surgeon Champion
Langley Memorial Hospital
2014 Qual...
Background
 Langley Memorial: 200 bed community hospital
 NSQIP since 2011
 Multidisciplinary action teams to reduce UT...
Goals
 Understand that skeptics are common, and
skepticism is a natural response to
something new
 Identify different ca...
Example: UTI
 When LMH started with NSQIP, we had a high UTI
rate in surgical patients, according to risk-adjusted
data
...
Prevalence of Skepticism
“We don’t need to change
the current system. It works
just fine.”
Prevalence of Skepticism
“We can’t change anything until
they give us more money.”
Prevalence of Skepticism
“We tried this before and it
didn’t work”
Prevalence of Skepticism
“They should just fire all of the
administrators – we physicians
know what’s best for our
patient...
Prevalence of Skepticism
 Skepticism is a normal, healthy response of a critical
mind
 Physicians are increasingly train...
Stakeholders
 Cast a wide net to include all potential stakeholders,
including those impacting a change, and impacted
by ...
Failure to Target the
Real Issue
Stakeholders: Power
Brokers
 Those with ultimate decision-making over the
change
 Ability to allow or prevent what you a...
Stakeholders: Agents
 Those responsible for enacting the change, carrying
out the day-to-day implementation
 Typically f...
Stakeholders: Constituents
 Those impacted by the change, the targets or
beneficiaries of the proposal
 Typically patien...
Stakeholder Stance
 Supporter: can be counted on to support and even
promote the initiative – OR nursing staff
 Undecide...
Urgency
Urgency
 Urgency can be thought of as a means of influencing
the degree of enthusiasm with which an individual
becomes in...
Strategic Approach to
Stakeholders
 Supporters: inflate urgency to inspire continued
active support, but don’t continuall...
Strategies for Agents
 Supporter: designate responsibility for process
improvement, give them ownership or the change
 L...
Strategies for Agents
 Dissenter: find supporter with knowledge or data to
counter negative messaging from dissenter
 LM...
Strategies for Agents
 Undecided: use information or data to design or
refine the change, identify “what’s in it for them...
The Power of a Group
 Inflating and deflating urgency can be done individually;
commitments to action should be done in a...
What Physicians Want
 Respect
 Acknowledge their role as stakeholders
 Expertise
 Responsibility for patient care

 I...
Don’t Over Complicate
We’re all in this Together
 At the end of the day, we want the same thing:
optimizing patient care
 Different ways of ac...
Questions
Physician Engagement: Turning Skeptics into Allies
Physician Engagement: Turning Skeptics into Allies
Physician Engagement: Turning Skeptics into Allies
Physician Engagement: Turning Skeptics into Allies
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Physician Engagement: Turning Skeptics into Allies

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This presentation was delivered in session B5 of Quality Forum 2014 by:

Mitra Maharaj
Surgeon Champion, NSQIP, Langley Memorial Hospital
Fraser Health

Published in: Health & Medicine
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Physician Engagement: Turning Skeptics into Allies

  1. 1. Turning Skeptics into Allies Dr. M. G. Maharaj Chief of Surgery NSQIP Surgeon Champion Langley Memorial Hospital 2014 Quality Forum, British Columbia
  2. 2. Background  Langley Memorial: 200 bed community hospital  NSQIP since 2011  Multidisciplinary action teams to reduce UTI and SSI rates  Pneumonia team on the horizon  ENT surgeon at LMH for 10 years, chief of surgery since 2008, surgeon champion since 2011  Advisory board company talent development
  3. 3. Goals  Understand that skeptics are common, and skepticism is a natural response to something new  Identify different categories of stakeholders and strategies which will help them align with your goal  Walk through a real example of managing skeptics in the setting of change to reduce postop UTI in surgical patients
  4. 4. Example: UTI  When LMH started with NSQIP, we had a high UTI rate in surgical patients, according to risk-adjusted data  We assembled a multidisciplinary team who identified that the best practice of early foley removal, or avoidance of indwelling catheter altogether, in total joint patients was not being adhered to consistently  We encountered some skeptics whose objections may sound familiar…
  5. 5. Prevalence of Skepticism “We don’t need to change the current system. It works just fine.”
  6. 6. Prevalence of Skepticism “We can’t change anything until they give us more money.”
  7. 7. Prevalence of Skepticism “We tried this before and it didn’t work”
  8. 8. Prevalence of Skepticism “They should just fire all of the administrators – we physicians know what’s best for our patients.”
  9. 9. Prevalence of Skepticism  Skepticism is a normal, healthy response of a critical mind  Physicians are increasingly trained to rely on evidence based practice  Any change or proposal is inherently flawed until there is convincing evidence to support it  A skeptical response is simply an indicator that the individual is a stakeholder
  10. 10. Stakeholders  Cast a wide net to include all potential stakeholders, including those impacting a change, and impacted by the change.  Failure to include and consult all stakeholders can result in a fundamentally flawed approach, giving strength to skeptics and undermining allies
  11. 11. Failure to Target the Real Issue
  12. 12. Stakeholders: Power Brokers  Those with ultimate decision-making over the change  Ability to allow or prevent what you are advocating from getting off the ground  Typically executive level  LMH: OR and surgical ward Manager
  13. 13. Stakeholders: Agents  Those responsible for enacting the change, carrying out the day-to-day implementation  Typically front line staff, including physicians  LMH: OR nurses, ward nurses, orthopaedic surgeons
  14. 14. Stakeholders: Constituents  Those impacted by the change, the targets or beneficiaries of the proposal  Typically patients  Often also includes the frontline staff and physicians  LMH: patients, OR and ward nursing staff, Urologists
  15. 15. Stakeholder Stance  Supporter: can be counted on to support and even promote the initiative – OR nursing staff  Undecided: uncertain, could be swayed to action either in support or in opposition – Orthopaedic surgeons, Ward nursing staff  Dissenter: actively opposed, unlikely to switch allegiance - Urologist
  16. 16. Urgency
  17. 17. Urgency  Urgency can be thought of as a means of influencing the degree of enthusiasm with which an individual becomes involved  Times sensitivity and personal importance can impact how strongly a support promotes, or a dissenter thwarts, an initiative  Urgency can be raised or lowered for any given individual
  18. 18. Strategic Approach to Stakeholders  Supporters: inflate urgency to inspire continued active support, but don’t continually preach to the choir  Dissenters: reduce urgency to reduce reaction, maintain in an inactive status; don’t expect to turn dissenters into supporters  Undecided: articulate the reasons why undecideds should become active supporters; this should be the group receiving most of your attention
  19. 19. Strategies for Agents  Supporter: designate responsibility for process improvement, give them ownership or the change  LMH: OR nurse charged with communicating the new policy, reporting on compliance
  20. 20. Strategies for Agents  Dissenter: find supporter with knowledge or data to counter negative messaging from dissenter  LMH: other Urologist tasked with presenting the data in support of the new policy
  21. 21. Strategies for Agents  Undecided: use information or data to design or refine the change, identify “what’s in it for them”, and how this change will serve their needs  LMH: emphasis on patient benefit to avoiding UTI  happy patient = happy Orthopod  fewer UTIs reflect positively on ward nursing care
  22. 22. The Power of a Group  Inflating and deflating urgency can be done individually; commitments to action should be done in a group  Groups allow individual expertise and perspective to work synergistically to the benefit of the collective  Groups also prove as “testing grounds” for more extreme views, and can be an effective venue to quash dissent  LMH: all stakeholders brought together in person to air their concerns, hear reassurances from colleagues, get a sense of the collective will to act to correct a proven problem with patient care
  23. 23. What Physicians Want  Respect  Acknowledge their role as stakeholders  Expertise  Responsibility for patient care  Independence  Patient advocates  Ultimate responsibility is to the patient, not the institution
  24. 24. Don’t Over Complicate
  25. 25. We’re all in this Together  At the end of the day, we want the same thing: optimizing patient care  Different ways of accomplishing the same goal  Skeptics should be respected, put in the context of the group opinion, and managed in such a way as to either become a supporter, or a non-disruptive dissenter  A track record of success will predispose prior dissenters to be less likely to dissent in the future  LMH: successful implementation of new policy resulting in ~30% reduction in UTI rate
  26. 26. Questions
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