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The only way to get physicians on board with a change management initiative is to use the same weapon they use when treating a patient - data.
Every day, physicians engage with their patients to solve all types of clinical issues. Typically, the encounters begin with patients expressing the nature of their concerns. The doctor then engages a process of identifying objective data (exam, labs, imaging) to properly establish a diagnosis and treatment path. While it is the patient history that establishes the context of the problem, it is the data that determines the clinical decision-making.
So why are we not following this “tried and true” process to address clinical workflow issues within the office? “People are waiting too long” or “this process is a bottleneck” are typical subjective complaints found during a workflow improvement project. Yet these complaints also have their objective measures, and dare I say, diagnostic data elements, which can lead to a root cause and plan of attack.
Let’s consider the doctor-patient paradigm once again. In managing a patient with worsening fatigue and weight loss, physicians would never accept a few sporadic blood sugar readings taken over a single day to properly qualify a diagnosis of diabetes. Yes, any glucose readings, no matter how sporadic or biased, could raise the specter of a diabetes diagnosis. But it would be considered malpractice to use it as the sole basis for establishing an effective treatment path. Likewise, in a practice improvement opportunity, physicians are rightly suspect of the scant data obtained from watches that measure the intervals for a few dozen patients.
Over the past few years, I have been part of a team that provides external lean expertise for physician practice change management initiatives. In each of these engagements, it was extremely difficult to engage physicians in the change management process. Their tacit support and limited engagement often created frustration in the office team who were trying to improve workflow.
As the lone physician on the consulting team, I often would be asked to “talk with Dr. X” to see if we could change this or change that in his or her practice pattern. Or, worse yet, practices would ask me to make decisions about aspects of their workflow based on my clinical training and office management experience. Suddenly, I found myself as a doctor of workflow, prescribing a therapeutic change with little data and zero involvement of the actual “patient” (i.e., the physician provider).
So how do physicians engage in change? As physicians, we are scientists who expect hypotheses to be supported with conclusive data. Scientists are trained to respond to data and view subjective findings as mere context for analysis.
Recognizing this, we decided our next workflow enhancement engagement had to make use of strong data. To do this, we sought the help of real-time locating system (RTLS) technology. At a six-physician primary care practice in Ohio, we embedded 34 sensors and assigned locating badges to the entire clinical staff and all patients. For a period of three weeks we used the system to monitor the flow of patients and interactions with clinical staff. This allowed us to automatically collect a wealth of data on wait times, time spent with provider, lengths of stay, provider time spent at the computer, and more.
We then engaged the client in the change management process but strategically withheld the data. In keeping with the spirit of how clinical encounters are conducted, we first listened to the staff describe their issues and asked them to estimate the various wait times, delays, intervals, etc. Then, one by one, we revealed the relevant actual objective data related to their concerns. With each reveal, without exception, the time estimates were at least 25 percent erroneous, usually underestimating. Physicians were uniformly overly optimistic and significantly underestimated the waiting intervals.
This is where the magic happened - this is where the physicians engaged in change. When the physicians saw the actual data for their individual workflows, including consistent patient wait times, prolonged electronic documentation times, below-expected face-to-face time with the patient, they asked probing questions. Just as important, they wanted to know how they compared to their peers. With this level of investment in the process, they suddenly became more open to change. Later, they began leading their teams with ideas and welcomed consultative feedback.
The result was that patient face-to-face time with the clinical care team increased by double digits. Physician productivity improved significantly in documentation and on-time performance. Moreover, patients expressed improved satisfaction.
It turns out, the way to manage change is to treat a physician like they treat their patients. Let them tell their story and then provide unbiased data that allows them to diagnose their own issues. They are then well informed to prescribe components of their own therapy. Doctor, heal thyself!
“Dr. Tom” Schwieterman is the Vice President of Clinical Affairs and Chief Medical Officer for Midmark Corporation, a leader in workflow solutions for outpatient settings. Midmark recently acquired Versus Technology, a workflow technology firm that uses real-time locating system (RTLS) technology and rules-based automation tools to make health systems safer and more efficient.