PHM 2024 Session Recap
This session, presented by Brittany Hunter, MD, and Cynthia Castiglioni, MD, MS, was a high-yield quick hit that gave practical solutions on how to implement meaningful change in multiple settings relevant to hospitalists. Dr. Hunter’s expertise as an MBA student at Northwestern’s Kellogg School of Management was evident throughout the session. Dr. Castiglioni brought skills from her experience in hospital operations and her education in change management. The session was an excellent primer in organizational psychology for hospitalists looking to impact change at any level in their rounding team, division, or hospital.
Drs. Hunter and Castiglioni began the session with the statistic that 70% of change initiatives fail because human nature is hardwired to resist change. They emphasized that some of the strategies discussed during the session may be intuitive, but naming these strategies can help us employ them when we need them.
Their first strategy to lead change is to tell the story. For each strategy, the speakers discussed the psychology motivating the strategy. Dr. Hunter emphasized that humans process information in stories. Stories can outline a compelling reason for change, a vision for change, and a path to change. A story can help answer the all-important question WIIFM, “What’s in it for me?” Dr. Hunter then went on to give examples of how telling the story can be incorporated in multiple settings in which a hospitalist may find themselves. For example, Dr. Hunter told the story of an incorrectly documented baseline neurologic exam in a patient’s admission history and physical. Subsequently, the patient received unnecessary workup because there was concern that their neurologic status had changed. Without a carefully documented initial exam, the team was obligated to pursue further testing. As an audience member in this session, this story was memorable and relatable to my experiences. It made me think about how accurate I am in my own documentation, demonstrating the effectiveness of telling a story in motivating others to consider changing behaviors.
Second, the speakers recommended involving stakeholders early to implement change. When stakeholders have a sense of ownership over change, they are more likely to make a commitment and less likely to be resistant. Then stakeholders can become champions for your changes themselves. To ensure no stakeholders are excluded, consider asking known stakeholders if there are others you have not considered. Noting preferred communication modalities may also help with maintaining open communication with stakeholders. Stakeholders aren’t just in hospital operations, however. The speakers pointed out that our pediatric patients have stakeholders in their medical care. For example, when determining medication adherence, you might ask the patient or caregiver who helps with administration. It may be a school nurse, a daycare provider, or a grandparent. As hospitalists, we can care for our patients more effectively when we can identify these individuals who are key to their care outside the hospital.
The third strategy for change is to harness the power of options. Psychologically, humans need comparison to understand the value of an option. Drs. Hunter and Castiglioni made an especially impactful statement during this section: “If only one option is presented, the alternative option is always the current state.” Presenting options in a group of three may make people more likely to choose the “middle of the road” option because it seems realistic, and this can be used to your advantage in how you may present your goal state compared to your current state. At an institutional level, a hospitalist may use the power of options by convincing stakeholders that the current state is inadequate for patient safety, patient experience, or cost. Then, if your goal state is a better option, stakeholders will be more likely to buy into your changes to achieve the goal state.
As Drs. Hunter and Castiglioni mentioned at the beginning of the session, humans are resistant to change. Therefore, to enact change, you must make change easy. This is the fourth strategy discussed. Like breaking any bad habit, change is more likely to occur if the effort to perform the desired behavior is decreased, and the effort to perform the undesired behavior is increased. The speakers used the example of having an interpreter tablet already in the room of a non-English speaking patient to improve interpreter use on rounds. At an institutional level, requiring infectious-disease consultant approval to order broad-spectrum antibiotics may bolster antibiotic stewardship efforts.
Finally, Drs. Hunter and Castiglioni presented the fifth tip for leading change: focus on people. They closed out the presentation by connecting this strategy to the other four. To initiate successful change, one must use storytelling to involve stakeholders, make change easy for people, and empower others to participate in the change by providing options to do so.
Overall, Drs. Hunter and Castiglioni compiled a clever presentation that used behavioral psychology to demonstrate how, as hospitalists, we already incorporate change daily in our clinical practice, and we can employ the strategies we likely already intuitively use to enact change on a greater scale.
Key Takeaways
- Change is necessary, but people are inherently resistant to change.
- Hospitalists already incorporate change strategies in our day-to-day work that we can apply to institutional-level change.
- The most important strategy to enact change is to focus on people by building social capital, knowing your audience, understanding the diversity of thought, and empowering those with whom you are working.
Dr. Krause is a second-year pediatric hospital medicine fellow at the Medical College of Wisconsin/Children’s Wisconsin in Milwaukee.
