Engaging the Medical Community in Change Jason M Matuszak, MD FAAFP Chief of Sports Medicine, Excelsior Orthopaedics

I am a Family Physician who Practices Sports Medicine Family Medicine is at intersection of public health and patient care More than 84,000 board certified family physicians 80% of health outcomes are based on factors other than the healthcare we provide

Change Management Change management is an ongoing organization process, not a means to a single event Change is predictable – it will happen; the outcome of change is not always predictable No change is without consequences “If you do not change direction, you may end up where you are heading.” – Lao Tzu

Resistance to Change Uncertainty Leadership Issues “Change Fatigue” Previous Failed Changes False Starts Resistance to Specific Innovation

Obstacles to Medical Community “Buy-In”

Institutes of Medicine (National Academy of Medicine) report: – “It would take 21 hours per day for individual primary care physicians to provide all of the care recommended to meet their patients’ acute, preventive, and chronic disease management needs” – “nurses spend only about 30 percent of their time in direct patient care”

Overcoming the Inertia: Obstacles to Medical Community “Buy-In” 1.Must actually improve outcomes (quality) 2.Must be important 3.Must be scientifically valid 4.Must be reliable to measure 5.Must be feasible to assess 6.Must be able to use the data 1.Reporting programs/Payment 2.For clinical research 7.Must have access to resources 8.Must be easy to re-educate practicing clinicians 9.Must be free of significant commercial bias

Overcoming Obstacles Physicians want help overcoming obstacles

Outcome Improvement Must actually improve outcome – “Not everything that counts can be counted” – “Not everything that can be counted counts” Can it be sustainable? – 10% more patients self reported adequate physical activity at 4 and 10 months “Measuring Pain as the 5th Vital Sign Does Not Improve Quality” (Mularski JGIM 2006)

Scientific Validity The extent to which a concept, conclusion or measurement is well-founded and corresponds accurately to the real world.

Reliable to measure “The patient’s self-report of pain is the most reliable indicator of pain.” What is the most reliable indicator of physical activity? – Self reports ρ = 0.3 – Accelerometers Smart devices Connected devices GPS monitoring

Feasibility Ease of data gathering Workflow changes – Staff training – Implementation Vendor support – Electronic measure

Usability Ease of Interpretation Treatment opportunities – Toolkits – Readily available resources Reporting programs – PQRS Clinical research – Outcomes based research

Change Management Assess Current State Envision Desired Future State Make and execute Plan Evaluate Outcome Change can be perceived as both good and bad at the same time “What the caterpillar calls the end, the rest of the world calls a butterfly.” – Lao Tzu

Kotter’s Three-Phases of Change Management Phase 1: Creating a Climate for Change Establish a Sense of Urgency Build a Coalition Create vision for Future State Phase 2: Engaging & Enabling the Organization Communicate Future State Empower others Plan for and create short-term wins Phase 3: Implementing & Sustaining Changes Focus: problems, solutions, behaviors Training, retraining, technical assistance Celebrate Successes

Establish a Sense of Urgency: The Changing Healthcare Landscape

Create and Communicate Vision for Future State

Strategies for Successful Change Empower Others Engage Innovators/Early Adopters – Early wins!! – e.g. Walk with a Doc Address concerns of late adopters Use Social Influence Strategies (e.g. conformity, reactance, persuasion)

Implement and Sustain Change Think globally, act locally – Engage your physician – “Doc, what do you do for physical activity?” “How many steps a day do you get?” “Did you know physicians who do not get recommended weekly physical activity are 3x’s as likely to suffer burnout?” – We love to give out stuff Have pre-packaged info

Outreaching the Medical Community County Medical Society Regional Health Collaborative – Specialty Medical Societies Medical Schools Residency Programs

Outreaching the Medical Community Specialty-specific medical societies – American College of Sports Medicine – American Medical Society for Sports Medicine – American Academy of Family Physicians – American College of Physicians – American Academy of Pediatrics – American College of Obstetrics & Gynecology – American College of Cardiology

Key Action Items Engage your physician at your next appointment Meet with your local medical society or regional chapter of specialty society – Present at a meeting to members Be prepared with the facts (and pre-printed materials to hand out) Follow up early and often