Translate to Transform

Illustration: Lee Sauer

As a recent addition to the MedAxiom Consulting Team, Denise Busman, MSN, brings more than 30 years of experience as a cardiovascular clinician and leader. Her clinical expertise is complemented by a passion for engaging multi-disciplinary teams to transform care delivery and enhance clinical quality. Known for her work in program development and change management, Denise is skilled in the implementation of new programs and clinical initiatives.

In my more than 30 years as a cardiovascular clinician and leader, I’ve seen how challenging it can be to translate science into practice and I’ve made it my mission to bridge the gap.

Cardiovascular care is awash in evidence-based guidelines, expert consensus documents and performance criteria. These are all intended to improve outcomes and transform care into something better, but transformation can’t happen until we take the science and translate it into delivering the care itself. High-quality evidence doesn’t ensure evidence-based decision-making unless it is actually implemented. Yet, it is well described that it can take up to 17 years for only 14% of published evidence to translate into practice.^1,2,3

Doing new things requires intentional action to adjust old behavior to a new one. Introducing new ideas and clinical practices is much the same, it requires intentional action and a change in behavior. We usually don’t likechange, we tolerate change. A new process can feel like a big disruption in our day. Clinicians are experiencing burnout especially having lived and worked through two years of a pandemic. Conjuring up the energy and engagement to learn new processes and behaviors may feel like too much work. So where do you start when the task feels daunting in an already challenging healthcare environment? As trite as it may seem, you take one step at a time.

Look For the Helpers

The first step is to engage those doing the work. W. Edwards Deming stressed the importance of understanding the psychology of change, emphasizing that people — not processes or products — are the fundamental source of value in our systems and must be treated as partners.⁴ As Mr. Rogers famously said, “look for the helpers.” In this case, the helpers are those closest to the process, the ones doing the daily work. Start by identifying a clinical champion, then gather input from a team of operational and clinical staff. Acknowledge your current state and clearly identify what the desired future state is. Then, involve them in designing a plan on how to get there. Learn about their daily workflow and ask what would need to change to deliver the care outlined by guidelines. Posing the question as “what would it take?” is often a good start to get the team thinking.

Build Consensus and Shared Ownership

Next, build consensus. Guidelines are exactly that, guidance, not rigid rules. While the goal is to minimize variation and deliver evidence-based care, there may be times in which customization is appropriate, so long as it stays within the boundaries of the evidence. Creating consensus and shared ownership will help generate the motivation and commitment you’ll need to maintain accountability and drive success when implementing new workflows and management strategies.

I’m a creature of habit. As much as life allows, I like my morning coffee and evening glass of wine. They are rituals that bookmark my days, worthy of a little less sleep or a later dinner. Moreso, they are intentional habits that help with connection and mindfulness. However, I probably would not look forward to those times if they were forced, or without a choice to put cream in my coffee, or heaven forbid, drink Moscato!? Similarly, “because I said so” is not a change management strategy with survivability. Top-down change may get the work done, but it’s less likely to succeed. Change that sticks is change that starts with the people it impacts and takes their perspective into account when designing a new behavior or workflow. 

Implement Change Management Strategies 

Once clinical pathways and accompanying workflows have been developed, employing known change management strategies to support their adoption is crucial. Applying tactics to create awareness and desire to change, along with transparent communication with clinical teams, will help build the foundation for introducing new workflows. This should be followed by training with clear instruction on expectations and practice time with access to team members that have established competence. Finally, providing feedback and support along the way will help reinforce behaviors and sustain desired changes.

Teams are more likely to be successful if you make it hard to ignore or forget to do an activity, while making it easy to do the right thing. Engage bedside clinicians to understand what documentation tools and strategies will make it easy to prescribe guideline-based care. Tactics such as embedding clinical decision support tools, checklists, logic-based orders, EHR documentation smart phrases and note templates will make it easier to do and document the right thing.

Leverage the Entire Care Team

Finally, be sure to leverage the talents of the entire team, so everyone works at the top of their license. This may mean adjusting rounding templates or ensuring advanced practice providers (APPs) have the education and skills they need to manage more specialized care. It may also mean building nursing protocols or algorithm-based orders that grant nurses the ability to manage patients while reducing the number of phone calls sent and received. MedAxiom experts have developed APP resources to help optimize your care team and develop sustainable transformation initiatives. Explore resources and more in the Advanced Practice Provider Hub.

In the end, the innovative implementation of evidence-based pathways will reduce variation, increase the effectiveness of care and minimize complications – all driving value. It is only then that we will truly transform cardiovascular care. 

References

1.Westfall JM, Mold J, Fagnan L. Practice-based research- “Blue highways” on the NIH roadmap. JAMA 2007 Jan 24;297(4):403-6.)

2. Balas, EA, Boren SA. Managing clinical knowledge for health care improvement. Yearb Med Inform. 2000(1):65-70.
3. Beauchemin M. et.al. Implementation of clinical practice guidelines in the healthcare setting: A concept analysis. ANS Adv Nurs Sci. 2019 Oct-Dec 42(4):307-324.
4. Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. (Available at ihi.org)