Getting buy-in isn’t easy
Attitudes change when staffers feel empowered
Jennifer Lain, BSN, and Cheryl Young, RN, recently spearheaded an initiative to decrease the costs associated with open-heart surgery by 25% at Morton Plant Hospital (MP) in Clearwater, FL. (See cover story about the initiative.)
Cost Management in Cardiac Care asked them if the core team of four encountered any resistance to the project.
"Yes, there were some barriers to change," answered Lain, the cardiac surgical case manager. In fact, she says, initially, even the core team was somewhat inflexible and lax on disseminating information on change cycles.
"And, of course, some non-team individuals were resistant to change and didn’t buy into the goals right away," she says.
Everyone in the OR was asked to follow specific procedures established for this improvement process. A lot of people who had worked at MP for many years said, "But we’ve always done it this way. Why do we have to change now?"
Those attitudes ran from surgeons all the way to patient care techs, says Young, the director of surgical services.
"It was important for everyone to buy into what we wanted to do and into the reasons we were trying something new," she says. "We had to prove to everyone that it wasn’t just something we were pulling out of the sky and trying for the first time — that the processes had been tried and proven in other institutions and we were using their accomplishments as our benchmarks. We had to prove that we weren’t taking chances or trying something new just to be different; what we were proposing was actually an approved process that someone else had worked through. We also had to tell them how long this initiative would last."
Young says it was hard for some individuals to work with that. CMC asked her how they eventually got buy-in.
"Peer pressure," she explains. "Physicians put pressure on other physicians and said, If we want the OR staff to do this, it has to start with us.’" The cooperative attitudes flowed from that.
Staff attitudes also changed when the core team empowered staff members outside the team to generate process revisions themselves. Then, the entire staff acquired a sense of ownership of the initiative.
What would the staff get out of making this initiative work? What was their incentive?
"The biggest advantage of buying into this initiative for the individual OR staffer was the promise of a decrease in variation," says Lain. "For an OR nurse to remember how every surgeon does a process — and they practically all did things differently before we standardized processes — was time-consuming. It’s to the nurse’s advantage if every surgeon proceeds the same way, because then the nurse knows exactly what to prepare and how to do things. Life is made easier. Less questions are asked."
Young says the physician leader of the MP initiative consistently updated senior management and the hospital board.
"Senior leadership has to be integrated into the project," she says, "to get their buy-in and also supply needed resources."
At the first sign of resistance, the team made several site visits to cardiac surgery programs throughout the country, including Munroe Regional Medical Center in Ocala, FL.
They included in their entourage a medically naïve engineer from MP who could observe processes without bias and provide insight on tasks that other team members might not notice because they perform them automatically. He noticed, for example, "minimal conversation between surgical team members during the operation" and that all tasks appeared to be anticipated.
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