Yesterday I met with a CNO at a hospital. Very much on her mind was one of her biggest burdens – preparing to get physicians on board with a new communication protocol. It’s no secret that hospitals struggle with physician adoption of many kinds of new technology.
I’d like to share how we at Vocera have been finding success in addressing this challenge when it comes to getting physicians in particular on board with technology solutions that streamline clinical workflow and improve communication.
A key element of the Vocera solution is an enterprise-class smartphone application that enables HIPAA-compliant voice and secure texting. The idea of enabling two people to communicate directly might seem straightforward to an outside observer. But within a hospital it can represent a shift in a communication paradigm that’s been in place for decades.
A hospital implementing a new communication technology is redesigning how nurses and physicians communicate. They’re affecting deeply ingrained, cultural, automatic processes. Simply putting a software application on physicians’ smartphones will not change their behavior. Changing behavior requires strategic thinking and planning so that physicians and nurses will see benefits and value.
The challenge: different priorities, different incentives
Nursing and physician executives want to find a more standardized way for everybody to communicate as part of improving workflow to improve patient care. The core of the challenge is that physicians and nurses are not aligned on priorities or incentives.
At the core of everyone’s priority are the patient, patient outcomes, and the patient experience. Chief medical officers oversee the medical staff and focus on quality outcomes. The chief nursing officer focuses on operational excellence and clinical outcomes. Because of fundamental differences in how physicians and nurses work, communication sometimes breaks down.
Anyone who has worked in a hospital is aware that physicians have always worked from a position of control over how they’re communicated with. A nurse sends a message out to them; they have autonomy about how and when they respond, and the nurse traditionally has to wait for the response. I’ve worked in hospitals where anytime a nurse pages a physician, they can’t even page directly. They have to go through a switchboard.
And then there are disparate cultural protocols and methodologies related to workflow communication. The ER might have a cultural protocol that says you call these numbers first, then you do this, then you do that. The surgical floors might have a different cultural protocol where they want you to do number three on the list first, and then do number two and number one.
When we enable direct communication, what we’re doing is removing barriers and obstacles to having direct contact to the physician. When you’re bringing nurses and physicians closer together through communication, you may find resistance. But you will also ultimately improve communication, which reduces errors and improves outcomes.
Start with a few persuasive hospitalists
We often hear hospital leaders say to physicians, “We don’t want you to just text like you normally do just using your smartphone. We want you to download this secure app on your phone if you’re going to discuss patient care with anyone in the hospital.”
We then hear physicians say, “I’m not going to do that, it takes too much time. I don’t want to have to learn it, I don’t want to go to training, and you can’t make me, etc.”
That’s really how the conversation goes. And CMOs call us asking for guidance on how to drive compliance and adoption among the medical staff. That’s when we make recommendations, starting very small.
Physicians in general are self-employed and choosing to have privileges at a hospital. Consequently when hospitals say I want you to do it this way, they feel somewhat immune to that.
In contrast, hospitalists are employed by the hospital. Because they’re paid by the hospital, they have an incentive to cooperate with any hospital initiatives and adopt protocols or technologies or policies.
We look for hospitalists who can be persuasive and who have what I would call physician authority in the hospital, like a CMO or CMIO. They get a few more folks on board and then we do the “I tell two friends and they tell two friends” method. We get a quarter of the physicians using the solution and then we bring in another group of physicians and continue to expand. The physicians who want to remain outliers soon find it difficult to communicate because their colleagues and the nursing staff are on the secure platform.
How to get physicians on board: six steps
At Vocera, we have a large team of clinicians who are experts in designing and deploying clinical workflow and communication solutions. We’ve outlined six steps that we recommend to hospitals to help ensure successful physician adoption of Vocera solutions. A hospital’s clinical leaders drive these activities.
1. Enlist nursing and physician executives.
Nursing and physician executives must be involved with introducing the new solution and understand the impact it will have on staff, physicians, and patients. Executives need to be more than just sponsors; they must be active participants and champions.
2. Identify physicians likely to be successful with the technology.
Ideal candidates are influential with their peers, natural team players, and tech-savvy. We work with nursing management and physician leadership to identify these physicians.
3. Provide in-depth training for end users within the context of their workflow and develop supporting policies.
End users need to understand how the solution works in the context of their workflow. This means that physicians and nurses need to meet together to discuss expectations and policy guidance such as:
- When it’s appropriate for a nurse to send a web console message versus a page
- How physicians will manage messages when they are not on call or available
- What a nurse should do if he or she has sent a web console message to a physician who hasn’t responded, and the nurse is going off shift
- How a physician will be connected to the nurse taking over a patient for a nurse who’s gone off-shift after paging the physician
- How unanswered messages should be handled
4. Follow up support and feedback.
Physicians and nurses will need to be supported closely when they use a new technology solution for the first time. There should be onsite support for the technology and for the physicians including regular check-ins and retraining as needed. Processes, expectations, and policies should be reinforced and refined through regular meetings with physicians and nurses.
5. Measure satisfaction and create internal marketing.
Formally measure user satisfaction to aid in system-wide awareness and to identify users who can be featured in a hospital’s internal marketing efforts. Additionally, nurse and physician executives should plan on sharing the experience with other CNOs and CMOs in the system.
6. Expand
Once success has been achieved, select another group of physicians and repeat the process.
Leading physicians to embrace new technology isn’t always easy, but it pays off.
