After Podcast #44 regarding how to incorporate change, our friend Patrick Bafuma reached out to provide his thoughts on how to make change happen in your department. He has championed the process and has pearls that are well worth the listen.
If you have not listened to Podcast #44 yet, please go back to that first since we are discussing some finer points today. In case you did not know, Patrick has a blog called EM in Focus. Check it out! It has some great content and another piece of#FOAMed out there for the taking.
Patrick's first point is that if you have a radical change, you need to mask it to some degree or it may not get picked up well. In the example of ketamine, he managed to get it used outside of sedation by finding an excellent clinical situation then negotiating some to graduate its introduction in a controlled manner that led to more people being comfortable with the change. Basically, you need people to "buy in" to this idea.
To sell something like this, Patrick has found a lot of benefit from marketing and psychology. Specifically, he mentions a book called Made to Stick which also hits on points like how branding and finding a particular point to capitalize on (like Southwest being known for its low air fares).
Data is not enough! Anecdotes can be the winning mark when making change in the department. Staff will not care if your cool idea saves thousands of lives around the world, but they will care if they can see right in front of them or hear the story from their colleague about the sentinel event that is going to lead everyone to stop and consider adapting to a new idea. Most of us practicing long enough can come up with such examples in their own department. A more negative but easily recalled example for most of us is probably the new policy that has been introduced because a poor outcome happened that led to a serious adverse event even if it may have happened time and again in the past without such complications.
Patrick gave an excellent tip that if we want to make change we need to be involved! This may sound like a no-brainer but this is harder than may be anticipated. Being involved in committees or special groups can be very powerful. Showing interest earlier and being able to get into such positions can facilitate change, especially outside of your own tribe. This is very important if you are an administrator. In emergency medicine especially, we should probably be at every department meeting that we can get into since we actually touch every single one because of how we evaluate and treat patients.
By going to all of these different meetings, people become familiar with you. It is much easier to become the voice of reason and for people to know your thoughts. By being involved and receptive, the pathway to communication opens more readily. This also means that we must be professionals all the time. It is also important is to take advantage of anything that falls into your lap. If you cannot do it for whatever reason, do not leave it alone but try to get someone who you know is competent take that role.
The key is to build relationships with each department both in and out of clinical practice. Patrick did this by having his providers go to the operating theater for intubations. This was to build better relationships on friendly ground for anesthesia.
Celebrate your wins! Not you the individual but those of your colleagues and the department. Be humble and make it about your team. As Patrick points out in the podcast, people will promote your actions as well by celebrating your wins. Boasting the wins of others helps promote the change you have been working for just like the anecdotes we discussed at the beginning of this post.
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