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How to take the pain out of healthcare change

January 23rd, 2013

by Mickey Lebowitz

According to Albert Einstein, the definition of insanity is continuing to do the same thing and expecting there will be a different outcome. In the current healthcare environment, hospitals may be considered "insane" if they continue to do the same thing and don't "reform" (change for the better).

Not improving on patient outcomes and satisfaction could lead to financial hardships, if not organizational demise.

But change can be painful because it creates fear.

Studies using functional MRI scans suggest areas of the brain that are activated when one is fearful are similar to areas that are activated when one is asked to change. So what can hospitals do to carry out these painful healthcare reforms?


It may come down to the old joke, "How many psychiatrists does it take to change a light bulb? One, but the light bulb has to want to change." Getting the light bulb to want to change is, however, no joke, though it could be fun.

At Crouse Hospital in Syracuse, N.Y., we're following the Pike Place Fish Market's "FISH principles" (be there; choose your attitude; make their day; play) to encourage continued reform of our staff's culture. By doing so, we hope to help staff bridge the gap between what they know to do and actually doing it.

Recently, a group of physicians and nurses (aka the Crouse Germinators) created a rap video encouraging our staff to reduce hospital-acquired conditions (HAC) and improve patient safety (a win-win-win for our hospital, staff and patients). The chorus sings, "Hey HAC NO, Hey HAC NO, we want our complication rate to be zero ..."

The Germinators continue, "It's up to us now you and me, to give our patients quality."

Yes, it's a serious topic, but one can periodically hear the staff singing, "Don't be a shlub, take 10 seconds and scrub the hub" when they are caring for a patient's PICC line.

We are in the process of making a sequel to our rap video with staff from all areas of the hospital--trying to create a positive emotional contagion--saying, "HAC NO" (not "heck no," get it?) when asked if they would cause a HAC.

But we are not only relying on a fun video and a catchy slogan to reduce our HACs; we're also giving our staff tools to do so.

Over the last six months we initiated Six Sigma Black Belt projects to reduce our fall risk, improve pain management and reduce CLABSIs (central line-associated bloodstream infections). Even before that, we developed our STOP CAUTI initiative to reduce catheter-associated urinary tract infections by empowering our nurses to remove Foley catheters that are no longer medically necessary, and our "Increasin' C. Dif is No Myth" initiative to lower the risk of hospital-acquired clostridium difficile colitis.

It has been most satisfying to see our efforts are being rewarded with decreasing HAC trends.

Also during this time we adopted the American Board of Internal Medicine Foundation's "Choosing Wisely" philosophy. We "Crousified" it, and as a result, we reduced our lab usage by many thousands of tests and saved the hospital more $100,000 dollars, compared with the prior year. We also reduced our blood utilization and saved more $400,000, all while caring for equally ill patients and not increasing our length of stay or readmission rates.

In Rocky III, Clubber Lang (Mr. T.) predicted "pain" when asked what Rocky could expect during their bout. Some organizations also may predict pain when trying to institute elements of the Affordable Care Act. At Crouse Hospital, we've gone "FISH-ing" to try to take the pain out of adapting to healthcare reform, which makes me want to predict success.

Mickey Lebowitz, M.D., is an endocrinologist and internal medicine physician who currently serves as senior medical quality director for Crouse Hospital in Syracuse, N.Y. He also is the author of "Losing My Patience: Why I Quit the Medical Game," published in 2009.


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