What are 5 ways to get surgeons to drive change?

By Michael Donoghue

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Know what's weird? Day by day, nothing seems to change, but pretty soon...everything's different.
       - Calvin from Calvin and Hobbes

In previous posts, we have made reference to things like governance, the surgical block schedule and driving change in the OR. When considering change in the OR, the one seemingly impossible task is altering surgeon behavior.  I believe that changing surgeon behavior, while difficult, is very achievable and not entirely different than changing the behavior of anybody in an organization. Change is inevitable today and every organization must adapt to environmental changes in order to survive. In the early 1990's, while Jack Welch was chairman of GE, we began to embrace change utilizing a model known today simply as CAP (the Change Acceleration Process). I'm convinced that CAP's 5 essential components and 2 foundational principles apply as well to surgeons as to others. The tools that make up the CAP Model are used to help facilitate change and accelerate the acceptance of that change. Following this model will improve your chances of implementing sustainable change in the OR.

Two Foundational Principles
The first of the 2 foundational principles is Leading Change, or having strong visible leadership commitment to supporting and leading the change efforts. You must first identify that surgeon leader to champion the change effort. This leader must have support of the administration of the hospital to be successful. The OR must also have strong governance including policies and procedures in place to support the change. These systems and structures are the second foundational principle.

Five Components of the CAP Model
  1. Create a Shared Need - In order for a surgeon leader to successfully drive change, they must consciously include the 5 components of the CAP model. The first of which is creating a shared need. Surgeons must see the benefit of change. Different things motivate different surgeons. Some surgeons prefer a block of time on one day in one room with one team so that the rest of their week can be spent seeing patients in their office. Some surgeons value an early start or a rapid room turnover. Other surgeons would like more open time to book outside of normal block hours. Creating a shared need involves finding out what motivates surgeons on an individual basis. The need for change must exceed its resistance.
  2. Shape the Vision - The second component in the process is to shape the vision of the outcome of the change. The outcome of the change must be clear and widely understood. Surgeons must visualize how their life will be better after the change. Having a more predictable schedule with on-time starts and rapid room turnover times is often a nice vision to project. Having clearly articulated rules that will be strictly enforced gives surgeons confidence that the administration and staff are committed to improving service.
  3. Mobilize the Commitment - Once you have surgeon buy-in, it is time to mobilize the commitment to change. One of the most effective ways to get surgeons to begin to change is for staff to demonstrate commitment to improving things for surgeons. Surgeons become more efficient when the OR schedule is more predictable. Starting cases on time and quickly turning over rooms show surgeons that change is possible and helps garner their support for change initiatives.
  4. Monitor Progress - The fourth and fifth components of the CAP model are making change last and monitoring progress. It is important that once the change is started, it endures. Having the systems and structures to monitor the change and take corrective action when necessary is crucial to sustaining the change. Dashboards with metrics related to block utilization, on time starts and room turnover help provide visibility to process performance.

Following this methodology does not guarantee success. But, it greatly improves the probability that change will not only occur, but also will be sustained.  

Comments (2)

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  • Tulika July 22, 2010 7:16 PM

    This write up is excellent!! I like the way you've articulated the CAP tools to a healthcare setup.I was working with the back office team of GE Healthcare in India and now at the Cleveland, was aware of the CAP tools for transitions and now a great insight to a hospital setup.Thanks for sharing

  • Michael Donoghue July 23, 2010 2:32 PM

    Tulika- Thank you for your comments. I hope you have the opportunity to utilize the CAP tools to help drive change in your organization. They can be very powerful. They have helped me enormously over the years. Please share your success stories as the come!