Getting your staff to play follow the leader

One practice uses docs to create culture change

Creating change in any business can be difficult. People get comfortable with doing things the way they have always been done. Getting 13,000 people in 100 locations to sign on to change is even harder. But Randy Hutchison, administrative director of Penn State Geisinger Health System in Danville, PA, thinks he has found a way to get people to modify their behavior: He makes physicians - a group he admits can be more resistant to change than others - lead the parade.

Change starts at the top

"The theory is that if we want to create change, then it has to come from the physician leader in each clinic. It doesn't matter how big we are, if a physician leader is ho hum about corporate directives, then so is everyone else."

Hutchison says that his 100 clinics are facing a future where service is key. He has started a series of initiatives to ensure that the practices in Penn State make the changes necessary.

One of them is a pilot program in which physicians from 24 sites were put through a training session and required to deliver the message to their clinics.

A two day train-the-trainer seminar was led by a consultant, says Hutchison. The physicians were given teaching materials to use in their practices. "That got them familiar with it and also gave them some information on how to teach," he says.

The materials included a simple list that was used as a discussion outline. "We didn't want to spoon-feed them, so we gave them a certain amount of flexibility to use what materials they felt were important at their locations," he says.

The physician leaders were paired with a nonphysician leader at each site. This allowed them to either train their staff in tandem or to separate the medical staff and nonmedical staff. "We thought that physicians might be more open to having training sessions just with other docs," says Hutchison.

But Hutchison admits that in at least one case, a training session held separately didn't work out well. The physician session was derailed by the doctors complaining about how bad managed care was for them. The nonphysician staff, however, felt that the training was very motivating.

So far, about 20% of physicians have gone through the training and taken the service lessons back to their clinics. It will take time to get through the whole organization, but Hutchison thinks it will work.

"I think we will do this every year," he says. "I think that if you appeal to physicians with facts on health care, with an emphasis on accountability and how important it is in the current market, you can get them to agree to anything. And if you get your physicians to lead the charge, then the change will follow."