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Story Telling As a Strategic Communication Tool. George L. Higgins III, M.D., F.A.C.E.P. Professor and Research Director Department of Emergency Medicine Maine Medical Center Portland, Maine. Today’s Objectives.

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Story Telling As a Strategic Communication Tool

George L. Higgins III, M.D., F.A.C.E.P.

Professor and Research Director

Department of Emergency Medicine

Maine Medical Center

Portland, Maine


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Today’s Objectives

  • To describe the essential elements of an inspiring and motivating SPRINGBOARD STORY

  • To role play story telling using a CPOE campaign implementation scenario

  • To review an actual story and its aftermath that helped kick-off a successful CPOE campaign


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Stories Can…

  • Deliver complex ideas in a simple, consistent and memorable way

  • Convey a consistent message across cultural diversity

  • Be a safe way to challenge dogma

  • Be a more comfortable way to discuss failure or promote learning

  • Be told and retold with new value over time to adapt to unforeseen change


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SPRINGBOARD STORY

  • Effective leadership requires the ability to choose the right story at the right time and tell it well.

  • A “SPRINGBOARD STORY” communicates a new idea and inspires others to work to implement it.


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8 Steps Toward aSPRINGBOARD STORY

Have a Clear and Central Purpose and

Write it Down in a Single Sentence:

  • What are you trying to change in the world?

  • What is the specific idea that you want people to understand and implement?

  • What are people not doing now that you want them to do in the future?

  • How will you know progress is being made?

Step 1


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8 Steps Toward aSPRINGBOARD STORY

Step 2

Identify an Example of Successful Change that Resonates

  • Somebody, somewhere has already been brave enough to blaze a trail

  • Look within your own institution

  • Be comfortable using another institution as a role model


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8 Steps Toward aSPRINGBOARD STORY

Step 3

Tell the Truth

  • The truth of the story will shake the skeptics out of their complacency

  • Strive to be factually accurate and authentically true

  • Not: “700 happy passengers reach New York after Titanic’s maiden voyage”


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8 Steps Toward aSPRINGBOARD STORY

Step 4

Say Who, What and When

  • A few particulars help anchor your story in person, time, place and reality

  • Choose your protagonist carefully

  • Your audience should be able to easily put themselves in the protagonist’s shoes

    • “That could be me!”


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8 Steps Toward aSPRINGBOARD STORY

Step 5

Trim Detail

  • Don’t overdo on specifics

  • The story is the means to the end, not the end itself

  • Brevity can be powerful


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8 Steps Toward aSPRINGBOARD STORY

Step 6

Underscore the Cost of Failure

  • Make a compelling case that the status quo is no longer acceptable

  • Be explicit about the negative consequences of inertia


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8 Steps Toward aSPRINGBOARD STORY

Step 7

Close with a Positive Note

  • A SPRINGBOARD STORY should end happily and inspire the audience

  • Create a sense of excitement, strive for euphoria


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8 Steps Toward aSPRINGBOARD STORY

Step 8

Invite Your Audience to Dream

  • Encourage others to internalize your passion

  • “Just imagine…”

  • “What if…”

  • “Just think…”


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Don’t Be Afraid to Use an

Inspiring Speaking Style

“All free men,

wherever they may live, are citizens of Berlin.

And therefore,

as a free man,

I take pride in the words ‘Ich bin ein Berliner!’”


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Don’t Be Afraid to Use an

Inspiring Speaking Style

“If a man hasn't

discovered something

that he will die for,

he isn't fit to live.”


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Appropriate Humor in Story Telling

  • Humor involves spontaneous acts of fun, surprise or exaggeration that make people feel good

    • Releases tension

    • Creates a sense of acceptance

    • Restores a healthy perspective

    • Underscores the central theme of the story

  • Leaders who use humor effectively enjoy enhanced perceived status

  • Self-deprecating humor can be effective


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The Dark Side of Humor

  • Avoid any attempt at humor that is hurtful of offensive

    • Off limits: religion, politics, body function, sexual innuendo, race, ethnicity, profanity

  • Never make people lower in the workplace hierarchy the butt of jokes

    • Poking fun at people in power positions can be effective

  • A good rule to follow: When in doubt, don’t.


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A Couple of Final Points

  • Listen to your audience and adapt your story telling accordingly

  • Vary your tone and speed of delivery

  • Leave the podium if possible

  • Let your eyes connect with all quadrants of the room

  • Never read your story…speak from the heart

  • Stay fresh by never telling the exact same story twice


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Role Playing Time

You have been given the responsibility

of leading the CPOE campaign for your hospital.

Most members of the medical staff are voluntary.

The by-laws do not mandate CPOE as an expectation.

You have been given 10 minutes on the agenda of the annual staff meeting to introduce

this campaign for the first time.

Springboard to Greatness!!!


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CPOEComputerized Physician Order Entry

MMC

CPOE ?

ASK ME !

SIMPLY THE RIGHT THING

TO DO FOR OUR PATIENTS


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MMC’s Mission

◊ To provide patients with the

best and safest care possible

◊ To educate tomorrow’s caregivers

◊ To research new and better ways to provide care


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To Err is Human: Building A Safer Health System(1999 IOM Report)

  • The burden of harm conveyed by the collective impact of all of our health care quality problems is staggering.

  • Tens of thousands of Americans die each year from medical errors.

  • No matter how dedicated or well-intentioned, clinicians will never achieve perfection because of the reality of human error.


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Human Error Probability


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The Medical Executive Committee Endorses CPOE

  • Identified CPOE as an expectation of every member of MMC’s Medical Staff

  • Conducted a virtual survey of the Medical Staff to determine depth and breadth of physician support


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Survey Results:

Virtual Medical Staff Meeting

(over 300 respondents)

Should the start date for

100% CPOE be 10-01-02?

Should there be physician and

midlevel provider training?

Should accurate CPOE compliance data be regularly provided to individual clinicians?


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The MEC and InstitutionAre Committed

  • Provide exceptional communication

    • “8 ways, 8 times”

  • Make training easy for physicians

    • Group and one-on-one training

    • E-Learning

  • Limit the order “domain” to…

    • Radiology test orders (easy)

    • Medication orders ( error-prone)


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e-Learning:

From Any PC,

At Any Time


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Communication Activities

MMC

CPOE?

Ask Me!

  • “8 Ways, 8 Times”

    • E-mail letters

    • Snail-mail letters

    • Posters

      • CPOE message

      • Countdown

    • NetNews message screens

    • Announcements at educational sessions

    • Hallway cheer leading and promotion

    • CPOE SuperUsers

      • Look for the Buttons


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So Why Have I Volunteered

To Take On This Potentially

Lethal Assignment?


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Megan’s Story


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Megan was given this list

of orders to transcribe


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Megan entered the insulin orders as…

The “U” for units

was understandably

misinterpreted as

the number “4”


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What was the physician’s response when this error was brought to his attention?

“I can’t help it if Maine Medical Center

hires stupid unit clerks.

And by the way,

I didn’t go to medical school

to be a damn secretary.”


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An Illustrative List of Dangerous Medical Abbreviations


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Another MMC Insulin Order


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And Another


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The Classic

Magnesium for Morphine Error


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Pure Human Transcribing Error


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The Peril of the Faxed Order


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So why will MMC’s

medical staff be one of

the first in the nation to

fully implement CPOE?

Because…

It’s simply the right thing

to do for our patients

It’s simply the right thing

to do for Megan


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Baseline MMC CPOE Utilization Rate Trends(All Orders)

%


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Overall CPOE Utilization Rates:Attending PhysiciansDomain Orders

Goal 95%

%


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CPOE Utilization Rates:Non-domain Orders (e.g. diet)

%

Weeks


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Medical Provider CPOEFirst Week of Implementation

%

38,447 Orders Directly Entered


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Individual Physician Compliance

Was Reported Weekly to the

Entire Medical Staff

Some practices quickly

adopted this as a pay-for-performance

measure for their physicians


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Another Major Benefit of CPOE:Decision Support Alerts

Examples of point-of-care alerts

that fired during the first week:

Epidurals/Anticoagulants: 102

Major Drug Interactions: 2,671

Duplicate Labs/Medications: 3,944

Dosage Outside Range: 1,616

Allergy Alert: 2,351


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A Painful Lesson Learned the Hard Way

  • When implementing new electronic patient management systems…

    • Turn off all decision-support functions

    • Let clinicians master the basics and survive the transition

    • Turn on one alert at a time, starting with the most valuable

    • Failure to do so will immediately result in “alert fatigue”


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CPOE Impact on Medical Transcription Errors

CPOE

Publicity

CPOE

“Go Live”

Number of Medication Transcription Errors


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Medical Provider CPOE:April through June 2007

%

An Average of 7,800 Orders

Directly Entered Every Day


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Dr. X Drove Me Crazy

  • He hated the CPOE expectation

    • “I’m a doctor, not a secretary!”

    • “My patients will die because of this!”

  • He publicly and regularly let everybody know he thought it was a stupid idea

  • He never let me pass him in the hallways without criticizing me

  • Then someone sent me the following transcription error caused by him


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I Thought I Finally Had Dr. X in My Crosshairs

□ STAT Labs

□INR: Call if >/= 1.5

□Serum potassium: Call if <3.5

□Prothrombin Time: Call if PT >14 seconds


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Payback Time!NOT

  • I decided to check Dr. X’s most recent CPOE report so that I could include his dismal overall compliance in my letter of reprimand

    • Fully expecting it to be near zero

  • Much to my surprise, and actual delight, I found that Dr. X’s compliance rate was nearly 95%

    • He had entered hundreds of orders by himself

  • This allowed me to totally change the tone and content of the letter

  • I personally followed-up with him to thank him for his efforts and to review this particular incident in a constructive manner

  • His resistance disappeared overnight


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An Indicator of Success??

  • Earlier this year, our primary IT system “went down” for 12 hours in order to install some pharmacy hardware

  • This required hand writing orders

  • We had to demonstrate how to do this for some of the Emergency Medicine residents


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