Overcoming Barriers and Objections of a CRM- based Project

It’s inevitable that your staff will have barriers and objections throughout implementation of a CRM- based project. There will be points of resistance revealed in loaded questions asked by those who will be affected by the project. The questions are loaded in the sense that each has an underlying message. The key to answering the question lies in understanding the hidden message and responding to it.

The loaded questions asked are not unique; they’ve been asked everywhere in every institution that has embarked upon a CRM project. For example, let’s examine the following question…

“We’ll be liable if teamwork becomes the accepted standard of care.”

The underlying message is this: “We’ll be sued. We fear change. We’ll all be expected to do this. We don’t want a new standard to operate by. This makes it harder on us.”

Your response might sound something like this:

“Yes, many others have had the same question and concerns. And this program is the right thing to do for the safety of our patients. When it does become our standard of care, there will be fewer errors that harm patients, and therefore less risk of a lawsuit.”

By practicing responses to tough questions like the one illustrated above, it will eventually become second nature. Below are some examples of effective responses to typical objections of CRM raised by “slow adopters.”

Loss of Authority

This is probably the most common concern of physicians. It is not always directly articulated, but rather suggested by such phrases as “There can only be one person in charge,” or “There can be only one captain of the ship!” In fact, the goal of CRM is to use all available resources, i.e. the entire team, to make better decisions. Making better decisions enhances the leader’s authority. Remember, CRM was developed for very hierarchical airline and military aircraft crews. The “captain’s” authority in those organizations was enhanced, not diminished.

What if I do speak up and get yelled at, or worse…?

This is the most common concern expressed by staff members. The institution is giving CRM training to all members of the healthcare team. The leader of the team has made a commitment to listen if the team members commit to speaking up when there is a patient safety or other important issue identified. The benefit of having everyone looking out for the patient and the team is self-evident. The institution must also have made clear to everyone that CRM principles and practices are encouraged and “put- downs” are unacceptable. Finally, the individual has a choice: he or she can speak-up when patient safety is at stake or remain silent. It’s our obligation as healthcare professionals to intervene when patient safety is at stake. Isn’t it better to get “yelled at” than spend the rest of your life feeling guilty because silence led to patient injury? The institution must make it absolutely clear that ignoring or becoming hostile about questions is unacceptable behavior and be prepared to deal with it when it inevitably occurs. Everyone will be watching and failure to honor commitments in this area will greatly lessen the institution’s CRM program effectiveness.

This takes time and time is money; I’m already overbooked; etc.

Taking time to do something right saves time. How many times has a procedure or process been delayed because someone or something was missing? Taking a minute or so means having everyone ready, understanding what will be done, what each person needs to do and what equipment and supplies are needed. The actual time required to accomplish various CRM activities should be measured directly and fed back to the staff as they improve and become more efficient. Many institutions report increases in efficiency as a byproduct of becoming more safe.

Be sure to check out our next issue of The Pulse for more effective responses to objections.

Improvement in Observed To Expected Mortality Numbers

For an academic health center, LifeWings worked with the Dean of Clinical Affairs and his project team. Their goal was to improve their observed to expected mortality figures. Their pre-project rate exceeded 1.0, and was a key metric in their drive to become one of the safest institutions in the country.

The hospital leadership analyzed the factors contributing to the higher-than-desired number and decided they needed better teamwork, communication, and processes to lower the number and ensure the safety of their patients. They realized communication was the heart of every other process implemented to improve their score. As long as communication patterns were flawed, all other improvement processes would suffer.

They needed powerful communication training for their critical care staff and physicians and system tools that would require and support the use of the new communication skills learned in the training.

LifeWings’ training provided both the targeted communication training and system tools they needed. Since implementing the communication tools, the hospital has experienced a 43% improvement in their observed to expected mortality figures.

Why are we doing this? What difference will it make?

Experience with CRM in both military and commercial aviation shows that significant decay in skills and practices will occur unless specific ongoing training is conducted. So, planning and preparing for a CRM- based project should be taken into account before you begin your project. Below is an activity you can do to help prepare you and your staff on CRM implementation.

Objective

A successful executive leader must develop, in longhand, their own script about the CRM-based project.

Task

After explanation about the project, write the following:

1. This program is about…
2. It is important for us because it…
3. The advantages/benefits of this project are…
4. I expect the impact to be…
5. We can support this project by…

Once you prepare your responses share them with your coworkers for feedback and other ideas. Collaborate and develop the best answers—answers that will make sense for your organization. It’s important to train everyone involved in project leadership to respond similarly to these statements. That way everyone is on the same page and has a common understanding of the project direction.

Repeatedly practice these statements. Preparation and practice will provide the tools you need to move forward with a CRM-based project.

Milk Run
by Chris McKenna

The following resources include links to articles and websites that may provide valuable patient safety information, as well as fresh ideas for the new year.

Vanderbilt University Medical Center (VUMC), Nashville, TN

VUMC has developed the internal capability to conduct LifeWings training and safety tools in their hospital. They continue to train in their facility to meet the goal of training all personnel. They are currently implementing the LifeWings program in the Oral Surgery, OR/Periop, Cardiac Cath Lab, and OB/Gyn areas of their hospital.

Commonwealth Neonatology, Inc. (CNI), Richmond, VA

They've completed risk management training in their Neonatology department, and have one class to complete in the spring. They conducted the 4-hour course and an advanced course for those who have completed the 4-hour course last year.

Nebraska Medical Center (NMC), Omaha, NE

NMC has transitioned an internal expertise and implementation of the LifeWings system. They are currently working in the Orthopedic and Cardiac Surgery areas of their hospital.

Northshore Alija Health (NAH), Lake Success, NY

NAH has recently completed 4-hr training for their leaders as an introduction of the LifeWings patient safety system. To date, they have trained about 50 staff.

University of Texas Medical Branch (UTMB), Galveston, TX

An 8-hr training class is scheduled for mid-January at UTMB in Woman & Infant Services. Their safety tools implementation will begin towards the end of February.

Vanderbilt Children’s Hospital (VCH), Nashville, TN

VCH has recently completed the Observation, Coaching, and Feedback part of their project for the ED, PACC, PCCU, Acute Care Floors and Hematology Oncology departments. Their tools workshop and more Observation, Coaching, and Feedback is scheduled for mid-January.

BayCare Health System, Inc (BCHS), Clearwater, FL

BCHS has recently completed their Leadership Development Institute for Morton Plant Mease Hospital in the L&D department. BCHS's Mease Countryside Hospital will begin their Leadership workshop soon in their L&D department.

Community Health Partners (CHP), Lorain, OH

CHP’s 4-hr training will be completed soon in the OB department. Their Hardwired Safety Tools implementation will start in the beginning of February.

Holy Cross Hospital (HCH), Taos, NM

HCH will begin their 3-day Observation, Coaching, and Feedback workshop around mid-January for Surgery, ICU, and ED areas. They are also in the process of the Hardwired Safety Tools implementation.

Middle Tennessee Medical Center (MTMC), Murfreesboro, TN

MTMC will kick off their LifeWings’ project for their OR department with a Leadership Development Institute workshop that will be scheduled soon.

North Bronx Healthcare Network (NBHN), Bronx, NY

NBHN has recently completed training at the Jacobi Medical Center in the ED and Radiology areas. They've also completed team training in the ED at North Central Bronx Hospital.

Provena Health (PH), Mokena, IL

Provena Saint Joseph Medical Center recently completed their training workshop. In addition, they've built safety tools that they are in the process of implementing in the L&D department. Provena United Samaritan Medical Center is scheduled to conduct their Leadership Development Institute in mid-January for their L&D department.

University of Missouri Health Care (UMHC) Columbia, MO

UMHC continues to train their staff on the LifeWings patient safety system throughout their hospital.

Vassar Brothers Medical Center (VBMC), Poughkeepsie, NY

VBMC in the process of implementing Hardwired Safety Tools in the ED and L&D departments. LifeWings will also be conducting an Observation, Coaching, and Feedback visit soon.

St. Luke's Episcopal (SLE), Houston, TX

SLE will kick off their Leadership Development workshop soon and begin CRM implementation in their Surgical Services department.

The Society for Thoracic Surgeons (STS), San Diego, CA

Members of the LifeWings’ team will travel to San Diego to present a 4-hour training seminar for the 2007 STS conference at the end of this month.

Physicians Reciprocal Insurers (PRI), Long Island, NY

PRI and LifeWings recently partnered to develop courseware and materials for PRI's General Sessions. A train-the-trainer program will also take place towards the end of February for the PRI facilitators.

Be sure to check out our next newsletter for more updates on current projects with our clients.

If you would like a reference for any of our clients listed above, please feel free to contact K.C. DeBra at kdebra@SaferPatients.com or (901) 844- 9226.

One Little Corner

There's one little corner of your life where you can make an improvement today. Take the opportunity to do so.

There's one little corner of the world where you can make a difference right now. Go ahead and be the person to make that difference.

One little corner may not seem like much. One little corner may not appear to be worth the trouble.

Yet when you get things working well in that one little corner, something wonderful happens. You discover how delightful, inspiring, fulfilling and compelling the experience of achievement can be.

And then you start looking for other little corners where you can work the same magic. One little corner after another, you begin to have a major positive impact.

To achieve great things requires no great effort, just a modest effort repeated again and again. Start right now by improving one little corner, and you're on your way to change the world.

-- Ralph Marston

Call or email today to set up a FREE phone consultation with an experienced LifeWings instructor that will be able to assess the current level of teamwork in your facility.

For a limited time only!

To set up the date and time of your call simply contact K.C. DeBra at (901) 844-9226 or kdebra@SaferPatients.com.

5 Million Lives Campaign

The Institute for Healthcare Improvement (IHI) estimates that 15 million incidents of medical harm occur in U.S. hospitals each year. The 5 million lives campaign is a national initiative to protect patients from 5 million incidents of medical harm over the next two years. IHI aims to enlist 4,000 hospitals, challenging to adopt 12 improvements in care. Listed below are some examples of the interventions:

• Prevent adverse drug events…by reconciling patient medications at every transition point in care.
• Prevent surgical site infections…by following a series of steps, including reliable, timely administration of correct perioperative antibiotics.
• Prevent central line infections…by implementing a series of interdependent, scientifically grounded steps.

Many of the interventions set forth by IHI in the new campaign are ones that a CRM-based program can help improve.

The program is designed to teach hospital staff how to properly use standardized protocols. Hospitals learn to create checklists and steps for every procedure to ensure no slip occurs that may lead to patient harm or an adverse event.

Aviation-based Crew Resource Management training is quickly gaining popularity in the healthcare industry due to the similar stresses flight crews and medical teams endure. In fact, one LifeWings’ client, after six wrong surgeries in a single year, eliminated that problem with a CRM-based system in place.

The principles of this training (communication/teamwork skills, and the use of safety tools—standardized checklists and protocols) are all being successfully applied to healthcare to improve patient safety.