Adopting a Standard of Care: Says Who?

In our last post, we explored how adopting a new product can result in some heavy lifting. Not only does product adoption require financial investment, it requires significant investment of time and resources even before the decision is made. Even after the new product is in place, the heavy lifting can continue, especially if the intended users are resistant to change. In today's post, we'll look at the obstacles to adopting new products, even if they are proven to improve patient outcomes or save money. Even if they are considered standard of care.

The concept of "standard of care" refers to a baseline of medical care. Used in a legal context, it refers to "minimally sound medical judgement" and "minimally competent care," that is, the standard at which medical care starts, with anything below considered unsound, incompetent, and ultimately, against the law. 

When used by health systems or facilities, however, "standard of care" means that it is a treatment, procedure, therapy, or product that is accepted by medical experts as effective, and that it is widely used within the system or facility. More than just a "best practice," it is an established protocol that all patients can expect to receive. In some cases, the innovation is considered "a new standard of care, but not the only standard of care" (NEJM, 2004). Innovations can stand alongside traditional methods until there is such a marked difference between patient outcomes that the new replaces the old as the only standard of care. 

Getting a group of professionals to accept a new standard of care takes time - from an environmental services worker to a physician. They must first learn about the areas where the traditional methods could use improvement, and be made aware that making improvement is possible. They must be provided educational opportunities to learn about the innovation and the chance to "play around with it," using the new product or try the new product to gain familiarity. They should be given a timeline for when the new standard of care will be implemented, and continue to receive support even after the deadline has been reached: positive feedback, presentation of improved patient outcomes, or sharing how the new standard improves the financial health of the facility. 

Healthcare professionals are used to adapting, thinking on their feet, being resourceful, and using their training to create solutions. However, it is only human to resist change, and there will be some individuals who resist more than others.

1. Some individuals may lack trust in their employer, and that lack of trust extends to the employer's decisions about new standards of care. This lack of trust can even stem from one poor professional relationship. In these cases, an individualized approach may help, with peers providing support rather than coming from above.

2. If the new standard is rolled out with poor or uneven communication, the resulting confusion can result in resistance to change. Professionals need - and deserve - time to learn about and accept a new standard, and rushing or poorly communicating the change will get the process started on the wrong foot. The key is transparency. Let employees know what possible changes lay ahead once decisions are made, why the changes are made, and how these changes will impact them directly. Give them the opportunity to ask questions, express concerns, and process the change.

3. When our lives change, one thing is for certain: We will have an emotional response. This goes for change in the workplace as well. Any change implies that the previous standard was not good enough, and some individuals or groups may interpret this to mean that they were not good enough. Consider infection prevention: How many changes or innovations come with a lecture about low hand hygiene compliance, ineffective cleaning, or lapses in PPE? Each of those "failings" are strongly associated with staffing shortages, lack of supplies, and constant turnover, among other factors. But inevitably, some healthcare workers will feel personally responsible and come into a discussion about a new innovation with an emotional response which, if not allowed to be expressed, can hinder the change process. Give these professionals a chance to voice their emotions, name their emotions and give them validation for their response.

4. Healthcare professionals literally hold lives in their hands. They do not consider failure an option. Therefore, when presented with a new standard of care, they want to know all about it, master it, and feel confident using it. They enter the change process with a healthy fear of failure. Will this new approach hurt my ability to heal my patients? Will I be able to use this product as well as the one I'm so good at already? Individuals, often highly proficient experts, may balk at change because it forces them into the role of novice (or makes them feel like a novice). These individuals will need opportunities to use the new standard on their own time, and ideally be involved in teaching peers how to use it. Use their expertise to your advantage.

Some changes to standard of care are more dramatic than others. Changing to an entirely new electronic record system, a new way to procure pharmaceuticals, or a new surgical technique are all examples of huge changes that will require long preparation periods before implementation. More modest changes, such as using a new protocol for inserting a central line or hair removal prior to surgery to prevent infection, will require a shorter implementation time. But all change requires some degree of preparation, and it shows employees respect when you give them the time they need to accept a new standard of change.

Now, the ideal new standard of care would be one that requires no extra work, no training, and no changes to routine. Alas, very few changes to standard of care are this hands-free. Thankfully, the use of preventive biocidal materials such as EOScu overbed tables, bed rails, and countertops is just such an innovation. Already accepted as a standard of care at large healthcare systems, EOScu, a copper-impregnated polymer, is a virtually hands-free upgrade to "standard" materials. Replacing the most-touched items in the patient room with EOScu is a new standard of care that can be deployed from one day to the next. That's a new standard of care we can all get behind.