3 reasons doctors struggle with change--and why we should be patient

Now that FiercePracticeManagement is a daily publication, we're offering you five times the advice to make your jobs easier and do them better. Along with that comes quintuple the volume of suggestions that you change.

Knowing the weight of the word change, we might lighten it up as "update," "evolve," "revisit" or "adopt." Or we may try to imply enthusiasm with terms such as "innovate" and "reinvent."

But whether we're talking about redecorating your waiting room or conducting patient visits through a computer, change is change.

And for physicians, simply saying, "This is great. Here's why. Try it," isn't going to be terribly effective, Colin Furness, Ph.D., an epidemiologist with Infonaut Inc. and assistant professor at the University of Toronto, told me during an exclusive interview.

There are three key reasons physicians prefer stepwise, evidence-backed, fully tested change in healthcare, which practice leaders and advisers are wise to respect, Furness, pictured, tells FiercePracticeManagement.

Healthcare is complex. "I've had a lot of experience watching healthcare happen and watching innovation happen in healthcare, Furness says. "Healthcare is often fingered as being laggard, and that may be a bit unfair because it suggests laziness or selfishness or an attitude that is simply unhelpful. And I don't think that's actually what it is. I think healthcare is a really complicated workplace, and with complexity comes less capacity to change."

As a result, even seemingly positive, simple changes can pose disruption to physicians' workflow, making it difficult to predict what offerings will and won't catch on, says Furness.

To illustrate the point, he gave an example of a newly available, inexpensive device that can sanitize cell phones using UV light in about 30 seconds.

It's an elegant solution to counteract the risk of phones carrying microbes into operating theaters, he says, but it might not get adopted because it calls attention to the fact that cell phones are entering operating rooms when they're really not supposed to. "What we see is doctors explain that they're not the ones touching the phones, that the nurses do," Furness says. "[That reaction] is not malevolent, it's not laziness, it's not any one of those things. It's trying to get them to reorient to a slightly different way of doing things, which is often awfully difficult with this group."

Physicians are fiercely independent. Trying to throw change at people who are highly intelligent and self-reliant is kind of like herding cats, Furness says. "I say that with a genuine love for cats. They're very smart and have great personalities. But one thing they tend not to do is do what you want them to do when you want them to do it."

And in physicians, this is a quality to be truly respected. Doctors know that at the end of the day, they are the ones who are responsible for what happens to patients as a result of whatever change they adopt. As doctors, "it's really on you to understand the implications of what it is you're going to be doing," Furness says. "And the implications of new stuff are going to be almost always really hard to tell."

Liability is a real concern. It's no wonder, then, that potential liability represents a big factor in physicians' calculus of change. "Doctors can't help thinking about liability. And liability is often a paralyzing force for them," he says. "Something new, untested, with no court case, no clear sense of what the liability might be or might not be--having that inserted into their work I think is a cause of anxiety. It's a genuine anxiety borne from their understanding of their work and their awesome responsibility in that work," Furness says.

I'm glad that I had this conversation with Furness when I did, because his insights do open my eyes to the significance of change in the practice environment.

Of course, we'll keep reporting on "updates" and "innovations" that show promise to improve physician practices--but respectfully leave it up to doctors to investigate and incorporate when they're satisfied the ideas are sound. - Deb (@PracticeMgt)