Story Telling As a Strategic Communication Tool

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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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Todays 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
Step 1

• 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?

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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 Titanics 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 protagonists shoes
• That could be me!

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8 Steps Toward aSPRINGBOARD STORY
Step 5

• Trim Detail
• Dont 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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Dont 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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Dont 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, dont.

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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 storyspeak 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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CPOE Computerized Physician Order Entry
MMC CPOE ? ASK ME !
SIMPLY THE RIGHT THING TO DO FOR OUR PATIENTS
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MMCs Mission

• ? To provide patients with the
• best and safest care possible
• ? To educate tomorrows 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 MMCs 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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Megans 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 physicians response when this
error was brought to his attention?
I cant help it if Maine Medical Center hires
stupid unit clerks. And by the way, I didnt
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 MMCs medical staff be one of the
first in the nation to fully implement
CPOE? Because Its simply the right thing to
do for our patients Its 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 RatesAttending
PhysiciansDomain Orders
Goal 95

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CPOE Utilization RatesNon-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 CPOEDecision 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 CPOEApril 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
• Im 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 gt/ 1.5 ? Serum
potassium Call if lt3.5 ? Prothrombin Time Call
if PT gt14 seconds
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Payback Time!NOT

• I decided to check Dr. Xs 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. Xs 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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