Leading Your Standardization Efforts: How Fast? How Far?

It is wise to enlist a group that involves practicing physicians for advice on what to standardize and why.

It may be intuitive to many physician leaders to start with the small parts of the practice when it comes to standardization. However, sometimes what may seem small to a physician leader outside of the practice may be huge to the practice or to research.

James S. Hernandez

For example, years ago many practices switched from latex to vinyl gloves for non-sterile use because of the concerns of latex allergies. Vinyl gloves typically didn’t have the same feel and didn’t fit nearly as well as the latex gloves, according to many health care workers. The change was not always communicated beforehand to the practices. Naturally, there was resistance. Eventually, health care systems moved on to nitrile gloves, which fit better and offer good protection.

Commodity items such as gloves, pipettes, blood collection tubes and other disposables seem like a good place to start. However, it is wise to have a group or committee that involves practicing physicians give advice on what to standardize and why. Although it may seem like physicians may not be necessary in supply chain decisions, the challenges from the practice can be dampened by seeking physician input. This helps to build trust and visibility between the medical practices and supply chain leadership.

Ultimately, decisions to standardize even small items will affect the medical practices. When practice leadership is consulted they will have more buy-in, especially if there are data to support the proposed changes. Often the practices themselves can show physician leadership where to start.

How Far to Standardize?

Initial enthusiasm to standardize, especially from supply chain leadership, sometimes can overwhelm the practices. The benefits of cost savings, cost avoidance and better negotiating power with vendors seem so obvious to supply chain leadership. When given good data, physicians in the practice are more likely to be supportive.

However, there is a danger when standardization becomes the end, rather than the means to the end, of optimizing patient care. In the minds of supply chain leadership, why not achieve 100 percent standardization? For integrated health care systems, there may be valid reasons not to pursue 100 percent. No standardization means that the practices are missing opportunities to pursue value. But overly aggressive moves to reach 100 percent standardization can be counterproductive.

In my experience leading standardization efforts for more than a decade, 80 percent to 90 percent standardization seems like a more realistic goal, depending on the situation. Zeal to reach 100 percent standardization carries the risk of eroding the trust of the practices, which is vital to the standardization efforts. Arguments by the practice to leave some room to innovate are quite valid, in my view.

How Fast to Standardize?

Physicians can be either the anchor or the rudder in these efforts. They can be the strongest advocates or the strongest opponents to standardization. Physicians should be consulted on what to standardize.

In addition, they should be allowed to voice their concerns on how fast the standardization efforts should proceed. Physician leaders must recognize and titrate change fatigue. Physician leaders must hear the physician voices of concern by visiting the practices.

I recall when I consulted for a health care system that had acquired several adjoining systems rather rapidly. The medical director of the flagship laboratories was having trouble getting his counterparts at the smaller acquired laboratories to cooperate. I asked him if he had met the other laboratory medical directors and whether they felt that they had had a chance to give their perspectives. He said no. He had chosen instruments for the acquired laboratories by himself. I advised him to meet face to face with the other medical directors without an agenda. To his surprise, after he got to know them, they made significant progress.

Assess Readiness for Standardization

Ask and answer these questions to gauge whether standardization is feasible:1-5

1. Why is the practice being asked to standardize?

2. How will this impact patient care?

3. Is there support from upper leadership and the practice leaders?

4. Is the affected medical practice aware of the request to standardize?

5. If in an integrated practice, is the request to standardize to best practice based on peer-reviewed literature?

6. Does the proposed change require significant resources like information technology or capital?

7. Is the practice ready for the change? Are tools like ADKAR (Prosci) used to assess the readiness for change?

8. Is there consensus among the affected practice to change?

9. Is administrative help, including a project manager, available for larger standardization efforts?

10. Is the gain worth the pain for this standardization project?

Summary

Before engaging in widespread standardization, the physician leader who is tasked with implementing standardization should have clear and visible support by upper leadership. Nothing can damage earnest efforts like strong practice leaders bypassing the chief medical officer and going directly to the CEO. In this way, the CMO must communicate upward and laterally to be sure that the practices are willing and ready to begin standardization of some parts of the medical practices.

There is an art and a science to standardization. The art is getting to know who will support and who is likely to oppose standardization efforts. Generally, the opponents can have valid reasons besides individual preference. The wise physician leader will invite criticism of the proposals to standardize. Opponents can serve a valuable role as the devil’s advocate. Most physicians can read the tea leaves of change and know that business as usual is unsustainable. By providing clear, transparent data for the proposed changes, the medical practices are much more likely to support efforts at standardization.

James S. Hernandez, MD, MS, FCAP, is medical director and laboratory medicine division chair, and associate professor of laboratory medicine and pathology, at Mayo Clinic and its College of Medicine in Arizona.

REFERENCES

1. Hernandez JS, Newton NC, O’Hara SK. Integration and standardization within the Mayo Foundation Laboratories: the centralized laboratory purchasing group. Clin Leadersh Manag Rev. 19(6):E2, Nov-Dec 2005.

2. Hernandez JS, et al. Successful models for shaping test utilization patterns in academic and community hospital settings. Clin Leadersh Manag Rev. 23(1):E5, Jun-Jul 2009.

3. Standardization of Practice to Improve Outcomes , American College of Obstetricians and Gynecologists.

4. Lehmann, CU, Miller, MR. Standardization and the practice of medicine. Journal of Perinatology 4(3):135-6, Mar 2004.

5. Clinical Practice Guidelines We Can Trust , Institute of Medicine.