Structured Implementation of Changes for Success - How We Reduced Specimen Oversampling With Desired Outcomes

Document Type

Conference Proceeding

Publication Date

3-2018

Publication Title

Laboratory Investigation

Abstract

Background: Healthcare reform imposes a pressing need for efficiency and cost-effectiveness. However, changes are difficult. In addition to psycho-social inertia, concerns about the risk to patients and professional liability also contribute to strong resistance. We report how we effectively overcame resistance and implemented desired changes in reducing specimen oversampling. Design: Historically, oversampling of breast cancer case in our institution resulted from surgeons dividing a tumor resection case into multiple parts, and pathologists taking an excessive number of samples from each part. Strong resistance to changes in such practices was anticipated from three main stake holders – pathologists, surgeons and pathologist assistants. We took a structured approach to overcome resistance and implement the changes: 1) Collate data from 3 different sources for evidence-based argument: our tissue sampling data to illustrate the need to change, information from peer institutions to create the sense of “social approval”, and relevant/credible scientific literature. 2) Spell out key components of the project: Purpose, Plan, Process and Procedure (4P’s). Flowchart and diagrams were created for effective communication and implementation guidance. 3) Set specific criteria for implementation: Actionable, Achievable, Accountable, Assessable and Amendable (5A’s). Results: Effective communication to stakeholders the reasons for the change, and developing a specific plan and processes, are critical to overcoming resistance. Tangible data/evidence against presumptive concerns is very effective to fend off resistance. The 5A’s strategy makes each step of the plan specific and tangible to act upon and breaks main task into small ones that seem achievable. Our overall sampling has been reduced from prior 37.9 +19.4 to 29.5+12.7 blocks/ case afterwards (P=0.004), and for lumpectomy alone, the reduction was from prior 29.5+19.9 to 25.5+9.5 (p=0.005). Goals were met with an estimated savings of >$60K/year. No increase in tumor detection error was detected. Conclusions: Most resistance to change is psycho-social and cultural. A structured approach with a clear goal based on tangible data, a detailed plan and process are effective means to overcome resistance to change. Using the short set of implementation criteria (i.e. 5As) is a pragmatic strategy to achieve the project goal. The approach is applicable to other similar operational scenarios.

Volume

98

Issue

Suppl 1

First Page

779

Comments

United States and Canadian Academy of Pathology (USCAP) 107th Annual Meeting, March 17-23, 2018, Vancouver, BC, Canada

Last Page

780

DOI

10.1038/labinvest.2018.23

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