Story Telling As a Strategic Communication Tool

1. 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

2. Today’s 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

3. 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

4. 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.

5. 8 Steps Toward aSPRINGBOARD STORY 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? Step 1

6. 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

7. 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 Titanic’s maiden voyage”

8. 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 protagonist’s shoes • “That could be me!”

9. 8 Steps Toward aSPRINGBOARD STORY Step 5 Trim Detail • Don’t overdo on specifics • The story is the means to the end, not the end itself • Brevity can be powerful

10. 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

11. 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

12. 8 Steps Toward aSPRINGBOARD STORY Step 8 Invite Your Audience to Dream • Encourage others to internalize your passion • “Just imagine…” • “What if…” • “Just think…”

13. Don’t 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!’”

14. Don’t 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.”

15. 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

16. 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, don’t.

17. 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 story…speak from the heart • Stay fresh by never telling the exact same story twice

18. 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!!!

19. CPOEComputerized Physician Order Entry MMC CPOE ? ASK ME ! SIMPLY THE RIGHT THING TO DO FOR OUR PATIENTS

20. MMC’s Mission ◊ To provide patients with the best and safest care possible ◊ To educate tomorrow’s caregivers ◊ To research new and better ways to provide care

21. 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.

22. Human Error Probability

23. The Medical Executive Committee Endorses CPOE • Identified CPOE as an expectation of every member of MMC’s Medical Staff • Conducted a virtual survey of the Medical Staff to determine depth and breadth of physician support

24. 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?

25. 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)

26. e-Learning: From Any PC, At Any Time

27. 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

28. So Why Have I Volunteered To Take On This Potentially Lethal Assignment?

29. Megan’s Story

30. Megan was given this list of orders to transcribe

31. Megan entered the insulin orders as… The “U” for units was understandably misinterpreted as the number “4”

32. What was the physician’s response when this error was brought to his attention? “I can’t help it if Maine Medical Center hires stupid unit clerks. And by the way, I didn’t go to medical school to be a damn secretary.”

33. An Illustrative List of Dangerous Medical Abbreviations

34. Another MMC Insulin Order

35. And Another

36. The Classic Magnesium for Morphine Error

37. Pure Human Transcribing Error

38. The Peril of the Faxed Order

39. So why will MMC’s medical staff be one of the first in the nation to fully implement CPOE? Because… It’s simply the right thing to do for our patients It’s simply the right thing to do for Megan

40. Baseline MMC CPOE Utilization Rate Trends(All Orders) %

41. Overall CPOE Utilization Rates:Attending PhysiciansDomain Orders Goal 95% %

42. CPOE Utilization Rates:Non-domain Orders (e.g. diet) % Weeks

43. Medical Provider CPOEFirst Week of Implementation % 38,447 Orders Directly Entered

44. 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

45. Another Major Benefit of CPOE:Decision 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

46. 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”

47. CPOE Impact on Medical Transcription Errors CPOE Publicity CPOE “Go Live” Number of Medication Transcription Errors

48. Medical Provider CPOE:April through June 2007 % An Average of 7,800 Orders Directly Entered Every Day

49. Dr. X Drove Me Crazy • He hated the CPOE expectation • “I’m 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

50. I Thought I Finally Had Dr. X in My Crosshairs □ STAT Labs □INR: Call if >/= 1.5 □Serum potassium: Call if <3.5 □Prothrombin Time: Call if PT >14 seconds