June 11

Circle of Confluence Strategy Reduces Clinicians’ Fear of Change

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Push or pull clinicians in the direction of change, and they’ll probably resist. Embrace them instead and you’ll increase your opportunity for their acceptance of your ideas and recommendations for changes in their methods and practices. The concept is to build clinicians’ respect and confidence in you. This sets the stage for effective value analysis. We recommend an approach we call the “circle of confluence” which incorporates four C’s: contact, champion, communication, and cooperation.

Contact: It is crucial that you establish regular contact with clinicians through focus groups and surveys to understand their needs and ideas. But it takes a little more effort to build lasting relationships. Identify and be active in committees that are central to your clinicians’ deepest interests, such as infection control, the operating room, and quality. To prove you are committed to their interests, sponsor in-house seminars on new modalities, procedures, and therapies. Grab their attention with seminars on products like silver-coated catheters, which can reduce their patients’ nosocomial infections.

Champion: Clinicians respect their peers, so cultivate relationships with ones who will champion your causes and lead value analysis teams toward common and mutual goals. For example, the value analysis process at Pennsylvania Hospital, Philadelphia, Pennsylvania, was hugely successful in part because physicians themselves lead their VA teams (that’s right!).

Communication: Regular communication is fundamental. It gives clinicians the opportunity to share and digest diverse ideas. It can also generate new ideas by putting old ones into context. Publish newsletters to keep clinicians fully informed about your philosophies and actions and aware of your sensitivity to their needs. Ask for the opportunity to present new programs and initiatives at medical staff meetings and luncheons. Most of all, truly listen when clinicians tell you about their concerns and problems. Then, act to resolve them.

Cooperation: By serving and working with clinicians without expecting anything in return, you’ll build lasting alliances. For instance, lead the way to facilitate capital equipment requests and resolve product and quality problems. Combined with contact, champion development, and communication, this will bring confluence full circle and enable cooperation on common goals and challenges.

The circle of confluence is a continuous process, not a onetime event. Keep the loop closed by continuing to build on the four C’s and you will reduce clinicians’ fear of change and gain allies in your fight to manage and control costs and quality.


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circle of confluence, confluence, control costs, cost and quality, hospital, VA teams, value analysis


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