The end of October marked the third annual EndoTool User Group Meeting for Monarch. As EndoTool users from near and far convened in Charlotte, NC, the discussion centered on how users can further optimize EndoTool to see improvement in outcomes.
While the application has demonstrated success by statistically eliminating hypoglycemia, attendees and speakers all agreed, the outcomes can be amplified when their organization implement other glycemic management best practices, provides comprehensive education, and has a clinical champion driving system-wide change.
To optimize the use of EndoTool and ensure the delivery of diabetes care best practices, five themes emerged from the discussion on how you can be a champion for successful change:
Drawing from the examples of ants who can take a pile of dirt and create a complex structure with levels connected by a network of tunnels, Anthony Pick, MD, CDE of Northwestern Medicine pointed out, “a simple unit and simple rules can create highly complex structures and solutions.”
Simple initiatives can result in significant change. Take the surgical checklist from Dr. Atul Gawande. A straightforward checklist post-surgery reduced complications from 11% to 7%.
The same can be true for diabetes care. Whether it’s the implementation of technology like EndoTool, or tools like a pocket guide or tip card, streamlined initiatives can make a big difference. By focusing on the incremental change, an organization can create the building blocks for the program they want to see in the future.
When implementing new initiatives, it also takes socialization for the idea or solution to gain traction. As Dr. Pick said, “change is going to be rejected. However, once you socialize it, the change can happen.”
To gain buy-in, it’s important to know your audience and what will resonate most with them. Whether it is outcomes, components of patient care or the return on investment, you need to have the information at your disposal and hone in on what matters most to a particular group or individual.
For medical staff, our panel, which included Beatriz Francesca Ramirez, MD of East Carolina University and Vidant and Zachary White, RN of South Georgia Medical Center, reiterated the fact that data is necessary. Providers want to see outcomes, clinical research, and case studies. Additionally, it was suggested that you engage providers through grand rounds and one- on-one interaction to really instill the desired knowledge and actions.
Among nursing staff, Norma Brown, MSN, RN, CDE from South Georgia Medical Center emphasized the importance of giving staff significant notice that a new technology or tool is coming. She used posters in break rooms and computer and time clock screensavers to notify staff in advance of their implementation of EndoTool. Her team also created a bimonthly newsletter, “A Sweet Second,” that gave updates on their implementation project, education on workflow changes, and engaging questions and games.
The idea of socialization can be taken one step further with competition. Competition can be used to garner engagement and be designed in a manner to help your organization achieve desired outcomes. Ken Fogle, RN from Orangeburg Regional Medical Center explained how they used competition to reduce the timing between the blood glucose check, meal delivery and subcutaneous insulin therapy. The timing of the check, meal and insulin is one of the largest contributors to hypoglycemia, and the hospital was able to make a dramatic improvement in timing, reducing the average workflow time from 3 hours to 15 minutes in their largest units as a result of the competition. Noncritical care units competed against each other over the course of multiple weeks, and the winners were recognized and rewarded. They continued to stick to the workflow to keep their bragging rights!
While there are multiple ways you can try to simplify your plan, socialize the change and use competition, all the elements of championing change require persistence. It takes persistence to get approval and implement change, but also to continue reinforcement. As both Norma Brown and Ken Fogle said, the job of being a clinical champion for glycemic management is truly never done. Staff members will require check-ins to ensure old habits don’t rear their head, and with new staff coming on board, education never stops.
There also needs to be persistence when it comes to the analysis of data and outcomes. Linda Currie, RN, MSN, ACNS-BC, CCRN-CSC, WTA, from VCU Health explained how she regularly pulls her unit’s data to track performance from EndoTool Analytics. Not only can she see how they are trending, but she takes it a step further to drive down on specific cases to get to the root cause of a patient scenario. With that analysis, she can use the cases as a teaching opportunity with her staff or as an opportunity to make changes that will prevent errors and simplify workflow.
Finally, what was evident, above all else, was that in order to champion glycemic management initiatives successfully, the individual needs to be passionate. Passion, and often a team to rely on, were cited as the things that keeps them moving forwarding and inspiring change for better patient care. Through passion, champions were able to get administration, clinicians and support staff on board with the initiatives. They were able to overcome the challenges and barriers that stood in the way, and they were able to create a culture where improvements in glycemic management are recognized.
By keeping it simple, socializing the change, utilizing competition, staying persistent, and drawing upon your passion, you can be a champion for change to improve inpatient glycemic management and advance patient care.