How to persuade clinicians to change a wound care order

wound care order

How can you convince an ordering clinician to consider a more effective wound treatment? Psychology offers some clues.

By Keisha Smith, MA, CWCMS

If you’re a knowledgeable, certified wound care clinician, receiving an outdated or illogical wound care order can be frustrating.

So, what can you do when you’re tasked with administering treatments you believe will be ineffective or harmful to a patient?

First, practicing substandard wound care can land you in legal hot water, even if you are following orders.

To protect your license, reputation and financial well-being, you need to speak up about wound care orders that contradict your knowledge and training.

Of course, your real goal — beyond simply staying legally defensible — is delivering the best care to your patients. To accomplish that, you may need to educate your team, including physicians and other ordering clinicians.

“The reality is the care provided by a physician at times, be it in wound care or any other area of medicine, may not be considered ‘standard of care’ by his/her peers,” said Don Wollheim, MD, FAPWCA, WCC, DWC, clinical instructor for the Wound Care Education Institute (WCEI).

Wollheim notes that in many facilities, non-physicians take the lead on wound care management and educate the physicians on recommended wound care orders.

“The physician, in turn, needs to allow and accept this educational process to the point that he/she is satisfied with the treatment plan before signing off on the plan of therapy,” he said.

In some workplaces, however, physicians and other ordering clinicians adhere to a more top-down style and do not respond well to the questioning of wound care orders, even from certified nurses or therapists with specialized training.

We explain some principles that predict why an ordering clinician might resist your evidence-based suggestions. We also offer some persuasion techniques to help you overcome the hurdles.

Why some people resist new ideas

Nobody likes to be wrong. For people in positions of authority, it can be even more uncomfortable, thanks to a phenomenon psychologists call cognitive dissonance.

Cognitive dissonance occurs when our thoughts and actions are inconsistent with our beliefs. The inconsistency causes tension. Without even realizing it, we automatically take steps to reduce that tension.

For example, let’s say you think of yourself as a calm and rational person. If you lose your temper and shout at a colleague, you’ll experience cognitive dissonance. To relieve the tension, you may blame the colleague’s words or actions for triggering your response, rather than considering that sometimes you cannot control your anger. Therefore, you reduce the inner sense of inconsistency while keeping your beliefs about yourself intact.

Physicians and other ordering clinicians make unilateral, potentially life-altering decisions every day. Being confident, decisive and correct are key role expectations. It’s only natural that some ordering clinicians build a self-concept around having in-depth knowledge and superior judgment.

Therefore, accepting a wound care order correction from a non-ordering clinician can cause cognitive dissonance. Either the ordering clinician must adjust his or her self-concept by acknowledging misjudgment or he or she must discount the suggestion and the messenger.

Bias against new information

Psychologists also identify another obstacle to changing someone’s points of view: confirmation bias.

Confirmation bias leads us to give more weight to evidence that supports our existing beliefs than to contradictory evidence. We often dismiss any information that counters what we hold true. Thus, it’s hard to fight the “we’ve always done it this way” mentality.

There are individual differences, of course. Some people tend to remain open to new information. Others reject absolutely everything that doesn’t support their current point of view.

Most people, however, exist somewhere in between these two extremes. Therefore, when you need to convince someone to reconsider a past decision, your success may depend on how you present your case.

It’s not just about being right or even credible. It’s about understanding the psychological minefield you step into when challenging someone’s beliefs.

To increase your chances of convincing someone to change course, watch out for cognitive dissonance and confirmation bias.

Here are seven tips to help you use psychology to convince anyone — including people in authority — to consider a new alternative to a wound care order.

1 — Choose your timing wisely

Remember, being wrong creates internal discomfort and tension. So when someone is already under stress, hurried, in front of a big audience or in any other heightened emotional state, it amplifies tension.

If possible, pick a quiet moment away from other team members to bring up your ideas related to the wound care order.

2 — Understand and reaffirm a person’s self-beliefs

If you directly challenge someone’s belief, prepare for defensiveness. However, if you can reinforce the belief and connect it to your desired outcome, you can smooth over the cognitive dissonance.

Pay attention to what motivates the ordering clinician. For some, a deep concern for patient well-being is tantamount. For others, their power or reputation in others’ eyes is most important. Others are driven by mastery, knowledge and success.

If you understand how they see themselves, you can lay the groundwork with an introductory statement that supports their self-image, such as:

  • “I appreciate how you go the extra mile for your patients.”
  • “You’re a leader here, so I want to get your opinion.”
  • “I’ve noticed that you think things through carefully and thoroughly.”
  • “You like to stay on top of the most efficient treatments and their outcomes.”

3 — Ask for a small buy-in first

Research shows people are more likely to agree to a large request if they have already agreed to a smaller request. Psychologists call this the “foot-in-the-door phenomenon,” and salespeople call it the “yes ladder.”

Note how successful fundraisers typically ask you to sign a petition or give a tiny donation before suggesting more substantial contributions.

In this case, you can start with a question such as:

  • “I read something about a new dressing. Can I get your thoughts on it?”
  • “I learned an interesting fact in my wound care management course. Can I run it by you?”

The goal is to elicit the word “yes.” Once someone has agreed to the small request, they will be more open to saying yes again.

4 — Present your case in an organized, evidence-based fashion

You’ve chosen the right moment, caught the ordering clinician’s attention and even gotten explicit agreement to listen to your position.

At this point, preparation matters. You need to know your facts and offer supporting evidence, including written sources such as research studies, peer-reviewed articles or manufacturer’s instructions whenever possible.

Stay calm and positive while stating your case to change the wound care order.

5 — Do not criticize past wound care order decisions directly

People are more likely to go along with ideas they consider their own. In this situation, your goal is not to highlight the error of someone’s past judgments, but to offer useful information for future decisions.

After presenting your case, ask, “What’s your take on this?” If the ordering clinician shows some acceptance of the new information, try to climb another rung on the yes ladder by asking if it’s viable to use the alternative treatment in the future.

If the clinician agrees the treatment might have value going forward, then it’s a small step to ask, “Could you sign off on this for Patient X, since it would apply to her case, too?” You are framing your request as a new decision, not challenging an old one.

6 — Do not take rejection personally

Whenever you seek to reverse a decision, you’re working against human psychology. Some individuals simply cannot be moved.

Similarly, your success may depend on other factors, such as your history with the ordering clinician or even the clinician’s mental and emotional state on a given day.

You can only do your best to offer a respectful and convincing argument while introducing as little tension as possible.

7 — Prepare for additional efforts

If your persuasive techniques don’t work, you may need to involve a supervisor. Use your evidence to bring the supervisor up to speed, and don’t undermine your argument with anger or personal criticisms of the ordering clinician.

Your supervisor likely understands the personalities and dynamics involved, and if he or she agrees the original wound care order isn’t appropriate, the supervisor can take steps to resolve the issue.

Ordering clinicians who resist change present a special challenge. With the right psychological tools and support from your supervisor, breakthroughs can happen.

Listen to the perspective of a wound care physician on this topic at our 2019 Wild on Wounds (WOW) National Conference in September.

  • Michael Miller, DO, FACOS, FAPWH, CEO and medical director of the Miller Care Group, will lead the session “Herding Insipid Cats — Teaching Wound Care to the Modern, Omniscient, Dabbling Physician.” He will share an insider’s viewpoint on the state of wound care knowledge among his peers and discuss how nurses and therapists can help physicians update their approach.

____________________________________________

Keisha Smith, MA, CWCMS, is a freelance digital marketing consultant who works with clients in healthcare, law and behavioral health. Her specialties include content creation, social media and brand clarity. As an eight-time Wild On Wounds conference staff member and an alumna of WCEI’s training program for wound care marketing professionals, she loves the exceptional passion of clinicians who treat wounds. She frequently finds herself advising friends and family to keep their minor wounds warm and moist.

What do you think?

comments

Comments are closed.