Clinician Resistance to Adopting New Practices

This is a topic that I've pondered over and again. I work in an industry that deals with the interface between critical patients and life-giving (and potentially life-ending) equipment; yet those of us who operate that equipment are frequently unwilling or afraid to adopt other new technologies.

I received my copy of RT magazine this month. There is an article, "Current Trends in Automated and Mechanical Ventilation", by Robert L. Chatburn. (I am unable at this minute to find the article online. It is the November 2007 issue, pp 20-26.)

The article itself is fascinating, discussing ventilator evolution, current technology, and possible future trends. (I'm especially looking forward to when Med Vent takes over the world {wink}).

As fascinating as the entire article is, he makes a statement about our resistance to change that is so succinct and relevant, that I want to write simply about it.

Mr. Cochran is discussing the "reasons why clinicians resist adopting new practices despite clear evidence for change." (p. 26). Here is what he says:

"These (reasons) include fear of failure, excessive workload, lack of trust in change recommendations, lack of emotional investment due to noninvolvement in development of change policies, and simple intellectual inertia."

I'd like to examine each of these reasons by themselves.

1. Fear of failure

It is not hard to imagine the fear of failure on the part of respiratory therapists. The consequences of failure to a respiratory therapist are quite dire. We are seldom called to intervene on behalf of patients who are well, or stable. Simply put, they are having trouble breathing.
So our fears are legitimate. But being afraid to fail doesn't justify resistance to change. In fact, some of these changes would increase our success in treating patients. So what can we do?
A. Educate ourselves. In our department, we have a handful of people who are continually educating themselves about disease processes, therapies, and equipment. It is this example we should follow, so that we stay abreast of the reasons for the changes that are being made to our practices. It also keeps us on the cutting edge of these practices so that we are not taken by surprise when changes come. I submit therapists should exert a sort of peer pressure on each other to keep reading and reporting to each other regarding changes in practice, technology, and understanding of the diseases in our primary areas of work. (This is one reason I recommend forums such as "RT Corner.")
B. Back each other up. Educate each other, and support each other in the emotional impact of change. Acknowledge the stressfulness of it to each other, and give each other a break. Support each other in finding the resources to learn and become experts in these ever-changing technologies.

2. Excessive Workload.

From the figures in this article, things are not looking up for RTs on this horizon. Our enrollment is not keeping pace with the available positions. In addition, "turnover and vacancy rates for RTs were higher than those for nursing, radiology technology, and medical technology from 2004 through 2006" according to the Ohio Hospital Association. (p 24)

This is going to take some reworking of the way we do things. Here are a few possibilities for how to handle it.

A. Greater ventilator intelligence. Mr. Cochran is suggesting that part of the answer lies in ventilator technology that can relieve our workload through greater machine intelligence.

B. Use of other equipment and technology that reduces the need for therapist/time. Devices such Breath Actuated Nebulizers are a good start.

C. Development and implementation of therapist driven protocols. We need more authority to delineate the kind of services that are appropriate for our patients, so that we can deal with them efficiently. This means, again, that therapists need to educate themselves and be on top of what the best standards of care are.

D. Recruitment and retention. Why is respiratory therapy less desirable a profession than nursing, radiologic technology, and medical technology? I submit that the answer lies somewhere between satisfaction with our defined scope of practice; sense of worth as part of the health care team; ability to handle the emotional stress of this area of science and the lack of support systems or acknowledgement of that emotional stress; excessive workloads (chicken and egg thing); and inadequate monetary and other compensation.

3. Lack of trust in change recommendations.

I have been one of these therapists. Often when introduced to new equipment I am unconvinced that a change needs to be made. To a certain extent, I'm right; sometimes the decisions makers are awed by the bells and whistles of the new equipment, when it really does everything that our current equipment is doing.

I am guessing, if I was disciplined about following my own advice about educating myself, I would have less of this attitude. Or possibly, I'll get more involved in the decision-making process myself, and will have more input in the decision--see point 4.

4. Lack of emotional investment due to noninvolvement in development of change policies.

Or technology acquisition, for that matter. All too often, the changes in practice and technology are sort of thrust upon us, without involving the RTs in those changes.

Of course, see above. Perhaps if the decision makers waited for our involvement, no changes would occur?

5. Simple intellectual inertia.

I can't blame any of us for having phases like this. Life events of our own sometimes sap our intellectual stamina, and desire to maintain that learning attitude.

And I myself have been a victim of the respiratory equivalent of battle fatigue. We are on the front lines of some very heavy crises, and given our few numbers and issues such as inadequate staffing, it's quite challenging to remain excited, and mentally on the cutting edge. In addition, these are not the kind of jobs where you get much down time during your shift. I've almost thought about recommending to RTs that they get a different part-time job, and work in respiratory on a lower hour-per-week basis. It's very difficult to do full-time, year after year. I have actually, myself, never worked a regular 40 hour week, and have always handled it much better if I worked 32 our less hours per week. I just don't have the strength for that.

I'm sure others have many good ideas about how to rectify some of these issues. That's about all I have to say right now.