Promoting the adoption of
next-generation best practices in
treating complex conditions
Customer Success Story
Shining a light on “bright spots” is an effective approach to driving change.
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease (ILD) with poor prognosis and no cure. The treatment guidelines had undergone a radical evolution, but as is often the case, the new guidelines were being disseminated and implemented slowly. The slow pace of adoption was particularly problematic for patients with IPF because the previous standard of care had the potential to be harmful.
Despite the availability of evidence-based guidelines, significant gaps in care remained, including delayed or inaccurate diagnosis, delayed referral to specialty care, limited use of multidisciplinary care, variable—and at times ineffective—approaches to management, and poor patient-provider communication.
Recognizing this gap in care, a leading provider of independent medical education identified the Pulmonary Fibrosis Foundation (PFF) and their Care Center Network (CCN) as leaders in adopting these new care best practices. They had the potential to improve patient outcomes by sharing local expertise and clinical excellence in IPF diagnosis and disease management with other CCN sites and community clinicians. But the question about how to encourage clinicians to adopt new clinical practices remained.
It became obvious that behavior change science would be required to help drive adoption of the new treatment guidelines to improve diagnosis, treatment, and patient outcomes.
In collaboration with the client, ProChange designed a behavior change strategy that integrated multiple theories of behavior change, including the Transtheoretical Model of Change, Diffusion of Innovation Theory, and an approach centered on “Bright Spots,” into a comprehensive CME/CE curriculum. The “Bright Spots” approach emerged from the work of Chip and Dan Heath, authors of Switch: How to Change Things When Change Is Hard. They posit that to effect transformative change, we have to shift our traditional problem focus to identify “bright spots”—places where success is being achieved—and replicate those behaviors that lead to success. This philosophy of starting with what is right is a tenet of positive psychology and the foundation of a qualitative research technique known as appreciative inquiry. Combining these three approaches provides a new framework for developing and evaluating the efficacy of CME/CE activities.
ProChange conducted formative research with five interstitial lung disease (ILD) centers from among the “bright spot” members of the PFF Care Center Network. Through a series of phone and onsite interviews with center personnel, ProChange derived insights into particular clinical or interprofessional communication practices that facilitated the implementation of best practices in the treatment of IPF. The insights were synthesized into a CME/CE certified text-based activity that was mailed as a 16-page, 4-color print supplement to an issue of CHEST Physician, the official newspaper of the American College of Chest Physicians (CHEST). The print supplement was received by the publication’s full circulation of 17,000+ CHEST members and clinicians in pulmonary disease and pulmonary critical care medicine. Digital versions (HTML and PDF) of the supplement were subsequently launched to increase reach. The eleven practices also enabled the medical education provider’s development of a CME/CE activity for pulmonologists.
As a result of the behavior change activity content, a significant number of clinicians became more confident and ready to adopt new treatment guidelines.
To date, more than 11,000 learners have accessed the activity content. Learners were also asked to complete assessments of their intention to change as a result of the activity. This last item is extremely important to measure, as a key goal is to drive the adoption of Bright Spot characteristics. Thirty-two percent of clinicians advanced in their readiness to adopt new treatment guidelines at post-test, and more than 40% were more confident about their ability to do so.
This integrated approach to leveraging multiple theories and frameworks of behavior change science can easily be applied to virtually any behavior change challenge. Three important takeaways emerged:
- There is a definable set of clinical or interprofessional communication practices that facilitate the implementation of treatment guidelines and that likely translate to other therapeutic areas.
- “Finding the bright spots”: It is important to transform our efforts to be agents of change by starting with and learning from “what is right.” Analyzing success is the only sure way to create more of it: To inspire change, we need to shift from a problem focus to Bright Spots.
- Robust and well-established theoretical behavior change models can be integrated to enhance the implementation and evaluation of CME/CE activities at multiple levels (e.g., centers and clinicians).
Transtheoretical Model of Change
The Transtheoretical Model understands change as a process that unfolds over time as a progression through five stages of change and matches behavior change strategies and messaging to a clinician’s readiness to change. The Transtheoretical Model understands change as a process that unfolds over time as a progression through five stages of change and matches behavior change strategies and messaging to a clinician’s readiness to change.
Diffusion of Innovation
Roger’s Diffusion of Innovation Theory explains how, over time, an idea or behavior (i.e., an innovation) gains momentum and diffuses (or spreads) through a specific population or social system in part based on the personal characteristics of the members of that population (i.e. their adopter category—such as innovator or laggard). Roger’s Diffusion of Innovation Theory explains how, over time, an idea or behavior (i.e., an innovation) gains momentum and diffuses (or spreads) through a specific population or social system in part based on the personal characteristics of the members of that population (i.e. their adopter category—such as innovator or laggard).