“Evidence-based best practices so often cited in the literature require more than just clinical evidence. They also require the art of persuasion, as all change initiatives do. People change when they see the value in relinquishing what has worked for them in the past in exchange for what is possible in the future.”

In preparing to write my column for this quarter’s magazine, I wanted to explore a topic new to me – Enhanced Recovery After Surgery (ERAS), so I scoured the internet for the background. If you’re new to the concept of ERAS too, I recommend a look at the website of the ERAS Society, erassociety.org. The more I researched, the more intrigued I became because ERAS seems to encompass so many of my own passions- a commitment to excellence, the pursuit of improved quality in patient care and patient outcomes, and the use of evidence-based medical practices.

With my interest piqued, I reached out to Dr. Martin (Marty) Koonsman, Chief Medical Officer (CMO) of the Methodist Health System (MHS) in Dallas, Texas. I heard Marty speak at one of the system’s annual quality conferences several years ago. He impressed me as both an accomplished surgeon and as a compassionate human being. I wanted to ask his views on ERAS.

Basically, Enhanced Recovery
After Surgery or ERAS is an evidence­ based, multidisciplinary approach to caring for a surgical patient. It involves implementation of a series of evidence­ based protocols before, during and after surgery, which have been proven to have a significant impact on the length of stay and complication rates in surgical patients. Yet, implementing ERAS may be difficult because it requires a shift from traditional surgical care practices.
“MHS began its use of ERAS protocols about five years ago,” he says. It was the first health care system in the Dallas area to move to this new approach.

ERAS was first championed by one of the anesthesiologists where Marty was serving as hospital CMO at the time. This anesthesiologist reached out to the surgeons who cared
for patients with complex pancreatic conditions.

“That was a good approach,” Marty explains, “because this was a relatively small, defined patient population. We had the bandwidth to monitor both the patients and the key metrics, including a length of stay, readmissions, and the need for narcotic pain medications.” Since that initial pilot, MHS has expanded its use of ERAS to all four hospitals and treatment of complex hepatobiliary cases, colorectal cases, and more recently, gynecological cases. MHS has also participated in a collaborative ERAS project with the Mayo Clinic Network.

I asked Marty if he encountered any resistance at the first implementation of ERAS protocols. He laughed and said, “Most definitely! We were asking extremely skilled and successful surgeons and their teams to change from what had worked for them throughout their careers to a new and different approach. Everyone thinks their way is best! What we had to do was get them on board with the key elements of the pathway. Then we had to track and monitor both compliance and outcomes.”

That’s when it hit me that evidence­ based best practices so often cited in the literature require much more than just clinical evidence. They also require the art of persuasion, as all change initiatives do. It isn’t enough to issue edicts. People change when they see the value in relinquishing what has worked for them in the past in exchange for what is possible in the future. Marty concurs. “For those who were resisting, I needed to find out what their issues were. I needed to show them the results.”

I was curious about the benefits to physicians and other healthcare professionals who care for patients under the ERAS protocols. He says, “The consistency provided by the pathways, the protocols, ensures that everyone knows the plan, including the patients. [The health care team] can deliver high-quality care rather than dealing with variations coughed by physician’s preferences. They can clearly communicate expectations to the patients. Finally, they’re proud knowing that they’re following proven best practices.”

What words of encouragement does he offer to readers of Arkansas Hospitals magazine? “In considering ERAS, the results speak for themselves,” he says. “The significantly improved outcomes have been very dramatic in our four hospitals, as well as in the literature.”

And to that, I’d add, “Remember to bring along your change management skills.”

This example isn’t far different from the experiences of senior leaders in every field who embark on a performance excellence journey using the Baldrige Excellence Framework. In essence, they are asking other experienced and successful senior leaders to make changes from what has worked for them in the past to a new and different approach.

For more information about this contact Kay at 972-489-3611 or email Kay@Baldrige-Coach.com

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