CHICAGO — Changing the culture at a hospital can be hard enough for leaders, let alone when you have a defiant doctor mucking things up at every turn.

We've all probably encountered one in our past — easily angered, too busy to be bothered with meetings, too brilliant to take any constructive feedback. That behavior can be difficult for nurses to deal with on a day-to-day basis, but it becomes harmful or even deadly when a physician refuses to follow a hospital's established safety practices, such as washing hands or following a checklist.

Imogen Mitchell, professor of medicine and associate dean at Australian National University, and intensive care unit director at Canberra Hospital, attempted to define the problem, and lay out some possible solutions, during a session Friday at the Social Media and Critical Care conference.

"There are many different shapes and sizes of your recalcitrant physician," she told attendees. "So, how might we turn these people around so that they are actually moving in the same direction?"

To do so, Mitchell offered hospital leaders six easy steps to try to engage those hardened docs better and get them on your side:

1. Seek out a clinical champion: Find a leading physician in your organization who is respected, inspiring and has the time to do tackle the effort. Use him or her to intellectually engage both the heads and hearts of fellow docs so that they are hit with the reality of the problem.
2. Establish a common purpose and vision: Everyone on the team should be aligned toward improving the patient experience.
3. Engage other doctors to develop the intervention and implementation strategy: Hospitals should start off small, Mitchell said, and make it easy at the beginning.
4. Communicate, communicate and communicate: Hospitals must create plenty of opportunities to talk with their physicians. There should be no surprises once implementation starts, and doctors should have plenty of chances to offer feedback, whether through newsletters, grand rounds or unit meetings. The messenger is critical to such an effort's success, with a respected, nonthreatening clinician who can work up and down the hierarchy to deliver the message. Data and literature also help to improve credibility.
5. Identify barriers: Seek out any potential hurdles that might get in the way of your efforts, and determine how to overcome them.
6. What's in it for me? Tune into what makes such efforts meaningful for physicians. People are resistant to loss, not change, Mitchell said, so try to mitigate the perceived loss.

Characterizing these steps as "easy" is probably a little misleading, Mitchell admitted, as it can get to be "a little disheartening" trying to address a recalcitrant doctor. But with a little patience and persistence, and commitment from the top of the hospital, organizations can turn around even the most callous of clinicians.

For more on this topic, check out this H&HN Daily blog from Todd Kisiak on the six actions physicians and hospital administrators can take to improve engagement with one another.