March is a great time to talk about physician opinion leaders because March 30th is National Doctors Day. Physicians are clearly a key stakeholder group for appropriate blood use, so their engagement and ownership is essential for the success of comprehensive blood management programs. One of the common concerns I hear from hospital administrators and lab staff seeking to start blood management programs is the lack of active physician participation on their transfusion committees and on their blood management team. While the eventual goal is to have all physicians who order blood products fully bought in, an efficient and effective way to begin the change effort is to target key physician opinion leaders.
Opinion leaders can be defined as “influential members of a community, group, or society to whom others turn for advice, opinions, and views”.1 For years, pharmaceutical and medical device companies have sought to use physician opinion leaders (POLs) to help integrate new products into hospitals and physician practice groups. The medical literature is also beginning to recognize the importance of POLs to help implement practice guidelines, an area of increasing interest as the healthcare system seeks to reduce practice variation that results in unnecessary tests and treatments. Physician opinion leaders are those physicians informally judged by their peers as educationally influential and trustworthy to evaluate new information in the context of the local group norms.2 To lead opinion, a physician must be considered by associates to be technically competent and well integrated with his or her peers in the local medical community.3 It is important to note that opinion leaders are informal leaders who are practicing physicians and generally not administrators or authority figures.2 Unlike opinion leaders in other industries, physician opinion leaders are typically not innovators or early adopters; rather, they are conservative evaluators.3 Because their clinical judgment is highly valued, physician opinion leaders have the ability to directly or indirectly affect the practice patterns of their peers.
With regards to blood management and POLs, I wrote a book chapter on implementing evidence based transfusion guidelines in “The Transfusion Committee: Putting Patient Safety First”.4 I included an extensive discussion on the importance of integrating change management strategies in the process and the critical role of POLs. When developing transfusion guidelines, hospitals should first seek out national guidelines that have been established by expert groups and professional societies such as the AABB, ASA, SCCM and ASCO. However, it is essential that POLs be used to adapt those guidelines to local circumstances (promoting ownership) and then to help encourage use of the guidelines through peer-to-peer communication and education (establishing buy in). While this hospital-by-hospital adaption process may seem cumbersome, I believe it is necessary for successful guideline implementation and an acknowledgement that “all politics is local.”5
Finally, what is the best way to identify POLs? It begins with conversations among physician groups at your hospital to identify peers that they respect and trust. Key characteristics of POLs are that they are knowledgeable of the literature, they are clinically respected, and they are approachable. As such, they have good communication skills and don’t “talk down.” The ideal POL is one who is also supportive of the change process. I have found a useful way to visualize the ideal POL is by using a grid to map the desired characteristics: 1) influential with peers and 2) enthusiastic for the process (Figure 1). We have all known enthusiastic physicians who are not influential, and we regularly encounter influential physicians who are not enthusiastic for the change. There is very little I can do to make a physician more influential with their peers, but I always endeavor to make influential physicians more enthusiastic about blood management through meaningful education, clinical engagement, and a focus on patient safety through appropriate blood use.
- Borbas C, Morris N, McLaughlin B, Asinger R, Gobel F. The role of clinical opinion leaders in guideline implementation and quality improvement. Chest. 2000;118(2 Suppl):24S–32S. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10939996
- Greer AL. The state of the art versus the state of the science. The diffusion of new medical technologies into practice. International journal of technology assessment in health care. 1988;4(1):5–26. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10287114
- Hannon TJ, Gross I. Transfusion Guidelines: Development and Impact on Patient Blood Management. In: Saxena S, ed. The Transfusion Committee: Putting Patient Safety First. 2nd ed. Bethesda, MD: AABB Press; 2013 (in press).
- A saying made famous by Tip O’Neill, the late Speaker of the House of Representatives.