Case Examples


From Blood Utilization to Public Policy: Successful Persuasion Entails Personal and Diligent Efforts

Kathryn T. Knight, MD, FCAP
Kathryn T. Knight, MD, FCAP

Whether she plans to reframe a clinical colleague's thinking about blood product utilization or enable a legislator to see that high-quality laboratory services are fundamental to population health, Kathryn T. Knight, MD, FCAP, knows that successful persuasion is nearly as much about the messaging as the message.

Which explains why those attending an event in fall 2013 at the Hamilton Medical Center in Dalton, Georgia, where Dr. Knight is laboratory medical director, encountered posters emblazoned with the slogan for a new blood conservation campaign: "Why give 2 when 1 will do?" The tagline (a hybrid of several that hospitals in the area are using to persuade clinicians to start with one unit when ordering red blood cells) was catchy. But was the messaging clear? And would it stick?

It's early yet, but in a word, yes.


Blood utilization issues at Hamilton had always been dealt with ad hoc; Dr. Knight would call clinicians whose red blood cell orders fell outside the 289-bed hospital's recommended transfusion guideline (hemoglobin 8-g/dL). But as the literature began to reflect growing support for a tighter guideline (7-g/dL in hemodynamically stable patients), Dr. Knight and her blood bank supervisor decided to take a more formal approach.

So by the time those posters went up, they had a multidisciplinary committee to address blood utilization, which meant that those who reached out to colleagues whose ordering patterns fell outside the guidelines were often peers from the same or related specialty. As Dr. Knight had anticipated, meeting in person with colleagues to examine and address hospitalwide utilization data was enlightening…and effective.

Their collective persistence has already had a positive financial impact. The monthly bill for blood products in January 2014—which had been about $99,000 one year before—was $71,000. And at the end of that month, the hospital transfusion committee officially lowered the threshold to 7-g/dL.

Perhaps the best news is yet to come, Dr. Knight says. Hamilton is transitioning to systemwide use of an electronic health record. Soon, a transfusion order that calls for more than one unit or falls outside the new 7-g/dL guideline will trigger questions that must be answered before it will go through. Plus, the new system will track outliers for follow-up. Utilization can only improve.

"We've had support across the board," Dr. Knight says. "It takes a village, doesn't it?"

Same concept; new context

Dr. Knight devotes most of her time to anatomic/clinical pathology, cytopathol­ogy, and fine-needle aspiration. She loves this work. But when she attended the College of American Pathologists (CAP) Advocacy School (now the CAP Policy Meeting) 10 years ago, she discovered another passion—public policy. Today, she chairs the CAP Federal and State Government Affairs Committee and serves as president of the Georgia Association of Pathologists.

To her mind, it’s all of a piece.

"If you practice pathology because you love the challenges of diagnostic medicine, you have to care about keeping it viable," she says. Plus, she has found, an individual pathologist can influence policy in much the same way that the Hamilton team influences blood use: relationship building via diligent attention to the evidence, credible information freely shared, and personal conversations. One of the best places for that, she says, is your own laboratory, where visitors can see what pathologists do and what goes on day to day. "You can't have quality patient care without a quality laboratory," she says. "On a lab tour, they can see that."

Dr. Knight has hosted five congressional legislative laboratory tours at Hamilton to date. "A lab tour brings the practice of laboratory medicine to life," Dr. Knight says. "So much important information comes out of the laboratory. So I ask again and again. I bug people until they say, 'OK, OK. If you stop asking, I will come to your lab.'"


It's all about relationship building," Dr. Knight says. "You get involved. When there is a town hall meeting, you go. You ask questions. You do the meet-and-greet. And when you believe in someone, you host a fundraiser."

"Nobody knows our issues better than we do," Dr. Knight concludes. "In developing a relationship, you explain what it is that we do and the quality that we bring to the delivery of health care. You describe the indispensable nature of the pathology practice.

If we are not in a position to explain those things, nobody else will."

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