Online Program

Paradigms of change: How 16 organizations transformed prescriber-industry interactions

Monday, November 4, 2013 : 2:50 p.m. - 3:10 p.m.

Susan Chimonas, PHD, Center on Medicine as a Profesion, Columbia University, New York, NY
Academic medical centers (AMCs) and other healthcare organizations are notoriously conservative and resistant to change. Explanations for this conservatism vary, from the ingrained habits of tenured faculty to systems of training and promotion that privilege individual accomplishment over collaboration and teamwork. Whatever the reasons, healthcare organizations emerge as the picture of organizational entrenchment. Against this backdrop, an extraordinary change is underway: A number of healthcare organizations have taken bold steps to reform clinicians' relationships with drug and device companies. They have implemented stringent policies to control an array of conflicts of interest in clinical care (COIC), including bans on company-funded gifts and meals, limits on outside consulting and speaking, and public disclosure of physicians' industry ties. These sweeping initiatives are all the more remarkable in that they are not cost-neutral. To be sure, these organizations are unusual. Yet their outlier status makes them all the more vital as examples of organizational change. What drove them to break from their peers and begin this transformation? How were they able to implement policies which, in many ways, run counter to organizational and individual self-interest? To answer these questions, we conducted case studies at 16 institutions with exemplary COIC policies, using semi-structured interviews with leaders, administrators, faculty, and staff at all organizational levels so as to investigate the origins and dynamics of policy change. Our findings suggest ways in which healthcare institutions can overcome self-interest, entrenched habits, and other challenges to reframe their interactions with industry and affirm their core values and organizational commitments.

Learning Areas:

Ethics, professional and legal requirements
Social and behavioral sciences

Learning Objectives:
List obstacles to change in healthcare systems explain how medical centers have been able to overcome these obstacles Identify potential lessons for health system change

Keyword(s): Policy/Policy Development, Professionalism

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For the last 2 years, I have been the principal investigator on studies examining organizational responses to prescriber-industry conflicts of interest.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.