How one health system persuaded its doctors to change. Hint: It wasn't easy.

The Banner Health system, which stretches from Alaska to Arizona, delivers about 30,000 babies a year, about a third by cesarean section.

When Banner officials scoured their data, they found wildly different patterns in how those C-sections were performed.

That was the easy part. Getting doctors to change their behavior proved more challenging.

 “We realized just asking them was not going to cut it,” said Ken Welch, chief medical officer of Banner Estrella Medical Center in Phoenix.

We described Banner’s efforts to rein in variation in a recent USA TODAYBut we didn’t get into the nitty gritty of how the system convinced doctors to change. It’s an object lesson in the difficulty of getting doctors to change, but also the lengths to which health systems and insurers will go these days to make it happen.

Let’s start from the beginning. In its data analysis, Banner found striking differences in the use of pieces of film or fabric — called adhesion barriers — during C-sections. Some hospitals used the barriers during 79 percent of C-sections, while others used them less than 1 percent of the time.

The barriers are used to prevent abnormal scarring after abdominal and pelvic surgery, and marketers had urged doctors to use them for C-sections, Welch said.

But when Banner analyzed the data and academic literature, it concluded the barriers made no difference in how patients fared. It shared this information with its doctors and asked them to stop using them.

“We educated them and showed them data,” he said. “There were no differences between the various hospitals as far as the outcomes and no studies that supported what they were doing.”

The soft sell didn’t work.

After trying for six months to persuade doctors to stop using the barriers, the system got tougher. It told the doctors it no longer would provide the product for C-sections starting this year.

“We said no more, we’re not paying for it,” he said. “That was the turning point. … We took it off the supply shelf in the OB department.”

That helped, but there were still some holdouts. “We said if you really insist, do it, but we’ll track it,” Welch said.

Officials built an electronic dashboard available on the company intranet which showed how many adhesion barriers are used daily, and by whom.

“You can find out who is using it. It’s like the wall on the post office: Here are the guilty people,” he said

The tactic worked.

“They grumbled at first. What they have seen is that we mean it. We’re not going to waste money,” Welch said.

It costs $250 each time one of the barriers is used in a C-section, Welch said. So far in 2011, the barriers have been used in fewer than 1 percent of C-sections, which has meant a cost savings of more than $1 million systemwide.

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Emily Bazar

Emily Bazar is a columnist and senior writer for the California HealthCare Foundation Center for Health Reporting, part of the USC Annenberg School for Communication & Journalism. Her column, “Ask Emily,” addresses readers’ questions about the Affordable Care Act. It appears in more than 25 newspapers and NPR affiliate websites across California, including the Daily News of Los Angeles, The Sacramento Bee, The Orange County Register, the Fresno Bee and the Riverside Press-Enterprise. The column is consumer-driven, and has generated more than 1,500 direct questions and comments to and hundreds more to the newspaper and NPR affiliate sites where it appears. In her role as Ask Emily, Bazar also regularly appears on KPCC’s Take Two and AirTalk,  KQED’s Forum, KALW’s Your Call  and Valley Public Radio. Outside of Ask Emily, she covers stories about Medi-Cal, children’s dental care and variation in the use of medical treatments. Her reporting on Medi-Cal’s troubled children’s dental program was awarded the 2011 California Journalism Award for Special Feature/Enterprise Reporting. Prior to joining the Center for Health Reporting, Bazar was a national reporter for USA TODAY, where she covered immigration, the effects of the economic recession and other topics....

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