How to Get Nursing and Medical Staff to Adopt New Protocols

Trying to create lasting change in a healthcare facility often feels like pushing a boulder up a steep hill. Whether you are trying to roll out a brand-new protocol, get your department to adopt a new therapy technique, or simply ensure that nursing staff and aides follow mealtime safety recommendations, the system's default response is almost always… friction.

When change stalls, our instinct is usually to push harder. But the real secret isn't more brute force. It's understanding how human psychology works within complex environments so you can push smarter. And to push without pushing buttons. 

I rely on a synthesis of concepts originally laid out by Dan Heath in Reset and Chip and Dan Heath in Switch, adapting them into a clinician-centric model: the SPEAK Framework. It provides a grounded, practical recipe for creating change when change is hard (which it almost always is).

Here’s how to think about this framework: Every colleague you work with has two distinct, competing systems operating in their brain. To understand these systems, imagine a person riding atop a giant elephant.

The Rider is the rational, analytical mind. The Rider loves data, reviews spreadsheets, and tries to plot the course.

The Elephant is the emotional, instinctual side. The Elephant feels tension, avoids discomfort, seeks quick wins, and provides the actual muscular energy needed to move. It’s an elephant after all.

If the Rider and the 15,000-pound Elephant disagree on where to go, the Elephant wins every single time. You cannot criticize or rationalize with an exhausted Elephant. That’s not going to make him move. 

To make change stick, you must direct the Rider, motivate the Elephant, and clear the path ahead.

Here is how the SPEAK Framework puts that into practice:

S — See the Work

We assume we know why something is broken, but our conclusions are built on second-hand assumptions. Just like in patient care, if your diagnosis of the problem is a guess, your intervention will fail (Think clinical guesswork vs. an instrumental swallowing evaluation).

To avoid guessing and secondhand assumptions, step away from charting and actually observe how the work is being done on the clinic floor. Shadow a floor nurse, an aide, or an SLP colleague to spot the informal workarounds they have been forced to accept as normal. 

Example: Are physicians skipping consult orders out of defiance, or because the order interface buried it under 12 tabs while they are juggling endless calls? Write out the actual steps you need to take to facilitate your change right where the bottleneck actually exists.

P — Pave the Path

The Rider’s greatest liability is analysis paralysis. When we offer vague guidance or broad recommendations, we think we are lending them autonomy, but we are actually overwhelming them. Ambiguity is mentally exhausting. When the direction is murky, the Elephant defaults straight to the path of least resistance.

Example: Instead of letting them guess the way, pave the path by defining an unambiguous, black-and-white destination. Instead of telling a team, “We need to do more thorough swallow evaluations,” establish a crisp destination: “We will recommend an instrumental assessment on every patient presenting with suspected pharyngeal dysphagia.”

Remove the guesswork and give the Rider an unmistakable target.

E — Engage the Elephant

The Elephant is the emotional engine of progress, but it spooks easily and shuts down if something feels intimidating. Clinicians frequently make the mistake of relying on an Analyze-Think-Change strategy. For example, we often hand a stack of research articles to administrators or colleagues and expect immediate buy-in.

Real behavior changes depend on a See-Feel-Change sequence. People must feel the reality of a problem to care enough to act. Instead of citing an aspiration pneumonia risk percentage, show a medical team a short videofluoroscopic clip of silent aspiration.

Once the emotion is engaged, scale the task down. In a study by Bice and Galek, clinicians working with a patient with late-stage dementia who exhibited persistent oral holding bypassed her cognitive barriers by hooking her up to an sEMG biofeedback bar graph.

When she swallowed, a visual bar shot up, and a bell rang. They framed the task as a simple game with immediate feedback: “When the bar goes up and you hear the bell, you're the winner!” Within five sessions, she moved from oral holding to consuming a regular diet independently.

By making the task tangible, playful, and immediate, the Elephant engaged without hesitation. Provide an early win to give people momentum; individuals work far harder when they perceive they have already started a journey rather than standing flat-footed at an intimidating starting line.

A — Alter the Path

When colleagues fail to adopt a new protocol, human nature tends to lead to the Fundamental Attribution Error—we assume they are stubborn, careless, or disengaged. In reality, what looks like a character flaw is almost always an environmental issue.

Instead of relying on personal willpower or endless reminders, redesign the immediate physical space so that the right choice is friction-free and the wrong choice is inconvenient. Build action triggers that attach your desired outcome directly to already established routines.

Example: If certified nursing assistants struggle to recall individualized swallow precautions, post an explicit checklist right at the bedside whiteboard where they feed the patient. Work with the EMR team to create a default one-click consult trigger, or integrate swallow screening prompts into the nurse's routine morning vitals assessment.

To ensure it gets done, we have to make it easy first.

K — Keep Studying Bright Spots

When a department struggles, attention instinctively locks onto everything that is collapsing. We fixate on the kitchen sending the wrong meal textures or the specific physicians who refuse to refer.

Instead of obsessing over systemic dysfunction, hunt for the exceptions.

Questions to ask: Where is the system functioning properly right now? On the days when the kitchen sent all the correct trays, what conditions were present? Which nurse is already adhering to oral care recommendations without being asked?

In other words, what’s already working? Isolate the specific individuals, analyze what allows them to succeed under the exact same constraints, and replicate their methods across the rest of the facility.

Takeway

Systemic change in healthcare rarely arrives through sweeping mandates. It builds from small wins. By observing the real work, giving the Rider explicit directions, engaging the emotional Elephant, altering the physical environment, and cloning what’s already working, you give your facility the framework it needs to actually evolve.