By: Anne Marie Orlando, RN, RCIS, CVAHP

I recently had a conversation with a colleague about the high cost of a certain category of medical devices purchased in their system.  Like many facilities, their spend is split between two rival manufacturers.  One manufacturer had market pricing, and the other manufacturer was 4 times that cost.  With both product lines being similar in form and function, I asked my colleague if products could be consolidated which would yield not only better pricing (with either of the manufacturers) but more importantly consistent patient care across the organization.  My colleague stated that the project was not pursued because surgeons on both sides stated that they couldn’t change.  They used the “I can’t” phrase that plagues many a value analysis (VA) committee into indecisiveness and stagnation.  While my colleague didn’t think too much about it, I needed to take a pause.  You see, the distinction between "I can't" and "I won't" is subtle but powerful, especially in healthcare, where language can reveal barriers to change. Understanding the difference between these phrases and their implications can help facilitate more productive VA discussions and drive meaningful improvements in clinical practice.

In general, "I can't" is a statement of inability. The speaker perceives—or claims—that external constraints, resources, or skills prevent them from doing something. This phrase often implies a lack of control or helplessness, shifting responsibility away from the individual to external factors. For example, a surgeon might say, "I can't change the way I perform this procedure because the system doesn’t support it." This statement could stem from fear of failure, lack of confidence or training, or institutional and systemic barriers—whether real or perceived.

On the other hand, "I won't" is a statement of unwillingness. It signifies a choice not to act, often based on personal beliefs, values, or priorities. This phrase implies ownership of the decision, even if not openly articulated. For instance, a surgeon might say, "I won’t change how I perform this procedure because I don’t believe the evidence supports it." The underlying factors in this case may include resistance to change, skepticism or distrust of new practices, or personal and professional preferences.

In day-to-day practice, providers and other healthcare professionals may use "I can't" as a way to soften "I won't" because "I can't" is less confrontational and avoids direct accountability. Framing resistance as an external barrier can be less emotionally or professionally risky than admitting unwillingness. Additionally, some may subconsciously mean "I won't" but phrase it as "I can't" to avoid guilt or criticism. So, what do we, as VA and supply chain professionals, do to overcome this phrase?

First, we must clarify the barrier, whether real or perceived.  To do this, ask open-ended questions to explore whether the obstacle is external ("I can't") or internal ("I won't"). You may ask "What makes this change difficult for you?".  You can also ask "What support or information would help make this feasible?".  Second, we must reframe the language.  By this, I mean we must encourage self-awareness and ownership of decisions.  Yes, this involves more questions such as "It sounds like this isn’t something you’re comfortable with right now. Can you share why?" or "Are there aspects of this change you feel ready to try?".  Third, you must provide evidence and support for the change.  You know I would work data into this discussion somehow.  This may be the foundation for change.  Share data or case studies, offer peer support or training, and address fears and misconceptions.  You also have to acknowledge that any change can be challenging but it is possible.  It is achievable. 

Once you've identified the "why," this helps you address it with accuracy and removes any assumptions like the surgeon or provider is just “being difficult.”  They need to be heard and validated, as we all should.  Below are a few ways to address some specific concerns you may encounter:

-  If they lack trust in the evidence:

•   -  Share specific studies or real-world outcomes.
•   -  Connect them to peers who have successfully adopted the practice.
  
  
• -  If they fear negative outcomes:
•   -   Provide a safety net or pilot approach: "What if we try this on a small scale first and evaluate the results together?"
•   -   Is there advanced training and support offered for the provider and staff?
  
  
• -  If they’re concerned about autonomy:
•   -  Emphasize their role in tailoring the change to fit their practice.
•   -   “How could we adapt this (fill in the blank), so it works for you?"
  
  
• -  If time or resources are barriers:
•   -   Offer practical solutions: "What tools or support would make this easier for you?"

By distinguishing between "I can't" and "I won't," and addressing the underlying motivations behind these statements, you can facilitate more meaningful conversations and drive change in a way that respects individual autonomy while ensuring the best outcomes for patients and healthcare systems alike.

Want to learn more about Blue.Point?  Contact us today for a free product demo or for more information contact Jennifer Doty by email jdoty@bluepointscs.com or call 978-747-1529.