It’s not WHAT you do; it’s HOW you do it!

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<ul><li><p>www.ohri.ca | Affiliated with Affili </p><p>ITS NOT (JUST) WHAT YOU DO, ITS (ALSO) HOW YOU DO IT! </p><p>JEREMY GRIMSHAW SENIOR SCIENTIST AND PROFESSOR KATHRYN SUH, MD, FRCPC </p><p>6TH OCT. 2016 </p><p>jgrimshaw@ohri.ca @GrimshawJeremy </p><p>mailto:jgrimshaw@ohri.ca</p></li><li><p>WHO WE ARE Dr Kathryn Suh </p><p> Medical Director, Infection Prevention and Control Program and Antimicrobial Stewardship Program, The Ottawa Hospital </p><p> Associate Professor of Medicine, University of Ottawa. </p><p>2 </p><p>Dr Jeremy Grimshaw </p><p> Senior Scientist, Ottawa Hospital Research Institute </p><p> Professor of Medicine, University of Ottawa </p></li><li><p>Affiliated with Affili </p><p> Ensuring patient safety remains a high priority for healthcare systems, organisations and providers </p><p> The Canadian Patient Safety Institute has been at the forefront of efforts to promote safety in Canadian Healthcare settings and has achieved substantial improvements in patient safety. </p><p> However, there remain substantial challenges to implement patient safety practices. </p><p> Shift to Safety, the newest program of CPSI is launching a new initiative to promote the use of behavioral approaches in patient safety initiatives. </p><p>BACKGROUND </p><p>3 </p></li><li><p>Affiliated with Affili </p><p> Successful implementation of patient safety programs needs key actors (patients, healthcare providers, managers and policy makers) to change their behaviours and/or decisions whilst working in the complex (ordered chaos) of health care environments </p><p> There is a substantial evidence base in behavioural sciences that can support the development of patient safety programs and increase the likelihood of success </p><p>BEHAVIOURAL PERSPECTIVE </p></li><li><p>Affiliated with Affili </p><p> The Ottawa Centre for Implementation Research at the Ottawa Hospital Research Institute is an interdisciplinary group that undertakes research on behavioural approaches to enhance change programs </p><p> We are partnering with CPSI to increase the Canadian capacity to use behavioral approaches to optimise change programs. </p><p>OTTAWA CENTRE FOR IMPLEMENTATION RESEARCH </p><p>5 </p></li><li><p>Affiliated with Affili </p><p> Angel Arnaout, surgery, disinvestment in cancer </p><p> Sylvain Boet, anesthesiologist, medical education </p><p> Jamie Brehaut, cognitive psychologist </p><p> Ian Graham, medical sociology </p><p> David Moher, epidemiologist, knowledge syntheses </p><p> Justin Presseau, health psychologist </p><p> Janet Squires, nursing, implementation science </p><p> Dawn Stacey, nursing shared decision making </p><p> Monica Taljaard, biostatistician </p><p> Kednapa Thavorn, health economist </p><p> Noah Ivers, family physician, implementation science (Toronto) </p><p> Holly Witteman, engineering, human factors (Quebec City) </p><p>OTTAWA CENTRE FOR IMPLEMENTATION RESEARCH </p><p>6 </p></li><li><p>DESIGNING CHANGE PROGRAMS </p></li><li><p>Who needs to do what differently? </p><p>Using a theoretical framework, which barriers and enablers need to be addressed? </p><p>Which intervention components could overcome the modifiable barriers and enhance the enablers? </p><p>How will we measure behaviour change? </p><p>DESIGNING CHANGE PROGRAMS </p></li><li><p>Who needs to do what differently? </p><p>Using a theoretical framework, which barriers and enablers need to be addressed? </p><p>Which intervention components could overcome the modifiable barriers and enhance the enablers? </p><p>How will we measure behaviour change? </p><p>DESIGNING CHANGE PROGRAMS </p></li><li><p>Affiliated with Affili </p><p> Specify behaviour using TACTA principle </p><p> Identify: What needs to be done (Action) </p><p> By whom (Actor) </p><p> To whom (Target) </p><p> Where (Context) </p><p> When (Time) </p><p>DESIGNING CHANGE PROGRAMS </p><p>10 </p></li><li><p>Affiliated with Affili </p><p> What needs to be done (Action) Hand hygiene </p><p> By whom (Actor) All health care providers </p><p> To whom (Target) </p><p> Where (Context) Clinical environments </p><p> When (Time) Four moments of hand hygiene </p><p>DESIGNING CHANGE PROGRAMS </p><p>11 </p></li><li><p>Who needs to do what differently? </p><p>Using a theoretical framework, which barriers and enablers need to be addressed? </p><p>Which intervention components could overcome the modifiable barriers and enhance the enablers? </p><p>How will we measure behaviour change? </p><p>DESIGNING IMPLEMENTATION PROGRAMS </p></li><li><p>THEORETICAL DOMAINS FRAMEWORK </p></li><li><p>THEORETICAL DOMAINS FRAMEWORK </p><p>Michie 2005 Knowledge </p><p> Skills </p><p> Social/professional role and identity </p><p> Beliefs about capabilities </p><p> Beliefs about consequences </p><p> Motivation and goals </p><p> Memory, attention and decision processes </p><p> Environmental context and resources </p><p> Social influences </p><p> Emotional regulation </p><p> Behavioural regulation </p><p> Nature of the behaviour </p></li><li><p>15 </p><p>THEORETICAL DOMAINS FRAMEWORK </p></li><li><p>THEORETICAL DOMAINS FRAMEWORK </p><p>Michie 2005 Knowledge </p><p> Skills </p><p> Social/professional role and identity </p><p> Beliefs about capabilities Beliefs about </p><p>consequences Motivation and goals </p><p> Memory, attention and decision processes </p><p> Environmental context and resources </p><p> Social influences Emotional regulation </p><p> Behavioural regulation Nature of the behaviour </p></li><li><p>Affiliated with Affili </p><p>Key beliefs: </p><p> conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); </p><p> inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); </p><p> problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). </p><p> tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). </p><p>THEORETICAL DOMAINS FRAMEWORK </p><p>17 </p></li><li><p>Who needs to do what differently? </p><p>Using a theoretical framework, which barriers and enablers need to be addressed? </p><p>Which intervention components could overcome the modifiable barriers and enhance the enablers? </p><p>How will we measure behaviour change? </p><p>DESIGNING CHANGE PROGRAMS </p></li><li><p>DESIGNING IMPLEMENTATION PROGRAMS </p></li><li><p> Graded tasks - Set easy tasks, and increase difficulty until target behavior is performed. </p><p> Behavioural rehearsal/practice - Prompt the person to rehearse and repeat the behavior or preparatory behaviors </p><p>DESIGNING IMPLEMENTATION PROGRAMS </p></li><li><p>DESIGNING IMPLEMENTATION PROGRAMS </p></li><li><p>BEWARE POOR DESIGN </p></li><li><p>Affiliated with Affili </p><p>A PRACTICAL STUDY: PHYSICIAN HAND HYGIENE </p><p>25 </p><p> Healthcare-associated infections are one of the top 10 causes of hospital deaths worldwide </p><p> affect 10% of all patients in acute-care hospitals </p><p> Physician hand hygiene compliance is an international problem </p><p> Average reported compliance rate: 49-57% </p><p> Reasons for poor compliance not well understood </p></li><li><p>Affiliated with Affili </p><p>A PRACTICAL STUDY: PHYSICIAN HAND HYGIENE </p><p>26 </p></li><li><p>Affiliated with Affili </p><p>ASSESSING BARRIERS AND ENABLERS </p><p>27 </p><p> Key informant interviews with 42 staff physicians and residents in Medicine, Surgery </p><p> Two focus groups with four institutional hand hygiene experts: hand hygiene auditors, infection prevention and control professionals, and Senior Management </p><p> Observation of hand hygiene and audits on inpatient Medicine and Surgery units </p></li><li><p>Affiliated with Affili </p><p> Knowledge: I am / am not aware of hand hygiene guidelines </p><p> Skills: I have / have not had training in hand hygiene techniques </p><p> Beliefs about consequences: hand hygiene reduces transmission of infection </p><p> Memory and attention: reminders are / are not useful for hand hygiene </p><p> Social influence: others on my team do / do not influence my hand hygiene behaviour </p><p>INTERVIEW GUIDE </p><p>28 </p></li><li><p>Affiliated with Affili </p><p> Knowledge Skills Social/professional role </p><p>and identity Beliefs about </p><p>capabilities Beliefs about </p><p>consequences Motivation and goals </p><p>THEORETICAL DOMAINS FRAMEWORK Memory, attention and </p><p>decision processes Environmental context </p><p>and resources Social influences Emotional regulation </p><p> Behavioural regulation </p><p> Nature of the behaviour </p></li><li><p>Affiliated with Affili </p><p> Important TDF domains were prioritized with team input, and mapped to known effective behaviour change techniques </p><p> Intervention focused on five prioritized domains, considering feasibility in our environment, and acceptability to the actors </p><p> Knowledge; skills; beliefs about consequences; memory, attention and decision processes; social influences </p><p> Intervention delivery differed for medicine and surgery </p><p>INTERVENTION MAPPING AND DESIGN </p></li><li><p>Affiliated with Affili </p><p> Based on assessment of barriers, resources, practical aspects of implementation </p><p> Medicine: </p><p> Two slides for resident orientation </p><p> Four x 2 minute sessions during stewardship rounds </p><p> Glo GermTM demonstration </p><p> Surgery: </p><p> 10 minutes at resident half day, with Glo GermTM </p><p> 10 minutes at staff division meeting </p><p>IMPLEMENTATION </p><p>31 </p></li><li><p>EFFECTS OF INTERVENTION </p></li><li><p>Affiliated with Affili </p><p> Patient safety remains major concern in healthcare systems </p><p> Successful implementation of safety change programs requires actors to change their behaviour(s) </p><p> Insights from behavioural science can help optimise change programs and increase their likelihood of success </p><p> CPSI and the Ottawa Centre for Implementation Research at the Ottawa Hospital Research Institute are planning a program to enhance capacity to use behavioural approaches to improve patient safety </p><p>SUMMARY </p></li><li><p>Affiliated with Affili </p><p> Think about capacity development to use behavioural approaches within your group </p><p> When planning safety initiatives: Identify behaviour change needed to implement safety </p><p>procedures </p><p> Identify barriers to behaviour change preferably using behavioural theory </p><p> Consider assumptions and mechanisms to change when designing initatives </p><p>SUMMARY </p></li><li><p>jgrimshaw@ohri.ca @GrimshawJeremy </p><p>mailto:jgrimshaw@ohri.ca</p><p>Its not (just) what You Do, Its (also) How you do it!Who we arebackgroundBehavioural perspectiveOttawa centre for implementation researchOttawa centre for implementation researchDesigning change programsDesigning change PROGRAMSDesigning change PROGRAMSDesigning change programsDesigning change programsDesigning implementATION PROGRAMSTheoretical Domains FrameworkTheoretical Domains FrameworkTheoretical domains frameworkTheoretical Domains FrameworkTheoretical domains frameworkDesigning change PROGRAMSDesigning implementATION PROGRAMSSlide Number 20Designing implementATION PROGRAMSDesigning implementATION PROGRAMSSlide Number 23Beware Poor designA practical study: physician hand hygieneA practical study: Physician hand hygiene Assessing barriers and enablersInterview guideTheoretical Domains FrameworkIntervention mapping and DesignimplementationEffects of interventionSummarySummarySlide Number 35</p></li></ul>

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