Do Whats Right, Even When No One is Looking!
Why do we do the things we do? I dont profess to have a profound understanding of what occurs within the deepest recesses of the human psyche, but I do know that human beings are capable of some baffling behavior. Place that behavior within the context of the healthcare environment, and the stage is set for mystifying demonstrations of how those dark recesses start impacting clinicians actions. Take, for example, compliance with hand hygiene, an infection prevention strategy that is ignored consistently (and blatantly) by healthcare professionals even though they know it is the No. 1 way to prevent the transmission of pathogens.
A very interesting study conducted by Michael Whitby, MD, and colleagues attempted to pin down the behavioral determinants of handwashing among nurses. Researchers used the Theory of Planned Behavior, an offshoot of the Theory of Reasoned Action, which suggests that a persons behavior is determined by his/her intention to perform the behavior and that this intention is a function of his/her attitude toward the behavior and his/her subjective norm. In other words, the best predictor of behavior is intention, the cognitive representation of a persons willingness to engage in a certain behavior. Intention is determined by three factors an individuals attitude toward the specific behavior, their subjective norms, and their perceived behavioral control.
Whitby and colleagues essentially determined from their focus group that nurses have a self-developed hierarchy of risk to determine when handwashing was necessary. They discovered that a persons attitude toward handwashing was determined by their earliest experiences as a child, and that elective handwashing behavior is significantly predicted by nurses beliefs in the benefits of the activity, peer pressure of senior physicians and administrators, and role modeling.
The researchers note that compliance is not simply related to effort but is highly dependent on altering behavioral perceptions. The bottom line is, any tool used to boost hand hygiene compliance is less effective without an associated behavioral modification program. The same could be said about healthcare worker vaccination, or the usage of active safety devices to avoid sharps injuries and bloodborne pathogen transmission. You can give people the tools, but unless you get to the bottom of their belief system and address behavioral disconnects, most educational efforts will be for naught.
I indulged in this small bit of psychology while researching this months cover story on zero tolerance initiatives. So much of healthcare worker compliance with infection prevention strategies is tied up in behavior modification and addressing institutional cultural norms that are highly resistant to change, even when lives hang in the balance. I cant believe that healthcare professionals knowingly jeopardize the health and safety of their patients as well as themselves, but the data indicates thats exactly what they are doing. There are so many tools in the marketplace currently to help clinicians adopt infection prevention best practices (see related article on page 20), so it cant be for lack of materials, surely. Which brings me back to a willful disregard for doing whats right especially when no one is looking!
As 23-year CDC veteran William Jarvis, MD, notes in a 2007 white paper in the Journal of Hospital Infection, Despite knowing what to do, the challenge remains of getting clinicians to comply with these recommendations. Dont miss more of Jarviss insights, along with those of APIC president Denise Murphy, in the cover story starting on page 10. Pressure to comply with infection control principles and practices is increasing, whether in the form of new pay-for-performance mandates from CMS, or continued scrutiny by the public, the media, regulators and legislators, so lets hope our collective psyches will take notice.
Until next month, bust those bugs!
Kelly M. Pyrek
Group Editor, Virgo Publishing Medical Group