Transcript Document

By
Prof. OSSAMA RASSLAN
Secretary General,
Egyptian Society of Infection Control
How does one affect change?
• Changing H.C. worker behaviors is a challenge
• Before beginning any program to change
the planning process should be undertaken
• The cornerstone of this process is assessment
Attitudes & behaviors
Assessment
• Until you understand “who, what, when & why”,
you cannot design a program that will be successful
• Assessment helps the ICP understand both individual
& organizational factors that lead to a behavior
• It helps the ICP determine the priorities for change
• It provides the baseline against which change can
be measured
Attitudes & behaviors
Components of the Assessment
I. Factors related to the individual H.C.Worker:
• Sociodemographic characteristics
• Knowledge & educational level
• Attitudes
• Beliefs
Attitudes & behaviors
Components of the Assessment
II. Organizational Factors
• Resources
• Staffing
• Local & regional laws
• Organizational support for a behavior
Attitudes & behaviors
Strategies for change
• Are based on the assessment & prioritization
of the factors found
• Once a plan is implemented, re-assessment
can show success or failure in the program
Attitudes & behaviors
Hints for success
• Involve the target audience
• Work at all levels of the org. to get support
• Use positive reinforcements
• Acknowledge the inclusion of IC professionals
as persons who may need to change
Attitudes & behaviors
Assessment of attitudes & behaviors
Assessment is the cornerstone of program planning
(Include programs to change HCW behaviors)
•Systematic evaluation
• Identification of places to intervene
• Establishment of a baseline against which
to evaluate change
Attitudes & behaviors
Epidemiol. approach to behavior assessment
• Who is doing?
• What are the attributes & behaviors?
• Where does it happen? In what context?
• When does the behavior happen?
• Why (what are the reasons for the behavior?)
Attitudes & behaviors
Who: The Target Audience
• Physicians
• Nurses
• Family members
• Lay health workers & aides
• Infection control personnel
Attitudes & behaviors
What are the behaviors?
• Handwashing
• Use of barriers or isolation procedures
• Antibiotic prescribing
• Equipment handling procedures
• Procedures to protect worker safety
Attitudes & behaviors
Look at the behavior
• Is it right?
•Is it important
•Is there a standard?
• Is it effective?
•Is it realistic?
Prioritize
Attitudes & behaviors
Where is it happening?
• What type of facility?
• During which activity?
• What are the characteristics of the place
in which it occurs?
When is it happening?
• In emergencies or during normal care
• Time of day, day of week, or season
Attitudes & behaviors
Why: Individual reasons for behavior
• Age
• Beliefs
• Education
• Attitudes
• Profession
• Cues to action
• Gender
• Reinforcement
• Geographic location
• Self-efficacy
• Knowledge
Attitudes & behaviors
Why: Individual reasons for behavior
Knowledge
{It is rarely the only reason for behavior}
Beliefs
• Perceived susceptibility to health threat
• Perceived severity of the threat
• Belief that the behavior will be beneficial
Attitudes & behaviors
Why: Individual reasons for behavior
Attitudes
• Time
• Convenience
• Opinion of the behavior & its importance
Cues to action
• “Triggers”
• Reminders
• Presence of IC personnel
• Social pressure
Attitudes & behaviors
Why: Individual reasons for behavior
Reinforcement
• Positive or negative
• Performance feedback
Self-efficacy
• Perceived ability to do the desired behavior
• Perceived control
Attitudes & behaviors
Why: Organiz. reasons for behavior
• Resources
• Engineering
• Staffing
• Administrative leadership
• Administrative sanctions
Attitudes & behaviors
Planning for behavior change
(should be based on assessment)
Example: Hand Hygiene
to illustrate the many factors that influence behavior
• Who:
HC workers
• What: compliance with H.W. standards
• Where: a H.C. facility (type?)
• When: - In emergency or during normal care
- Time …?
Attitudes & behaviors
Hand Hygiene Reasons for noncompliance
I. Individuals:
• Knowledge:
Lack of scientific info; wearing gloves
• Beliefs:
• Attitudes:
(that interfere with HCW-patient
relationship)
Too busy
• Cues:
Lack of role model
• Reinforcements: Lacking
• Self-efficacy:
Lack of time: Pt needs priority
Attitudes & behaviors
Hand Hygiene Reasons for noncompliance
II. Organization:
• Inaccessible supplies
• Staffing
• Lack of institutional priority
• Lack of administrative sanctions or rewards
Attitudes & behaviors
Planning strategies for behavior change
Type of strategy: not always education
• Too busy: time mgt
• Peer pressure: assertiveness training
• Knowledge: education
• Resources: administrative commitment
Attitudes & behaviors
Strategies for behavior change
• Begin with OUR behavior
• Not proscriptive, but collegial
• Appeal to people’s knowledge & logic
• Involvement leads to ownership
• Empowerment leads to self-efficacy
• Change social norms to maintain
behavior change
Attitudes & behaviors
Strategies for behavior change
• Involve the leaders & influential persons
(formal & informal leaders)
• Work at every level of the org. to make
change happen
• Apply the basic concepts
• Keep it simple, applicable, achievable
& affordable
Attitudes & behaviors
Strategies for behavior change
• Use reinforcements & cues
- Positive reinforcements
- Negative reinforcements
(when all else fails)
- Repeat over time
Attitudes & behaviors
Strategies for behavior change
• Celebrate success, review failure
- Communicate results: share successes
& failures with staff
- Repeat assessment & planning process
- Include yourself in the change process
- Trust in yourself & others!
Attitudes & behaviors