Clearly the current toolkit for the ICP extends well beyond knowledge of infection prevention and control. Amongst others throw in a dose of psychology, implementation science and behaviour change.
Matthew Kreuter is a leading national public health expert in the field of health communications at Washington University in St Louis, and at the SHEA Spring Conference presented a plenary titled May the Forces be with You: Understanding How to Change Behaviour. Krueter packed in a lot of useful information in his presentation. Much of what he said I believe really underlined the importance of a comprehensive implementation strategy.
There is no substitute for taking time to understand the people you are dealing with and the environment they work in. One of the biggest challenges in behaviour change and infection prevention is we don’t always see the consequences of our action (the missed hand hygiene > unclean hand > contaminated environment > patient colonisation > breach of first line defences > infection), and not every bad action will necessarily result in an adverse outcome. Furthermore, HCW’s may suffer from a curse of “smartness”, i.e. “I know my patients best” which can lead to rejection of guidelines.
Some of the key messages I took away from this talk include:
- The easiest behaviours to change are the simple ones that have clear and immediate benefits “to me”
- When planning behaviour change, focus on identifying meaningful benefits and personalise the consequences. The consequences need to be relevant
- Utilise authentic stories of the consequences. Sadly we have no end of patients who have suffered as a result of a HAI, consider involving them and their stories
- Other factors that work include credible messengers (peers, champions) performance feedback and aspirational identity
Kreuter concluded by listing 4 factors that work MORE:
- Organisational Culture
- Engineering and Design, or
- a combination of these
note he didn’t use the term “Bundle”!