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Dr Judith Dyson, Senior Lecturer, Implementation Science

Achieving Behaviour Change Workshop Working Together for Improvement: Behaviour change in the NHS Quality Improvement Conference 12 July 2018. Dr Judith Dyson, Senior Lecturer, Implementation Science. Best practice?.

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Dr Judith Dyson, Senior Lecturer, Implementation Science

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  1. Achieving Behaviour Change WorkshopWorking Together for Improvement: Behaviour change in the NHSQuality Improvement Conference 12 July 2018 Dr Judith Dyson, Senior Lecturer, Implementation Science

  2. Best practice? • 40% do not receive care according to guidelines (Eccles et al., 2005), e.g. SR Hand Hygiene 38.7% (WHO, 2009 . .and various subsequent similar estimates. . . ) • Keeping up with the evidence. . . necessary for general medicine physicians to read 19 articles per day 365 days a year. . . the actual time reported - less than an hour per week (Sackett et al., 2007) • NICE . . . effects on practice have been limited

  3. We have gone to a lot of trouble to find out how to change/influence practice • 30+ SRs about strategies to enhance the implementation of best practice – “no magic bullets” • Some strategies work sometimes for some people in some environments. . . . . no one strategy is universally effective

  4. And concluded . . • We need to assess individualdeterminants to best practice (barriers and levers/facilitators and everything in between) • We need to tailorour strategies according to these • We need a theoreticalapproach to assessment and the intervention I will demonstrate why and how First, where does this approach (psychology/behaviour change theory) sit?

  5. An intro’ to . . W. Edward Deming 1900-1993 Improvement is (profound knowledge – four elements) 1. Appreciation of a system - the processes involved . . . e.g. flow (Prince2, Sigma black belt, Lean) 2. Knowledge of variation – common or special cause . . . . . an example

  6. Prof Mohammed A Mohammed

  7. W. Edward Deming 1900-1993 Improvement is (profound knowledge four elements): 1. Appreciation of a system; the processes involved 2. Knowledge of variation: the range and cases . . . 3. Epistemology – the theory of knowledge: the concepts . . and the limits of what can be known. . . an example . . . through the ages

  8. W. Edward Deming 1900-1993 Improvement is: 1. Appreciation of a system; the processes involved 2. Knowledge of variation: the range and cases . . . 3. Epistemology – the theory of knowledge: the concepts . .and the limits of what can be known. . . 4. Knowledge of psychology: human nature and behaviour . .

  9. We (health) are catching up with Deming

  10. Exercise One - in four groups – 5 mins • Barriers to your own health behaviour (e.g. exercise, diet, stop smoking) • Barriers to our patients/service users taking their medicines (e.g. emollient) • Barriers to our practice behaviours (e.g. hand hygiene) • How does our organisation support us in providing optimal care (if it helps think about what they do after a serious untoward inicident/never event)

  11. Why is Psychology Useful? Assessing, tailoring, Interventions Interventions underpinned with BCTs are more effective than those that are not (Webb et al 2010, Taylor et al 2014)

  12. Using Theory • We have demonstrated how interventions need to address barriers (tailoring) • We have demonstrated why we need to use theory to assess barriers • And why need theory to underpin our interventions as they are more effective • But HOW?

  13. Theory to assess barriers – problems

  14. Exercise 2 – shout out • Where do your barriers fit?

  15. BCTs are not all tricky. .. and some are mapped to determinants

  16. The process - three quick wins • Forming implementation teams • Identifying/defining the target behaviour(s) • Identifying local barriers to performing the target behaviour • Co-developing evidence based strategies to address local barriers (BCT and pragmatic) • Implementing interventions • Evaluation

  17. Exercise 3 – shout out Win 1. Identifying the behaviour? (the foundation of success) Example - Reducing antibiotic prescribing for unconfirmed UTIs • Inappropriate dip stick testing (e.g. catheter, e.g. no UTI symptoms) • Antibiotic prescribing without MSU • Antibiotic prescribing not in line with policy (e.g. Cefalexin 2nd line due to C diff being Rx 1st line) • Not all positive dipstick results followed up by MSU • Prescriptions for antibiotics 3 days or less. . . . .

  18. Win 2 -Identifying barriersSending an MSU after positive dipstick

  19. Win 3 - Co designing tailored (theoretically underpinned) interventions

  20. Some examples of brilliant, simple, tailored and theoretically underpinned interventions (and the barriers they address) • Talking cones (prompt - memory/automatic behaviours) • MRSA (YMCA) on hospital radio (info and prompt - awareness/memory) • A certificate and a day extra annual leave (incentives/rewards - motivation) • “sister”. . . . . . (peer pressure/encouragement/support - social influences) • Motorway service stations (peer pressure/encouragement/support -- social influences) • The accidental intervention. . . • The woman in the opposite bed

  21. Questions?

  22. Sincere thanks for listening. For references, help changing practitioner behaviour or because you feel like it . . . J.Dyson@hull.ac.uk @JudithDyson1 http://www.improvementacademy.org/patient-safety/behaviour-change-for-patient-safety.html

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