Making it happen

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Making it happen

• Evonne Curran
• Nurse Consultant

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Unknown but limited ingredients Variable
talent Time limit Goal Make the best possible
output with the above
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At the end of the day..... It would be good to
say..

• I can show that because of me (xxxxxxxxxxxx )
• Is now performed more safely
• Has improved the patient experience
• Has reduced risks to the organisation
• Has resulted in fewer infections
• Has resulted in less waste (money, time,
  resources)

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LAND MINES
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Lack of vision Lack of information Lack of
inclusion Lack of strategic thinking Lack of
strategic alignment Participation as an end Lack
of productive conflict Untested assumptions Lack
of alignment Lack of communication and
accommodation Focus on results not the steps
to the results http//www.rexroundtables.com/show
briefs-yplansfail.php
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Risk assessment
Potential benefits assessment
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Potential topics - what is important to

• You
• Your IPCT
• Those at the front line
• The antimicrobial pharmacist
• Those who hold the purse strings
• The patients
• The HAI executive lead

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What makes hospital infections

• Invasive Devices
• Urinary Catheter
• PVCs
• Norovirus
• Antibiotics
• Contaminated equipment
• Failure to comply with SICPs

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Topic Review

• The problem?
• How big is it?
• What is driving the problem?
• What is achievable?
• Benefit Assessment?

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Urinary catheters

• We use too many of them!
• We keep them in too long
• We dont know about alternatives
• By pass defence mechanism
• Perfect culture medium
• Alternatives not accessible
• Scales to weigh urine
• Female slipper pans
• Suitable inco pads

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Habits

• Habits emerge because the brain is constantly
  looking for ways to save effort (system 1 / 2
  thinking)
• When a habit emerges the brain stops fully
  participating in decision making.
• The order you wash in the morning
• Unless you deliberately fight a habit find new
  routines the habit will unfold automatically
• Habits work on cues
• Habits are driven by cravings
• Willpower becomes a habit when certain behaviours
  are chosen ahead of time routine followed when
  cue arrives
• The Power of Habit why we do what we do and how
  to change, Duhigg

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Q How man animals of each kind did Moses take on
to the ark?
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Habits in healthcare just as in life

• Serve us well
• Allow us to do things swiftly and consistently
• But from time to time we need to break old
  habits and create new ones

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Habit Loop
Action
Buy and drink coffee, eat muffin or sub
Cue
Reward Job done
Smell of coffee, Smell of cinnamon Smell of
Subway
Feel satisfied (and guilty)
Craving taste, effect of drinking coffee (not
hunger)?
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Habit Loop
Action
Indwelling foley catheter
Cue
Reward Job done
Urinary retention Fluid balance measurement
required
No longer in retention Urine measured
Craving to do something good / technical / solve
a problem
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Habit Loop

• For success
• Need a new habit
• Need to know and have access to alternatives
• Accurate fluid balance does not always need a
  catheter scales and a bottle
• Uro-sheaths reduce infection risk
• Intermittent catheters
• Need to believe that it can be achieved
• Some one else has done it group therapy
• Data to show it works
• Data to show it matters

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How do we change habits

• Need to learn new habits that overpower the
  current habit behaviours
• Find new routines and rewards from cues
• Works for (some but not all) alcoholics
• The ingredient that made a reworked habit into a
  permanent behaviour Belief
• What is our (habit) reaction to
• we are going to introduce a new initiative to.
  

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New Habit Loop
Action
Engage with patient to consider best possible
option for patient
Reward Job done
Cue
Urinary retention Fluid balance measurement
required
Patient centred care catheter avoidance
Our craving needs to be to achieve PCC
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Social Marketing

• A process that applies marketing principles and
  techniques to create, communicate, and deliver
  value in order to influence target audiences
  behaviours that benefit society (public health,
  safety, the environment and communities)
• Kolter et al (2006)

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If not social marketing what else?

• Education Data feedback
• Use of rational facts to persuade people to adopt
  a different behaviour
• Coercion
• Forces people to adopt a behaviour under threat
  of penalty for not doing so

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Social marketing

• Is
• A social behaviour change strategy
• Most effective when it activates people
• Targeted towards those who have a reason to care
• Strategic and requires efficient use of resources
• Integrated and works on a plan

Social marketing in healthcare, Radha Aras
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4ps of Social Marketing

• Product Desired behaviours
• Reduction in urinary catheter usage with an
  increase in safer alternatives
• Increase in patient involvement in decision
  making
• Optimisation of clinical decision making
• Price Cost associated with the behaviour changes
• Price of CA-UTI (physical and psychological)
• Effort resource required
• Place Make it convenient to translate the
  motivation into action. Intervene at the point of
  decision making
• Promotion Make the new habit acceptable, easy,
  and desirable to the audiences

Social marketing in healthcare, Radha Aras
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Lets now look at a plan to join our habit
knowledge with our social marketing knowledge
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To modify a habit you need to answer these
questions

• Location where are people when the cue happens /
  decisions are made / first acts?
• Time does it happen at a particular time?
• Emotional state what state are people in when
  the cue arises?
• Other people who else is around to help with
  decision making?
• Immediate preceding action what happens just
  before the decision?

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Before you start

• Identify and prioritise barriers
• Dont have easy access to alternatives
• Dont know what to use when
• Dont consider remove ASACI
• What will over come barriers
• Get help from continence support
• From whoever has the budget
• Alternatives and placement of alternatives
• Training
• Pilot
• (We still need education and data)

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Clear message catheters are dangerous
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Reason to believe Limiting urinary catheters is
doable and better for patients

• 7mth pre period 4 mth intervention period
• Limit criteria set urinary tract obstruction,
  hourly output measurement, etc.
• Measured
• CAUTI
• Urinary catheter
• Nursing experience
• UC usage decreased by 42,CAUTI by 57 nursing
  satisfaction improved
• Rothfeld et al AJIC 2010 38 568-71

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What we do in nursing

• Are learned behaviours
• Habits run by cue, action, reward
• To bring about safer action
• Need different habits (that involve patients
  more)
• Need education on safest alternatives for
  patients to optimise clinical decision making
• Need easy access to the safest alternatives
• Need data that shows we provide optimal care

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Habit and social marketing

• Social marketing can help deliver the message
• Alternatives to catheterisation are suitable and
  safer in many cases
• Here are the alternatives to catheterisation
• This messaging will make the case for new habits
  (create the belief) and make it easier for new
  habits to become established

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Need to find out what are the attitudes to
the process to be changed

• Is it a settled way of thinking or feeling,
  typically reflected in our behaviour?
• Or are we ready to break a habit?

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Potential benefits assessment
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Lets do one together

• The problem?
• How big is it?
• What is driving the problem?
• What is achievable?
• Benefit Assessment?