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
Education

Beliefs
Attitudes

Profession
Gender

Cues to action
Reinforcement

Geographic location
Knowledge

Self-efficacy

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: Beliefs: Attitudes: Cues: Self-efficacy: Lack of scientific info; wearing gloves (that interfere with HCW-patient relationship) Too busy Lack of role model

Reinforcements: Lacking 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 peoples 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