We ask patients to change their habits, but what about us?

Anna Sant

The management of cultural change is one of the most critical factors in the implementation of programs to improve the quality, safety and experience of the patient. The same thing that happens to our patients when we ask them to modify their behaviour to have a healthier life happens to health professionals in our work environment: it’s not easy for us to change the way we do things.

In the process of change, there is a particular moment in which we already know the correct protocols, and we are clear about the systems and behaviours that we must address. Even so, after an initial period of systematic implementation, we tend to return to old routines, those that seem more natural and familiar to us.

Changing behaviours implies leaving old habits and reflecting on how to do things differently. We know that not washing our hands sufficiently, prescribing penicillin without a proper allergy check or not going often to see how the patient is doing, can compromise clinical safety.

We also know that if we don’t treat the patients with respect, if we forget to explain what we are going to do in each moment of his care circuit or if we continue to insist that we know what is best for them, but without taking them into account, we can compromise the trust they need to place in us. Trust is essential to learning about patient's needs, expectations and fears to manage their health properly.

And why don't we find the change easy? Once the communication starts, the projects, actions, calendars and budgets have been approved, and the relevant training has been carried out, why don't things happen as we want? Why, after an initial time of motivation for change, things return to being as before? We forget to ask the patients, and we again assume that they know the processes well, the guidelines for the shared decision are diluted, and we no longer use the control systems we had designed. The answer could be that we focus too much on the process of analysis, diagnosis and design of improvement actions, but we need to analyze what are the main barriers that will influence this change in behaviour.

The Improvement Academy in 2016 has raised the same question. This entity, founded in 2013 by a team of scientists, clinicians and patient safety experts, aims to improve clinical quality and safety in the United Kingdom. To achieve this, they interviewed 200 professionals and health managers of the National Health Service to find out what happens in their organizations when a change and transformation project is being considered.

The contributions of the study led the academy to design and launch a program based on the psychological theory of Behavioural Change, whose main objective is to help health organizations implement cultural changes and innovations in an effective, safe and lasting way. It includes the realization of workshops aimed at professionals and health managers, as well as a toolkit and good practices for the success of the implementation of change projects. The program facilitates the analysis of barriers and detects the actionable levers to generate and make the desired change last as smoothly as possible.

The Yorkshire Patient Experience Toolkit, for example, is a package of tools and resources that allows patient experience project coordinators to address the main challenges facing their work teams.

One of the tools included in a simple methodological guide in six phases to transform patient feedback (collected in surveys, online opinion monitoring, focus groups, etc.) into concrete improvement actions:

1. Collaboration: the creation of a multidisciplinary team that includes health managers, patient care staff and clinicians
2. Feedback collection: compilation of all the information about the patient's opinion that we have to date, and implementation of new mechanisms to listen to the current patient
3. Make sense of the data: the systematization of the data collected to draw conclusions and lines of work
4. Priority definition: agree on priority work issues and “celebrate” those things that patients tell us we do well
5. Foster change: ideation, project creation and communication to other teams
6. Evaluation: use the new patient feedback to evaluate the impact of the actions implemented, identify new challenges and establish a process of continuous improvement

Another toolkit is a dossier of case studies that include the description of the challenges, solutions and results obtained in each project, and which is accompanied by a list of general recommendations to facilitate the implementation of projects.

Having had the opportunity to live up close to some of the difficulties that the teams that have the arduous task of implementing the projects are in the midst of their busy day-to-day care, I think it’s necessary and highly advisable to develop project manuals, kit of tools and training capsules that help professionals not give up on the management of cultural change and innovation in their health centres.