How do you get someone to change behavior when simply telling them to do so is met with resistance — the “righting reaction” as APIC closing plenary speaker Sanjay Saint, MD, terms it. One approach is called “motivational interviewing,” which first demonstrated efficacy in the addiction field, said Saint, director of the University of Michigan Patient Safety Enhancement Program.
The technique involves empathetic listening as part of a non-judgmental conversation with the person resisting change. If successful, they come to a decision on their own terms after an airing of their concerns, perhaps feeling somewhat validated in the process.
“The question we asked is, could motivational interviewing be used to improve healthcare worker behavior?” Saint said. “Ultimately, it will be their decision to wash their hands before touching the patient or to keep the catheter in. Our job is to provide new information during this conversation that will provide important [insight] about the problem and possible solutions. The goal is to help them see the discrepancy between what they do and what they should do.”
To provide an example that can be adapted by other IPs, Saint went through the following scenario of a chief of medicine, a non-surgeon, having a motivational interview with a surgeon who is resistant to changes designed to prevent CAUTIs by removing catheters promptly and other measures.
Chief: “Thanks for meeting with me. I guess you’ve been having some trouble with this CAUTI initiative. Do you want to tell me about it?”
Surgeon: “I’m disgusted with it. I’ve been ordering Foleys for 25 years and never had a problem. Now, all of a sudden, they come up with these new regulations. It can throw you off your game. As far as I’m concerned, if it ain’t broke don’t fix it. And pity the poor residents who are supposed to unlearn what they have just been taught.”
Chief: “You’re really frustrated about this. What else bothers you about these new regulations?”
Surgeon: “Don’t get me started. All these people telling me what to do. I’ve got the nurses telling me when I should and shouldn’t order a Foley, when I should or shouldn’t have it taken out. Give me a break.”
Chief: “What do you think about the science behind the initiative?”
Surgeon: “That’s another thing. They keep coming up with these new quality projects. It’s like a blizzard of them, and a couple of years later they change their minds. This is probably just another one of those things. Anyway, why all of this fuss about a little old UTI? CAUTI, schmauti — we are about saving lives.”
Chief: “I hear you. You’re frustrated to keep getting hit with these changes, and I really appreciate how open you’re being with me. One other thing, can you tell me whether your opposition to the regulations is making things awkward with your colleagues?”
Surgeon: “Well, maybe a little — especially the younger surgeons and some of the nurses, and I guess the docs who are running the initiative, along with one of the infection control gals, are also getting annoyed with me.”
Chief: “You seem to be saying you feel a little uncomfortable about that.”
Surgeon: “Well, they are committed to making the changes, and they are not totally stupid.”
Chief: “Speaking of that, I just got some new data about the initiative. I thought you might be interested. OK if I share that with you?”
Surgeon: “I suppose so.”
Chief: “There’s a new meta-analysis from Harvard and a national study from Michigan. They both show big decreases in CAUTI using these same evidence-based recommendations our hospital is pushing. The patients studied are similar to our patients. Did you know our CAUTI rate was up again last month?”
Surgeon: “No, I didn’t realize it was still rising. I guess that is something to worry about.”
Chief: “One other thing you might consider is that those bean counters from upstairs are all about making the patients happy customers. UTIs may not kill many people, but it sure makes them unhappy for a while. Plus, we have to use antibiotics, which may then lead to a case of C. diff which can kill people, especially the older patients you operate on.”
Surgeon: Yeah, yeah, I hear you. I suppose I’m going to have to give in sooner or later, so it might as well be sooner.”