Presentation is loading. Please wait.

Presentation is loading. Please wait.

Getting Corrections Professionals to Take Their EBP Medicine

Similar presentations


Presentation on theme: "Getting Corrections Professionals to Take Their EBP Medicine"— Presentation transcript:

1 Getting Corrections Professionals to Take Their EBP Medicine
APPA Summer Institute August 2010 Frank Domurad The Carey Group, Inc.

2 GREEN WORKSHOP For Handouts: send to

3 The Problem: Mrs. Beauchaine’s Hot Dog
A 75 year old great-grandmother suffering from heart failure Told by Berkshire Medical Center not to eat hot dogs at holiday cookouts because salt content would promote dangerous fluid retention At 4th of July picnic, Mrs. Beauchaine ate a hot dog and was back in hospital next day She told girl at food table, “I’m going to have a hot dog. If I’m dead in the morning, I’ll never know” The annual Medicare cost to taxpayers of Mrs. Beauchaine’s hot dog in terms of preventable hospital readmissions: $12 billion Winslow, Ron and Jacob Goldstein, “Cutting Repeat Hospital Trips—Simple Idea, Hard to Pull Off,” Wall Street Journal, July 28, 2009.

4 What Is Our EBP Hot Dog? If we know that doing EBP will change offender and delinquent behavior, reduce recidivism and enhance public safety, why don’t we do it? Why do we still eat the same old loveable hot dog even though we know it may do us and those around us significant harm?

5 Cross Your Arms

6 Medical Cost of Not Taking Medicine
In 2003, American Pharmacists Association estimated that failure to take medicine accounted for 11-20% of all hospitalizations and repeat doctor visits 125,000 deaths each year Hopfield, Jessica, Robert M. Linden and Bradley J. Trevelow, “Getting Patients to take their medicine,” The McKinsey Quarterly, 2006

7 Medical Cost of Not Taking Medicine
National Pharmaceutical Council’s Task Force for Compliance found that Poor adherence to medication regimen adds $100 billion annually to US health care costs Clinical research has shown adherence rates among patients of 30 to 70% Hopfield, Jessica, Robert M. Linden and Bradley J. Trevelow, “Getting Patients to take their medicine,” The McKinsey Quarterly, 2006

8 Taking Medicine and Patient Attitude
McKinsey study of 811 hypertension patients revealed that Hypertension affects 65 million Americans, half of whom don’t adhere to their drug therapies The usual interventions—electronic reminders and easy-to-open packaging—improve only short term adherence A one-size fits all approach fails A better understanding of patient attitudes improves adherence Hopfield, Jessica, Robert M. Linden and Bradley J. Trevelow, “Getting Patients to take their medicine,” The McKinsey Quarterly, 2006

9 Patient Attitude and Intervention
“Concerned” patients are 47 to 64% adherent Concerned about risks of high blood pressure Worry about long-term risks of medications Intervention: information on long-term patient safety quells their fears and increases adherence Hopfield, Jessica, Robert M. Linden and Bradley J. Trevelow, “Getting Patients to take their medicine,” The McKinsey Quarterly, 2006

10 Patient Attitude and Intervention
“Confident” patients are 69 to 82% adherent Rarely think of high blood pressure risks Confident in ability to control health No concerns about taking medicines Less reliant on physicians Intervention: respond to rewards programs such as loyalty-type programs Hopfield, Jessica, Robert M. Linden and Bradley J. Trevelow, “Getting Patients to take their medicine,” The McKinsey Quarterly, 2006

11 Patient Attitude and Intervention
“Resigned” patients are 13 to 45% adherent While afraid of high blood pressure, do not manage health actively Too much trouble to live a healthy lifestyle Have no routine and careless about taking medicine Intervention: provide simple reminder devices Hopfield, Jessica, Robert M. Linden and Bradley J. Trevelow, “Getting Patients to take their medicine,” The McKinsey Quarterly, 2006

12 Danger of Attitudes S.U.V.s are more dangerous than cars
They confer a sense of cognitive safety that invites careless behavior SUV drivers are more likely to Not bother with seat belts Talk on cell phones or text Not wear seat belts which talking on cell phones or texting Vanderbilt, Tom, Traffic. Why We Drive the Way We Do (And What It Says About Us. New York: Alfred A. Knopf, 2008.

13 A Model of Cognitive Performance
Three levels of cognitive performance Skills based: patterns of thought and action governed by stored patterns of preprogrammed instructions (schemata) and which are largely unconscious Rule-based: solutions to familiar problems governed by stored rules (“if x then y”) Knowledge-based: novel situations requiring conscious analytical processing Rasmussen, J. and A. Jensen, “Mental Procedures in real-life tasks: a case study of electronic trouble-shooting,” Ergonomics, Vol. 17 (1974)

14 A Model of Cognitive Performance
Departures from routine (a problem) lead to two types of reaction A bias to search for a pre-packaged solution (a rule) before resorting to more strenuous knowledge-based functioning A dependence on “expertise” consisting of an extensive repertoire of schemata and rules, with infrequent resort to knowledge-based functioning (reason) Leape, Lucian L., “Error in Medicine,” Journal of the American Medical Association, Vol. 272, No. 23 (December 21, 1994)

15 A Model of Cognitive Performance: Habits of Thought
Biased memory: tendency to based decisions on memory, which is biased to overgeneralization and overregularization of commonplace Availability heuristic: tendency to use first information that comes to mind Confirmation bias: tendency to look for evidence supporting a hypothesis and ignoring contradictory evidence Overconfidence: tendency to believe in chosen course of action Leape, Lucian L., “Error in Medicine,” Journal of the American Medical Association, Vol. 272, No. 23 (December 21, 1994)

16 Stress and Habits of Thought
Stress produces a Coning of attention: a tendency to concentrate on one single source of information, the “first come, best preferred solution” Reversion: recently learned behavior patterns are replaced by older, more familiar ones, even if they are inappropriate Leape, Lucian L., “Error in Medicine,” Journal of the American Medical Association, Vol. 272, No. 23 (December 21, 1994)

17 The Error of Our Ways: The Individual
When professionals do not follow evidence-based practices or procedures (when they make errors) we tend to blame the professional Well trained professionals, such as doctors, are not supposed to make errors (rule of infallibility) When they do make errors, they must have been incompetent or negligent, or it was someone else’s fault Errors never get reported because they are result of “individual failure” and no one wants to look bad Leape, Lucian L., “Error in Medicine,” Journal of the American Medical Association, Vol. 272, No. 23 (December 21, 1994)

18 The Error of Our Ways: The System
In any human system errors are inevitable because of our cognitive structures Proximal causes are individual Root causes are systemic Result from poor design, faulty maintenance (quality control), and erroneous management decisions Bad management decisions can result in unrealistic workloads, inadequate training, and demanding “production” schedules that force workers to make errors Leape, Lucian L., “Error in Medicine,” Journal of the American Medical Association, Vol. 272, No. 23 (December 21, 1994)

19 The Error of Our Ways: Root Causes
Cannot prevent errors by focusing on “unsafe” individual acts themselves Other “errors,” unpredictable and infinitely variable, will occur if underlying causes are not corrected Addressing root causes reduces probability, not inevitability, of error The way in which humans think is a major root cause of error Leape, Lucian L., “Error in Medicine,” Journal of the American Medical Association, Vol. 272, No. 23 (December 21, 1994)

20 What Are Common Line Staff EBP “Errors”?

21 The Error of Our Ways: Inside the Black Box
In terms of case management The research: the more time spent dealing with the criminogenic needs of the offender, the lower the recidivism rate The practice (in a study of 62 officers with 154 adult and juvenile offenders): Only 39.4% of identified criminogenic needs had a corresponding intervention plan While half of adult probationers had antisocial attitudes and peers, they were discussed with offenders only 8.8% and 21.1% of the time 30 of 31 youths had peer problems, but were discussed only 43.3% of time Bonta, James, Tanya Rugge, Terri-Lynne Scott, Guy Bourgon and Annie K. Yessine, “Exploring the Black Box of Community Supervision,” Journal of Offender Rehabilittion, Vol. 47, No. 3 (2008)

22 What Are Common Supervisory EBP “Errors”?

23 The Error of Our Ways: Wash Your Hands
Washing hands is one of the most effective ways to prevent infection in a hospital Health-care workers are less likely to wash hands if a higher ranking person in the room did not wash Only 8.5% of medical students (future doctors) washed hands after patient contact Recommendation: incorporate hand hygiene in medical school curriculum Lankford, Mary G., Teresa R. Zembower, William E. Trick, Donna M. Hacek, Gary A. Noskin and Lance R. Peterson, “Influence of Role Models and Hospital Design on Hand Hygience of Health Care Workers,” Emerging Infectious Diseases, Vol. 9, No. 2 (Feburary 2003)

24 What Are Common Managerial EBP “Errors”?

25 The Error of Our Ways: The Jerk Manager
The problem is widespread in private, public and non-profit organizations One study of 700 representative Michigan residents in the year 2000 found that 27% had experienced mistreatment in the workplace A 2003 study of 461 nurses found that, in the month before, 91% had experienced verbal abuse, primarily by physicians, that left them feeling attacked, devalued or humiliated The tolerance of such “jerks” leads to MORE STRESS AND MORE COGNITIVE ERROR Robert Sutton, “Building the Civilized Workplace,” The McKinsey Quarterly, May 2007

26 Correcting the Error of Our Ways: A Five Step Plan
Off the Jerk Manager Reinvent Tasks Rebuild learning Exploit hypocrisy Get the dumb stuff out of the way

27 Correcting the Error of Our Ways: Off the Jerk Manager
Firms that consistently make Fortune’s 100 Best Places to Work List: Plante and Moran Employee manual: “The goal is a ‘jerk-free’ workplace at this accounting firm. The staff is encouraged to live by the Golden Rule.” Barclay’s Capital COO Rich Ricci: “We have a no-jerk rule around here. Hotshots who alienate colleagues are told to change or leave.” Southwest Airlines Herb Kelleher, former CEO: “One of our pilot applicants was very nasty to one of receptionist, and we immediately rejected him. You can’t treat people that way and be the kind of leader we want.” Robert Sutton, “Building the Civilized Workplace,” The McKinsey Quarterly, May 2007

28 Correcting the Error of Our Ways: Reinvent Tasks
According to D.A. Norman four systemic steps will minimize error Tasks should be simplified to minimize load on weakest aspects of cognition (short-term memory, vigilance, prolonged attention) Power of constraints should be exploited “Forcing functions” should make it impossible to act without meeting a precondition Standardize procedures thereby reinforcing the pattern recognition that humans do well Operations should be easily reversible or difficult to perform when not reversible Norman, D.A., To Err Is Human. New York: Basic Books Inc. Publishers, 1984

29 Correcting the Error of Our Ways: Rebuild Learning
Bulk of our EBP learning focuses on knowledge-based cognitive performance Ignores skill- and rule-based cognitive performance (schemata and rules) Tends to believe that one type of cognitive intervention fits all Creates cognitive situations that may enhance rather than diminish “errors”

30 Correcting the Error of Our Ways: Exploit Hypocrisy
No one likes being a hypocrite Researchers have found that people who try to convince others to do something different and then are reminded that they are being hypocritical in not doing it themselves, change their own behavior Humans care intensely how they are perceived and don’t want to be seen as hypocrites by persons around them Technique has proven much more effective than education in encouraging people to practice safe sex, use sun screen to prevent skin cancer, and go to fitness centers prevent heart disease and diabetes Vedantam, Shankar, “Preach What You Plan To Practice,” The Washington Post, January 6, 2009

31 Correcting the Error of Our Ways: Exploit Hypocrisy
In the 1980s at University of Santa Cruz, AIDS was a death sentence Psychologist Elliot Abramson tried to get students to use condoms by Educating them (usage went from 17 to 19%) Make their use “sexy” with Romeo and Juliet films (usage soared to 60% only to drop to 20% after two months) Exploited hypocrisy by having students make video on importance of condom use, then asking them individually if they used condoms (usage among hypocrites were to 65-70% and stayed there) Vedantam, Shankar, “Preach What You Plan To Practice,” The Washington Post, January 6, 2009

32 Correcting the Error of Our Ways: Exploit Hypocrisy
Two caveats to using this technique It only works when people are convinced about the importance of the issue Do corrections professionals thing that protecting the safety of the public is important? Alert people to their hypocrisy in a subtle and supportive manner If people feel publicly humiliated, they will respond by minimizing the importance of the issue Vedantam, Shankar, “Preach What You Plan To Practice,” The Washington Post, January 6, 2009

33 Correcting the Error of Our Ways: Get the Dumb Stuff Out of the Way
Human factor in change process demands that we create the opportunity for normal human beings to implement and practice risk-reduction Simplicity leads to avoidance of error and prevents harm Check lists “get the dumb stuff out of the way, the routines your brain shouldn’t have to occupy itself with…and lets it rise above to focus on the hard stuff.” They force us to retool our skills-based and rules-based cognitions so we can focus our effort on knowledge-based cognitions Gawande, Atul, The Checklist Manifesto. How To Get Things Right. New York: Henry Holt and Company, 2009

34 Correcting the Error of Our Ways: Get the Dumb Stuff Out of the Way
Surgery checklists could save lives, study reveals Tom Blackwell, National Post  Published: Wednesday, January 14, 2009

35 Correcting the Error of Our Ways: Get the Dumb Stuff Out of the Way
Good checklists are Precise Short Easy to use even in difficult situations Do not try to spell out everything Provide reminders of only the most critical and important steps Practical Gawande, Atul, The Checklist Manifesto. How To Get Things Right. New York: Henry Holt and Company, 2009

36 Correcting the Error of Our Ways: Get the Dumb Stuff Out of the Way
Divide into three groups: managers, supervisors, line staff Develop a good EBP checklist for a supervising officer to use before seeing an offender in the office?

37 Correcting the Error of Our Ways: Get the Dumb Stuff Out of the Way
World Health Organization Surgical Safety Checklist Has the patient confirmed his/her identity, site, procedure, and consent? Is the site marked? Is the anesthesia machine and medication check complete? Is the pulse oximeter on the patient and functioning? Does the patient have a Known allergy? Difficult airway or aspiration risk? Risk of >500ml blood loss (7ml/kg in children)? <http://www.who.int/patientsafety/safesurgery/en>

38 Correcting the Error of Our Ways: Get the Dumb Stuff Out of the Way
Bad checklists are Vague and imprecise Too long Hard to use Impractical Made by desk jockeys with no awareness of situation in which they are to be deployed Gawande, Atul, The Checklist Manifesto. How To Get Things Right. New York: Henry Holt and Company, 2009

39 Correcting the Error of Our Ways: Get the Dumb Stuff Out of the Way
Checklist for Crime Scene Photographers Checklist for digital SLR camera Are batteries in the camera? Is the media loaded? Is the camera turned on? Is the ISO set (camera settings)? Is the shooting mode selected? Is the white balance set? Is the shutter speed set? Plus 120 more items

40 So Why Don’t We Take Our EBP Medicine?
Taking our EBP medicine Reduces community harm and increases public safety Challenges our brains to create new neural pathways, prevents brain atrophy, and may reduce risk of dementia or Alzheimer’s May help us lose and keep off weight by doing something different every day (we don’t know why) So why don’t we take our EBP medicine and persist in eating the old hot dog? Rae-Dupree, Janet, “Can You Become a Creature of New Habits?”, New York Times, Business Section, May 4, 2008.

41 Cross Your Arms--Again


Download ppt "Getting Corrections Professionals to Take Their EBP Medicine"

Similar presentations


Ads by Google