What can be done to change the behaviour of the people, who do things a certain way for the simple reason that they have always been done that way?, we asked Prof. Gerhard Voss, Professor of Infection Control, Radboud university medical center and keynote speaker at the Second Semmelweis CEE Conference on March 7th and 8th, 2017 in Budapest.
Prof. Voss, in one of your tweeds I found a link to an article of Dr. Sanjay Saint, Professor of Medicine at the University of Michigan. Not only that he obviously is a great admirer of Semmelweis, one can find a lot of information relating to the important issue of hand hygiene. He is speaking, inter alia, about the phenomenon, that opposition to hospitals’ infection prevention initiatives comes from a type of health care worker that he is classifying as active resisters. What can be done to change the behaviour of the people, who do things a certain way for the simple reason that they have always been done that way. What is your experience?
Obviously, this question can’t be answered in a few sentences. Any form of “change” is (in part) confronted with resistance. The amazing part is, that compliance to hand hygiene in many European countries isn’t about change. The system (hand rubs) are in place and the knowledge among healthcare-workers with regard to indication and techniques is present. What seems to be missing is “conviction”.
How the people could be convinced?
While all experts agree that interventions should be multi-modal and geared to the different HCW groups, I believe that the most important pre-request is the support of the hospital administrators. The more people do “the right thing” (especially key opinion leaders within the setting) the better will be compliance to hand hygiene, as well as to other guidelines. The aim is to create a “patient safety climate” within the institution, supported by the classical multi-modal interventions. Active resisters should be included in the team achieving this aim. If that isn’t enough, including hand hygiene indicators (e.g. compliance-rate, percentage without rings/bracelets/long sleeves, hand hygiene agent use per admission, …) in budget negotiations will help getting department heads get interested.
In their May-report, the Review on AMR calls for an awareness campaign to educate the public about the problem of antibiotic resistance. In Germany a team made up of Charité and other partners started the pilot project RAI. Is there a similar initiative in the Netherlands?
Yes, the Netherlands are preparing a major campaign with regard to AMR-control. AMR surveillance (including typing), infection control and antimicrobial stewardship are the corner stones of the initiative that will enable region coordination groups (clinical microbiologists, infection control nurses, public health services, elderly care specialists and pharmacists) to initiate their regional priorities, while generating data for the national system. The pilot will start in 5 regions in 2017, and should be expanded throughout the Netherlands by the beginning of 2019, with a yearly budget of EUR 15 million.