Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups

Grayson, M Lindsay; Macesic, Nenad; Huang, Glen; Bond, Katherine; Fletcher, Jason; Gilbert, Gwendolyn L.; Gordon, David L.; Hellsten, Jane F.; Iredell, Jonathan R.; Keighley, Caitlin; Stuart, Rhonda L.; Xuereb, Charles S.; Cruickshank, Marilyn

doi:10.1371/journal.pone.0140509

Cited by 24 publications

(18 citation statements)

References 22 publications

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“…A recent systematic review on vancomycin education strategies found that interventions which used multimodal strategies, a guideline, educational meetings and dissemination of educational materials had a greater effect than individual interventions on improving vancomycin use . The profession‐specific education strategies identified in our study by educators and recipients align with outcomes of a study that used a personality profiling tool to understand the requirements of different health professions in order to increase knowledge and successfully change behaviour . Similar to the current study, doctors required a personalised approach, with strong emphasis on the education being evidence‐based.…”

Section: Discussionsupporting

confidence: 62%

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Education to improve vancomycin use: the perspectives of educators and education recipients

Dort

Baysari

Carland

et al. 2020

Internal Medicine Journal

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Background: Vancomycin is the primary treatment for methicillin-resistant Staphylococcus aureus infections. Hospital audits have showed that dosing and therapeutic drug monitoring practices for vancomycin are suboptimal. Limited studies have examined the current educational resources used to support vancomycin use.Aims: To explore and compare the perceptions of health educators and recipients of education on the methods currently used to educate health professionals about vancomycin and to identify ideal methods of education.Methods: Semi-structured interviews were conducted with health educators around Australia and with recipients of education (doctors and nurses). Interview questions explored previous experiences of education and perceptions of ideal methods of education. Interviews were audio-taped, transcribed and thematically analysed.Results: Health educators explained that current vancomycin education comprises large-scale presentations, but they perceived these to be ineffective. The recipients of vancomycin education reported a lack of formal education on vancomycin. Despite this, both educators and recipients agreed on the ideal methods of education: nurses are reported to be protocol driven, and education for nurses should be through in-services or e-learning modules, while doctors require an evidenced-based approach. Senior doctors initially require convincing that education is needed. Once convinced, they respond well to brief emails and case-based and one-on-one education strategies. Technologybased strategies and problem-based learning were observed to be effective methods for junior doctors.Conclusions: Vancomycin dosing and therapeutic drug monitoring involves multiple health professionals, but current education strategies do not take this into account. Ideal education strategies need to be multimodal and targeted to specific health profession groups. AbstractBackground: Dedicated geriatric models of care are becoming more prevalent due to the complexity of, and increase in, acute healthcare presentations for older patients. For older people, a long stay in the emergency department (ED) may reflect the complexity of their presentation, or deficiencies in systems that manage these complexities.Aims: To identify predictors of a long ED length of stay (LLoS) for patients ≥65 years old. Methods: Linked hospital information systems data from a large, public Australian ED were analysed in this retrospective cohort study. LLoS was defined as the 75th percentile (617 min). Multivariate regression identified LLoS predictors for admissions and discharges separately.Results: Of 16 791 ED presentations made by older people, 4192 experienced a LLoS; 55% were admitted. Increasing age was associated with an increasing ED LoS. Factors most predictive of LLoS for both admitted and discharged patients included: investigations (both pathology and imaging), less urgent Australasian triage scale categories and after-hours arrival. Ambulance arrival did not increase the risk of a LLoS for patients eventually admitted...

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Section: Discussionsupporting

confidence: 62%

“…Similar to the current study, doctors required a personalised approach, with strong emphasis on the education being evidence‐based. In contrast, nurses required a collective approach, with education delivered through in‐services …”

Section: Discussionmentioning

confidence: 99%

Education to improve vancomycin use: the perspectives of educators and education recipients

Dort

Baysari

Carland

et al. 2020

Internal Medicine Journal

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“…Participants regarded doctors as generally resistant to external rules, which they see as a challenge to their clinical autonomy and self-perception as independent thinkers [36]. In relation to IPC they may exercise autonomy, either by taking it very seriously (exemplary practice) or by choosing to remain ignorant or dismissive of basic IPC precautions, which participants interpreted as evidence of a perceived entitlement to decide, for themselves, what is important.…”

Section: Discussionmentioning

confidence: 99%

The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians’ perceptions of professional and cultural factors that influence doctors’ attitudes and practices in a large Australian hospital

Gilbert

Kerridge

2019

BMC Health Serv Res

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Background Hospital infection prevention and control (IPC) programs are designed to minimise rates of preventable healthcare-associated infection (HAI) and acquisition of multidrug resistant organisms, which are among the commonest adverse effects of hospitalisation. Failures of hospital IPC in recent years have led to nosocomial and community outbreaks of emerging infections, causing preventable deaths and social disruption. Therefore, effective IPC programs are essential, but can be difficult to sustain in busy clinical environments. Healthcare workers’ adherence to routine IPC practices is often suboptimal, but there is evidence that doctors, as a group, are consistently less compliant than nurses. This is significant because doctors’ behaviours disproportionately influence those of other staff and their peripatetic practice provides more opportunities for pathogen transmission. A better understanding of what drives doctors’ IPC practices will contribute to development of new strategies to improve IPC, overall. Methods This qualitative case study involved in-depth interviews with senior clinicians and clinician-managers/directors (16 doctors and 10 nurses) from a broad range of specialties, in a large Australian tertiary hospital, to explore their perceptions of professional and cultural factors that influence doctors’ IPC practices, using thematic analysis of data. Results Professional/clinical autonomy; leadership and role modelling; uncertainty about the importance of HAIs and doctors’ responsibilities for preventing them; and lack of clarity about senior consultants’ obligations emerged as major themes. Participants described marked variation in practices between individual doctors, influenced by, inter alia, doctors’ own assessment of patients’ infection risk and their beliefs about the efficacy of IPC policies. Participants believed that most doctors recognise the significance of HAIs and choose to [mostly] observe organisational IPC policies, but a minority show apparent contempt for accepted rules, disrespect for colleagues who adhere to, or are expected to enforce, them and indifference to patients whose care is compromised. Conclusions Failure of healthcare and professional organisations to address doctors’ poor IPC practices and unprofessional behaviour, more generally, threatens patient safety and staff morale and undermines efforts to minimise the risks of dangerous nosocomial infection.

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“…74 Current AMS programmes that target junior medical staff often fail to recognise the difficulties in challenging this ingrained cultural hierarchy. 71,72,74 As medical personnel value autonomy, 75 the success of AMS initiatives is maximised when developed within a framework of collaboration and collegiality. 76 Ultimately, for AMS to be effective, initiatives need the sustained endorsement of senior clinicians and engagement by the hospital leadership.…”

Section: The Bundles Of Carementioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups

Cited by 24 publications

References 22 publications

Education to improve vancomycin use: the perspectives of educators and education recipients

Education to improve vancomycin use: the perspectives of educators and education recipients

The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians’ perceptions of professional and cultural factors that influence doctors’ attitudes and practices in a large Australian hospital

Healthcare‐acquired infections: prevention strategies

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