Changing healthcare professionals' non-reflective processes to improve the quality of care

Sebastian Potthoff; Dominika Kwasnicka; Leah Avery; Tracy Finch; Benjamin Gardner; Nelli Hankonen; Derek Johnston; Marie Johnston; Gerjo Kok; Phillippa Lally; Gregory Maniatopoulos; Marta M Marques; Nicola McCleary; Justin Presseau; Tim Rapley; Tom Sanders; Gill Ten Hoor; Luke Vale; Bas Verplanken; Jeremy M Grimshaw

doi:10.1016/j.socscimed.2022.114840

Changing healthcare professionals' non-reflective processes to improve the quality of care

Soc Sci Med. 2022 Apr:298:114840. doi: 10.1016/j.socscimed.2022.114840. Epub 2022 Feb 23.

Authors

Sebastian Potthoff¹, Dominika Kwasnicka², Leah Avery³, Tracy Finch⁴, Benjamin Gardner⁵, Nelli Hankonen⁶, Derek Johnston⁷, Marie Johnston⁸, Gerjo Kok⁹, Phillippa Lally¹⁰, Gregory Maniatopoulos¹¹, Marta M Marques¹², Nicola McCleary¹³, Justin Presseau¹⁴, Tim Rapley¹⁵, Tom Sanders¹⁶, Gill Ten Hoor¹⁷, Luke Vale¹⁸, Bas Verplanken¹⁹, Jeremy M Grimshaw²⁰

Affiliations

¹ Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, NE7 7XA, UK; Population and Health Science Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK. Electronic address: sebastian.potthoff@northumbria.ac.uk.
² Faculty of Psychology, SWPS University of Social Sciences and Humanities, 53-238, Wroclaw, Poland; NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, 333 Exhibition Street, 3000, Melbourne, Australia. Electronic address: dkwasnicka@swps.edu.pl.
³ School of Health & Life Sciences, Teesside University, Tees Valley, TS1 3BA, UK; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. Electronic address: leah.avery@tees.ac.uk.
⁴ Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, NE7 7XA, UK. Electronic address: tracy.finch@northumbria.ac.uk.
⁵ Department of Psychology, King's College London, SE1 1UL, UK. Electronic address: benjamin.gardner@kcl.ac.uk.
⁶ Faculty of Social Sciences, Tampere University, Tampere, Finland; Faculty of Social Sciences, University of Helsinki, Unioninkatu 37, 00014, Finland. Electronic address: nelli.hankonen@tuni.fi.
⁷ Health Psychology Group, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, UK. Electronic address: d.johnston@abdn.ac.uk.
⁸ Health Psychology Group, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, UK. Electronic address: m.johnston@abdn.ac.uk.
⁹ Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands. Electronic address: g.kok@maastrichtuniversity.nl.
¹⁰ Research Department of Behavioural Science and Health, University College London, London, WC1E 6BT, UK. Electronic address: p.lally@ucl.ac.uk.
¹¹ Population and Health Science Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK; Faculty of Business and Law, Northumbria University, Newcastle upon Tyne, UK. Electronic address: gregory.maniatopoulos@northumbria.ac.uk.
¹² Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Portugal. Electronic address: mmoreira@tcd.ie.
¹³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada. Electronic address: nmccleary@ohri.ca.
¹⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada; School of Psychology, University of Ottawa, Ottawa, K1N 6N5, Canada. Electronic address: jpresseau@ohri.ca.
¹⁵ Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, NE7 7XA, UK. Electronic address: tim.rapley@northumbria.ac.uk.
¹⁶ Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, NE7 7XA, UK. Electronic address: t.sanders@northumbria.ac.uk.
¹⁷ Department of Work and Social Psychology, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands. Electronic address: gill.tenhoor@maastrichtuniversity.nl.
¹⁸ Population and Health Science Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK. Electronic address: luke.vale@newcastle.ac.uk.
¹⁹ Department of Psychology, University of Bath, Bath, BA2 7AY, UK. Electronic address: b.verplanken@bath.ac.uk.
²⁰ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, K1H 8L6, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, K1G 5Z3, Canada; Department of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada. Electronic address: jgrimshaw@ohri.ca.

PMID: 35287065
DOI: 10.1016/j.socscimed.2022.114840

Abstract

Rationale: Translating research evidence into clinical practice to improve care involves healthcare professionals adopting new behaviours and changing or stopping their existing behaviours. However, changing healthcare professional behaviour can be difficult, particularly when it involves changing repetitive, ingrained ways of providing care. There is an increasing focus on understanding healthcare professional behaviour in terms of non-reflective processes, such as habits and routines, in addition to the more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding healthcare professional behaviour, although to date, each perspective has only been applied in isolation.

Objectives: To combine theories of habit and routine to generate a broader understanding of healthcare professional behaviour and how it might be changed.

Methods: Sixteen experts met for a two-day multidisciplinary workshop on how to advance implementation science by developing greater understanding of non-reflective processes.

Results: From a psychological perspective 'habit' is understood as a process that maintains ingrained behaviour through a learned link between contextual cues and behaviours that have become associated with those cues. Theories of habit are useful for understanding the individual's role in developing and maintaining specific ways of working. Theories of routine add to this perspective by describing how clinical practices are formed, adapted, reinforced and discontinued in and through interactions with colleagues, systems and organisational procedures. We suggest a selection of theory-based strategies to advance understanding of healthcare professionals' habits and routines and how to change them.

Conclusion: Combining theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors, operating at multiple levels of analysis, which can impact on the behaviours of healthcare professionals, and so quality of care provision.

Keywords: Behaviour change; Dual process models; Habits; Healthcare professionals; Implementation science; Quality improvement; Routines; Theories of practice.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cues
Delivery of Health Care
Habits*
Health Personnel*
Humans
Quality of Health Care

Abstract

Publication types

MeSH terms

Grants and funding