Reducing Physical Effort Decreases Negative Patient Outcomes

Frank Drews, MS, PhD, professor of cognitive and neural sciences at the University of Utah, Department of Psychology, discusses how psychological analysis of human behavior has lead his team to produce adherence engineering kits that would reducing physical effort and decreasing negative patient outcomes.

Interview Transcript (slightly modified for readability)

“To give you an example [of] an obstacle, I had mentioned earlier, physical effort is one of the principle [parts] of adherence engineering as a conceptual framework. We identified a number of principles that we think are psychologically solid because they are based on research in psychology as governing behavior, shaping behavior. One [obstacle] is, for example, that physical effort is an important variable and people try to minimize physical effort. Now, how can we implement a solution that gets us higher adherence and reduces physical effort? The idea was people do not adhere because adherence might be physically effortful, so one component in our kits is a little pocket with hand sanitizer.

Hand sanitization is really important prior to performing the procedure. How [hand sanitization] is done normally, without the kit, is, people walk over to the wall dispenser, perform hand hygiene, walk back, and [then] have to do it during the procedure one more time. This is covering quite a bit of distance and when I say, ‘quite a bit of distance,’ it ranges between 5 and 10 feet, so it’s not huge individually but it adds up if you do this procedure many times a day. To demonstrate how effective reducing physical effort in this context is, we added this little package of hand sanitizer into the kit and we increased [the] hand hygiene adherence to almost one hundred percent, after implementation. [With this] people did not have to walk over to a wall dispenser [because they] just it had in front of them.

Another motivation we think plays an important role is waste and reduction of waste. If you have a package with hand sanitizer in front of you, you are less likely to waste it; you are actually using it because it is there, it is present, and so that also may have been a factor [in] driving nurses’ adherence to performing hand hygiene prior to performing the dressing change. That’s just one example.

Another example is affordance, [which], as a principle, has been identified for quite a while. What it really means is [that] you design an object in such a way that it provides you with opportunities to interact with [the] object the way you, as a designer, [would] want people to interact with it. A good example is a coffee mug. A coffee mug has a handle, and you can use this handle or you can use the coffee mug by holding onto the handle; it’s creating an affordance. It’s the most intuitive way of holding a coffee mug, there are many other ways but that’s how we reach out for the coffee mug normally.

One of the things we did was, we created a [highly] intuitive accessibility kit by creating tabs, color-coded tabs, that indicate where to open the kit. The kit has three phases that are part of the task and each of the phases uses different requirements. During the sterile phase of central drawing dressing change you have to set up the sterile field. One thing we did, and again it creates adherence, is [we] used the material that contains pockets, with individual components that [are used] during the procedure, as the backdrop [or] the sterile field. You open it up using tabs and there you have a sterile field already laid out because all of the components, including the carrier material, the pockets, [have] been sterilized. Then, you can work your way through the procedure pocket by pocket by pocket, which provides guidance, which is another principle to [help] guide people to perform the tasks, so task-intrinsic guidance.

By following these principles, the idea is that [the kit] makes the tasks very easy: cognitively low demanding, [and] physically low demanding. [The kit] provides a lot of structure and as a consequence people can adhere [to the respective protocols]. They are less-likely to forget individual steps because they have to rely on memory, for example, and we are not very good at remembering long lists of items. Overall, [with the kit], [healthcare providers] can perform [each] task more effectively with regard to protocol and as a consequence, [there will be] safer and fewer negative outcomes for patients.”