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Dr. Gaunt is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/Ambulatory Care Edition.

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The New Year provides a valuable opportunity to discuss how New Year's resolutions can enhance efforts to improve patient safety. Most individuals make at least 1 New Year's resolution. Many involve changes with personal and job-related habits leading to the familiar vow—"I'm going to do things differently next year." Unfortunately, about 25% of New Year's resolutions will be abandoned by the end of the first week, with many falling by the wayside after 6 weeks.

In spite of this, individuals are rather resilient when faced with a setback. Of the individuals who will fail this year, 60% will make the same resolution next year.¹ It is understood that failures are far from inevitable, and with a few adjustments, successes will eventually occur. Therefore, the same pledge can be made each year for 5 to 10 years before a positive outcome is achieved. Despite setbacks, an individual's personal resolve can eventually contribute to his or her success.

3 Elements for Change

In addition to personal resolve, 3 further elements are needed to convert the best intentions into constructive actions on the job: (1) perceiving oneself as having an important role in identifying what needs to be improved; (2) having a process or set of procedures in place that will help guide and direct the change; and (3) obtaining positive support and feedback from others in the workplace.

A study of 84 pharmacists practicing in community pharmacy sites illustrates how these 3 elements and a resolve for change can lead to improved medication safety.² Over a 4-week period, pharmacists were given time each week to self-monitor their work and document any mistakes that they found and corrected in a small booklet kept near their work spaces. After 2 weeks, the study investigators provided anonymous written feedback to each pharmacist about how others performed as a group.

Feedback and Goal Setting

Using this feedback, the pharmacists were asked to set a goal to either maintain their current performance or improve their ability to identify and prevent mistakes. The pharmacists who just wanted to maintain their current performance increased their error detection by 22%, compared with a control group where no feedback or goal setting occurred. Even more impressive, the pharmacists who established goals to enhance error detection improved their ability to detect and prevent errors by 103%.

What brought about such improvement? In the study, the self-monitoring process allowed pharmacists to initiate and take control over areas of their work and identify where improvements were needed. It also provided a set of procedures to help facilitate change.

Sharing what was learned collectively among pharmacists also encouraged them to support each other's attempts to change. It also widened the scope of possible improvements by raising a broad range of issues for consideration. Interestingly, pharmacists ranked this type of feedback, support, and goal setting among the most effective medication error–reduction strategies investigated by the researchers.

So take heart and make those patientsafety resolutions! Perhaps small work groups could meet to share their personal and job-related resolutions related to patient safety to foster team support, feedback, and guidance to achieve the desired changes. Maybe someone's personal resolve to change will spark the interest of others on the team to follow suit.

Although individuals resist change when they feel coerced or believe they are doing it for someone else, group support for patient-safety improvements that have been chosen by individual team members will set the stage for more widespread changes among staff.Working as a team is the best way to move forward with safety resolutions.

References

1. Polivy J, Herman CP. If at first you don't succeed. Amer Psychol 2002;57:677-689.
2. Grasha AF. Tools for the reflective practitioner: Use of self-monitoring, personal feedback, and goal setting to reduce error. California State Board of Pharmacy: Health Notes: Quality Assurance. pharmsafety.org/extras/Feedback-Goals.pdf.