New Year's Resolutions Require More Than Resolve

Dr. Gaunt is a medication safetyanalyst and the editor of ISMPMedication Safety Alert!Community/Ambulatory CareEdition.

The New Year provides a valuableopportunity to discuss how NewYear's resolutions can enhanceefforts to improve patient safety. Mostindividuals make at least 1 New Year'sresolution. Many involve changes withpersonal and job-related habits leadingto the familiar vow—"I'm going to dothings differently next year." Unfortunately,about 25% of New Year's resolutionswill be abandoned by the end ofthe first week, with many falling by thewayside after 6 weeks.

In spite of this, individuals are ratherresilient when faced with a setback. Ofthe individuals who will fail this year,60% will make the same resolution nextyear.¹ It is understood that failures arefar from inevitable, and with a fewadjustments, successes will eventuallyoccur. Therefore, the same pledge canbe made each year for 5 to 10 yearsbefore a positive outcome is achieved.Despite setbacks, an individual's personalresolve can eventually contributeto his or her success.

3 Elements for Change

In addition to personal resolve, 3 furtherelements are needed to convertthe best intentions into constructiveactions on the job: (1) perceiving oneselfas having an important role in identifyingwhat needs to be improved; (2) havinga process or set of procedures inplace that will help guide and direct thechange; and (3) obtaining positive supportand feedback from others in theworkplace.

A study of 84 pharmacists practicingin community pharmacy sites illustrateshow these 3 elements and a resolve forchange can lead to improved medicationsafety.² Over a 4-week period, pharmacistswere given time each week toself-monitor their work and documentany mistakes that they found and correctedin a small booklet kept near theirwork spaces. After 2 weeks, the studyinvestigators provided anonymous writtenfeedback to each pharmacist abouthow others performed as a group.

Feedback and Goal Setting

Using this feedback, the pharmacistswere asked to set a goal to either maintaintheir current performance orimprove their ability to identify and preventmistakes. The pharmacists whojust wanted to maintain their currentperformance increased their errordetection by 22%, compared with a controlgroup where no feedback or goalsetting occurred. Even more impressive,the pharmacists who established goalsto enhance error detection improvedtheir ability to detect and prevent errorsby 103%.

What brought about such improvement?In the study, the self-monitoringprocess allowed pharmacists to initiateand take control over areas of theirwork and identify where improvementswere needed. It also provided a set ofprocedures to help facilitate change.

Sharing what was learned collectivelyamong pharmacists also encouragedthem to support each other's attemptsto change. It also widened the scope ofpossible improvements by raising abroad range of issues for consideration.Interestingly, pharmacists ranked thistype of feedback, support, and goal settingamong the most effective medicationerror?reduction strategies investigatedby the researchers.

So take heart and make those patientsafetyresolutions! Perhaps small workgroups could meet to share their personaland job-related resolutions relatedto patient safety to foster team support,feedback, and guidance to achievethe desired changes. Maybe someone'spersonal resolve to change will sparkthe interest of others on the team to followsuit.

Although individuals resist changewhen they feel coerced or believe theyare doing it for someone else, groupsupport for patient-safety improvementsthat have been chosen by individualteam members will set the stagefor more widespread changes amongstaff.Working as a team is the best wayto move forward with safety resolutions.

References

• Polivy J, Herman CP. If at first you don't succeed. Amer Psychol 2002;57:677-689.
• 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.