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Success with New Year's resolutions requires more than personal resolve

From the January 9, 2003 issue

Most people make at least one New Year's resolution. Frustrations with personal and jobrelated habits lead to a familiar vow -"I'm going to do things differently next year." Unfortunately, total faith in our personal resolve to change may be unwarranted. Depending upon the problem, 25% of New Year's resolutions will be abandoned by the end of the first week with the majority of them falling by the wayside
after six weeks.

In spite of this, people are rather resilient when faced with a setback. Sixty percent of those who fail this year will make the same resolution next year.1 They believe that failures are far from inevitable, and with a few adjustments, successes will eventually occur. Thus, the same pledge is made anywhere from five to ten years before a positive outcome is achieved. So personal resolve over time, despite setbacks, is one factor related to success.

Three additional elements are needed to convert personal resolve into constructive actions on the job: a) perceiving ourselves as having an important role in identifying what needs to be improved; b) having a process or set of procedures in place that will guide and direct the change; and c) obtaining positive support and feedback from others in the workplace. These help reduce the stress associated with personal efforts to change.

A recent study illustrates how these three elements can help drive change to improve medication safety.2 Over a fourweek period, pharmacists were given time each week to self-monitor their work and document the mistakes they found and corrected in a small booklet they kept near their workspaces. After two weeks, study investigators provided anonymous written feedback to each participant on how other participants performed as a group. Using the feedback, participants were asked to set a goal to either maintain their current performance or improve their ability to identify mistakes. Compared with a control group where no feedback or goal setting occurred, even those who just wanted to maintain their current performance increased their error detection by 22%. Even more impressive, pharmacists who established goals to enhance error detection were able to improve 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. Finally, sharing what was learned collectively among pharmacists encouraged the team 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 New Year's resolutions! Then, perhaps small workgroups could meet to share their resolutions related to patient safety with each other to foster team support, feedback and guidance with the desired changes. Who knows? Maybe someone's personal resolve to change will spark the interest of others on the team to follow suit. But remember, converting personal resolve into effective action cannot be jumpstarted easily by others. People resist change when they feel coerced or believe they are doing it for someone else.

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. Health Notes: Quality Assurance 2002; 1(6):19-24.

ISMP thanks Anthony F. Grasha, PhD, Professor of Psychology, University of Cincinnati, for contributing this article.

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