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
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
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