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Webinar WHO influencing HCWs
The document discusses several psychological models that are used to understand and predict behavior but are not widely applied in healthcare, including the Theory of Planned Behavior, Social Cognitive Theory, Operant Learning Theory, and others. It also examines how shortcuts in thinking, perceptual contrast, consistency principles, commitments, and opportunities for reciprocation can be leveraged to increase compliance. Specific techniques are provided like pre-committing individuals or asking for small initial favors to generate a sense of obligation to agree to larger requests.
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Webinar WHO influencing HCWs
- 1. 20-‐04-‐12 Psychological models & Healthcare • …. used to understand and predict behavior, but (so far) hardly used in healthcare • Theory of Planned Behavior (TPB) • Social CogniDve Theory (SCT) • Operant Learning Theory (OLT) • Common Sense Self-‐regulaDon Model (CS-‐SRM) • Stage Models (SM) • ImplementaDon IntenDon (II) BoneK et al. ImplementaDon Science 2010;5:20 Influence • While we wish to make the most thoughRul, fully considered decision possible … we frequently resort to comply on basis of a single piece of informaDon (trigger) • “Click-‐whirr” (automaDc response, fixed acDon paXern) – Mother turkey feeds chicks at the sound of cheep-‐ cheep • Stuffed “pole cat” (natural enemy) à rage • Stuffed pole cat with cheep-‐cheep à feeding Triggers for compliance Commitments • Commitments • Shortcuts – judgmental heurisDcs • OpportuniDes for reciprocaDon • Compliant behavior of similar others • Contrast principal • Feelings of liking & friendship • Authority direcDves • Consistency • Scarcity informaDon Shortcuts-‐ contrast -‐ consistency 1
- 2. 20-‐04-‐12 Shortcuts – judgmental heuristics Contrast principal • “Expensive = good” (and opposite) • Perceptual contrast • “If an expert said so, it must be true” – Buying suite and sweater à expensive item first – Airline industry “captainiDs” – Selling the car first, than the opDons • “Because” – Increase compliance even if no reasoning follows (example cuKng lines) – Possibly based on “because” … “just because” of parents when answering their children's quesDons Shortcuts-‐ contrast -‐ consistency Shortcuts-‐ contrast -‐ consistency Perceptual Contrast Consistency • Most people have a strong desire to look consistent within their words, beliefs, aKtudes • Whenever one takes a stand that is visible to others, there arises a drive to maintain that stand in order to look like a consistent person. • Therefore, wriXen-‐down and publicly made commitments can be used to influence others and ourselves Shortcuts-‐ contrast -‐ consistency Shortcuts-‐ contrast -‐ consistency Consistency Food-in-the-door (1) • QuesDon to home owners – place large billboard • At the beach “Drive Carefully” in your lawn – Leaving a blanket with valuables – pretended thec • Two groups: A) 17% complied – 4/20 people in the area reacted B) 76% complied – Saying “watch my things” first à 19/20 reacted • Why the difference between A + B ? ? B was asked a few weeks before to display a small If I can get someone to commit (take a stand or go on record) 3x3in sign in window “Be a safe driver” I can set the stage for automaDc consistency ! Shortcuts-‐ contrast -‐ consistency 2
- 3. 20-‐04-‐12 Contrast & consistency principle applied in infection control ? Promise of publicity • Key-‐person as role-‐models • Published list of supporters/let them sign a pledge Self generated support • Pre-‐prime your customer – Would you (theoreDcally) be supporDng our goals? Followed by a visit to commit them to IC New self-‐image Shortcuts-‐ contrast -‐ consistency Opportunities for reciprocation Examples of reciprocation • “we are obligated to future repayment” • Mailing a $5 gic along with a survey was twice • Regan et al. “Coke experiment” as effecDve as a $50 payment for sending it – Joe gave others (unasked for) a drink. Later asked them to back (James & Bolstein 1992) buy raffle Dckets from him à those who got a Coke bought more Dckets • à a small iniDal favor can produce a sense of à those you “liked” Joe bought more Dckets obligaDon to agree to a larger return favor, – but …. relaDonship between “liking” and compliance since most of us find it highly disagreeablte to wiped out in those that received a Coke ! be in a state of obligaDon “a feeling of indebtedness by doing us an uninvited favor” ReciprocaDon ReciprocaDon Reciprocation techniques Benefactor-before-beggar-startegy • Reciprocal concessions Disguised Krishna – Boy scout selling $5 Dckets for Saturday night event, when arrested for soliciDng rejected offering $0,50 candies (buyer feels that second request is a concession to him) without a license when pressing candy • Rejec1on-‐then-‐retreat strategy canes on shoppers and – Over ask first, than come with intended amount than asking for donaDons – Ask volunteers for 1 week of community service than offer 1 hour à reciprocity rule – Rejected-‐than retreat group has a higher compliance to actually do that service (85% vs. 50%) • Benefactor-‐before-‐beggar-‐strategy ReciprocaDon 3
- 4. 20-‐04-‐12 Benefactor-before-beggar-startegy Compliant behavior of similar others • Principle of Social Proof – Important means that people use to decide what A nice Christmas gic for to believe or how to act is to look what other your HCWs – believe or do shortly before launching • Social proof is most influenDal under two condiDons your HH campaign – Uncertainty – Similarity ReciprocaDon Similar others/social proof Principle of Social Proof 50 million can’t be wrong • “We view behavior as correct to the degree “people want to be part of the majority” we see other performing it” – When lots of people do it – it must be right Similar others/social proof Social proof - examples What is going to happen? • Laughing tracks – Others laugh = it must be funny • we react to the sound (even if fake) – not the content • works even if the sound is arDficial • Church usher salDng collecDon baskets Similar others/social proof Similar others/social proof 4
- 5. 20-‐04-‐12 Using principles of social proof in Pluralistic ignorance infection control? • Never again start a lecture with only 40% disinfect Uncertainty their hands … Hart aXack or drunk? – “all HCW agree that HH is the most important …” Other bystanders reduce • Pay people to be the good example (role models) personal responsibility • Movies with correct behavior around the hospital • Campaign logo/IC-‐logo worn by all KOLs Similar others/social proof Similar others/social proof Feelings of liking & friendship Halo effects • “ We most prefer to say YES to the request of • Occurs when a posiDve characterisDc of a people we know and like” person dominates the way a person is viewed • Factors leading to liking: – Good-‐looking = talent, kind, honest, intelligent – physical aXracDveness (halo effect) – similarity – Works in many situaDons: even judicial process – familiarity à handsome men lighter sentences – praise – associaDon Liking Liking Similarity Compliments • “We like people that are similar to us” – more likely to help those that dress like us • “We are phenomenal suckers for flaXery” – PosiDve comments produce just as much liking for the flaXerer independent if they were untrue or true Liking Liking 5
- 6. 20-‐04-‐12 Association Association • An innocent associaDon with either bad or • SALE good things will influence how people feel – Buying becomes more likely because it is about us or a product associated with good experience in the past – The good looking models next to the car • RaDng of idenDcal car changed with and without model • CelebriDes and adverDsement • Men didn’t believe that their judgment was influenced – Establish a connecDon; it doesn’t have to be a logical one, just a posiDve one Liking Liking Can you think about a situation in which you could use this ? Authority directives • Power of authority (Milgram study, 1974) • Praise instead of criDcize ! • Let others report about the outbreak & extra • Symbols of authority measures – Titles • InfecDon Control luncheon – Clothing • Use a (local) celebrity (non-‐medical) to adverDze for – Automobiles InfecDon Control Liking (aXracDveness, praise, familiarity, similarity, associaDon) Authority Power of authority (Milgram study, 1974) Symbols of authority • Appearance of authority is enough to get is into the click,whirr mode Expert/Authority • Symbols of authority – Titles – Clothes – Trappings Authority Authority 6
- 7. 20-‐04-‐12 Titles Clothes • PresDgious Dtles lead to height distorDon • Request by well-‐dressed person is more frequently obeyed • Visitor to college presented as “Student” – Man walking crosses red-‐traffic light: in suit to “Professor” at 5 different levels, college versus shirt & trousers students than asked to esDmate length: Δ – 3.5 x as many people followed suited 0.5 per category or 2.5 in overall jaywalker • Size and status is related Authority Authority Can you think about a situation in which you could use this ? Scarcity information • People assign more value to opportuniDes • Start wearing a De? when they are less available • Get an impressive office – “limited number” and “deadline” • Meet and be seen with senior clinicians and – Difficult to get = valuable CEO – Loosing freedom of choiceà increases wish • Use your Porsche to work à would achieve • Psychological reactance the opposite in the NL • Scarcity and informaDon Authority (obedience, Dtle,clothing, cars) scarcity, censorship, reactance Psychological reactance Censorship • “Things that are difficult to get are beXer” • Response to “banned” informaDon – Want the informaDon even more • When free choice is limited or threatened the – Believe the informaDon more even though it need to retain our freedom makes us want wasn’t received them significantly more – “Terrible two and equally desirable toys of which one behind a Plexiglas barrier – Parental interference with young love Reactance, an emoDonal reacDon to pressure or persuasion that results in the strengthening or adopDon of a contrary belief scarcity, censorship, reactance 7
- 8. 20-‐04-‐12 Commodity theory ‘Feeding frenzy” Humans and animals alike lose perspecDve on what they • Sale of product want and begin striking at whatever is contested – Standard info – Standard info + upcoming scarce x 2 • School of fish when loose bait in water will – Standard info + scarce exclusive source x 6 snap on bare hook • Overspending during aucDons • $145.000 for John T. Saturday Night Fever polyester suit, because two bidders became looked into a compeDDve bidding scarcity, censorship, reactance Can you think about a situation in which you could use this ? Summary • This were just a few examples of one book • IntroducDon of new hand-‐rub or catheters in your hospital • In order to effecDvely implement infecDon – Present & announce, restrict it to ICU and those units that control we need more knowledge in first order behavioral science • Announce a limiDon of hand-‐rub and than find a “new source of supply • Behavioral science furthermore offers explanaDons we see in healthcare seKngs scarcity, censorship, reactance The Spreading of Disorder • when people observe inappropriate behavior, this weakens their concern for appropriateness § Orderly alley: § Orderly alley 33% liXering § No graffiD sign § Flyer on handlebar § GraffiD alley: § 69% liXering § avoid liXering We need “order” in our hospitals and people showing appropriate behavior ! www.sciencexpress.org / 20 November 2008 / Page 1 / 10.1126/science.1161405 8