A series of novel behaviour change trials run in Victorian hospitals over the past three years has revealed insights on the role that human behaviour plays in avoidable medical errors and how some simple, low-cost interventions could help to reduce these risks.
The trials, funded by the Victorian Managed Insurance Authority (VMIA), targeted seven areas in which avoidable medical errors occur within the health system, key among them misdiagnosis and miscommunication.
One trial showed, for example, how a Rapid Diagnostic Discussion tool could be used to reduce cognitive bias (which is thought to be at play in more than three-quarters of misdiagnosis cases), by facilitating a structured discussion between two clinicians on the possible causes of abdominal pain in 115 cases. Because of this discussion, the working diagnosis was changed in almost a quarter of cases.
In a world-first, the team also trialled simulated training with an actor to build the skills and confidence of health service board members to have difficult conversations.
Monash University's BehaviourWorks Australia unit collaborated with The Shannon Company to conduct the VMIA Research and Innovation Program, which also involved the Victorian Department of Health and Human Services and the majority of Victoria's health services.
The overarching aim of the trials, run between 2017 and 2020, was to explore and better understand how behaviour change research can improve decision-making and patient care in a number of health settings.
Six trials looked at aspects of patient care, including:
- Reducing cognitive bias among clinicians by facilitating a structured discussion using the Rapid Diagnostic Discussion tool.
- Improving the speed and efficiency of communicating diagnostic test results by using a secure messaging app - myBeepr.
- Giving patients more of a voice in their healthcare by providing a simple bedside notepad.
- Helping clinicians gain experience navigating the key behavioural barriers to the escalation of care, such as fear of hierarchy, via a 'choose your own adventure' style training video.
- Fostering an empathetic and collaborative mindset among doctors receiving non-critical patient transfer requests from regional hospitals via a persuasive video.
- Improving the skills and confidence of health service board members to engage in difficult conversations via simulated training with a trained actor.
- A seventh trial seeking to improve informed consent conversations between surgeons and patients was halted due to COVID-19.
BehaviourWorks Associate Professor Peter Bragge said the trials were deliberately simple and low cost, intended to provide indicative results on where VMIA and health services could invest further in the future.
"The benefit of pursuing an innovation program like this is that it allows you to test things that are so simple you wonder why they haven't been thought of before, like what would happen if you gave patients a notebook to write down questions they had for their doctors instead of having to do it when there are 10 doctors crowded around the bed?," asked A/Prof Bragge.
"The trials touched on some areas where patients could be at risk and uncovered some really promising results that could be implemented across the health system."
VMIA Harm Prevention Program Manager, Ursula Harrisson, said the trial results were very valuable and that health service organisations could conduct further research to confirm the findings.
"There are indications that some – like Patient Power, the boardroom intervention and the secure messaging app – are being considered and we're delighted to have played a role in this unique program, which uses the latest behavioural science to address common problems across the health system," she said.
The Shannon Company helped bring the trials to life by creating communications that health service staff and patients would easily and readily engage with.
"From a creative perspective, unless you can actually communicate ideas in a way that engages people, builds an emotional connection and empathy, they probably won't be picked up," said Managing Partner, Ian Forsyth.
The findings have been shared with thousands of health service staff members through a unique 'Patient Journey' microsite that gives those involved in the trials a basic understanding of key findings . More in-depth and academic results can be found HERE.
The project involved health service partners including Peninsula Health, Austin Health, Eastern Health and Monash Health.
