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Writer's pictureDanielle Checketts

Resistance to change in healthcare

Changing habits

“Progress is impossible without change, and those who cannot change their minds cannot change anything”.

George Bernard Shaw


Changing one’s habits is a gradual process that requires patience and consistency, often

involving setting realistic goals, tracking progress, and staying motivated.


disposable theatre hats

Analogy of the Suitcase

One monumental change in history was a product which we all know well and that most

people use at least once a year- the suitcase! The simple and obvious choice of adding

wheels to a suitcase was rejected time after time.  All the major department stores knocked back the idea as ludicrous and crazy- pulling a piece of luggage rather than carrying it!!


Wheels on suitcases took several decades to become widely accepted. Bernard Sadow

patented the first wheeled suitcase in 1970 and the scepticism and resistance it faced went on throughout the 1970s. It wasn’t until the 1980s, with the rise of air travel and the need for more convenient luggage, that wheeled suitcases began to gain popularity. By the 1990s, they had become mainstream and widely accepted among travellers.


Overall, the transition from scepticism to widespread acceptance spanned roughly 20 to 30 years and today, you would never see a suitcase without wheels in any airport you visit throughout the world! It is hard to believe that the resistance to such a brilliant and ‘no-brainer’ of an idea took so long to transition and to become accepted, but this is a great example of how long culture change can take, even with the most fantastic and simple ideas which we would never ever go back on now.


Reusable theatre badge hats

Adding wheels to a suitcase is one example of a recombinant innovation- The idea

combined two existing concepts of luggage and wheeled transport to create a more

functional design. By integrating wheels, the suitcase became easier to manoeuvre,

enhancing user convenience and transforming the way people travel with luggage.


The theatre badge hats are another example of a recombinant innovation- combining a name badge with a theatre hat to create an identifiable theatre garment which can be detached and reattached, just like the simplicity of a basic name badge which has been used for decades!


Transitioning from disposable to reusable theatre hats is a great initiative for sustainability and patient safety, however, there are still many factors to consider in changing existing habits. Familiarity with using a product which is thrown away after each use, to one which is reused poses many other questions regarding ordering, storage and laundering that need to be addressed and decided upon.


The changes are not like for like, thus, inevitably it will take longer to change. Education of end users is paramount to gain a positive experience and thus acceptance of the change which would include informing staff about the many benefits, including environmental, patient safety, communication improvement and enhancing the patient journey.


Quality

The quality selection of the appropriate style and fabric of theatre hats is another area for thought. Durability, comfort and easy-to-maintain fabric are essential as there are various materials which can initially be better for the environment such as 100% cotton and hemp, however, washing these garments at the required high temperatures to sufficiently kill the microorganisms along with minimising the shrinkage of the garments needs to be considered, along with cost.


Polycotton is the preferred fabric for scrubs and has been for decades.  There is a good reason for this as polycotton can be laundered at high temperatures without causing concerning shrinkage and it is cost effective as it is readily available.


Introducing and Implementing

A well-planned, phased implemented approach to gradually introduce reusable hats is one route which some hospitals are taking, and some are starting with a pilot.  An example of a planned approach when implementing reusable hats is a hospital in Somerset where the pilot will commence in Orthopaedic theatres, intending to roll them out to the other theatres later.


We are working with J&J on change implementation within this theatre department and we will all learn from what went well and make improvements from what didn’t go so well.  Building up a knowledge bank to use on the subsequent department rollout will gradually become smoother each time. Collecting feedback from users is key to improving the process rollout, size preferred and requirements along with the logistics of having the hats laundered at a neighbouring site- all of which will ensure sufficiency, and acceptance and allow appropriate stock levels of hats and name badges.


‘Hello, my name is’ Campaign

In 2013, the ‘Hello my name is’ campaign was started and the importance of knowing the names of healthcare professionals was found to have tremendous benefits for patients and staff.  The ‘Hello my name is’ initiative was gradually rolled out throughout the UK; fast forward ten years and most hospitals have now adopted this proven best practice approach with staff wearing yellow name badges throughout wards and departments in both NHS and private sectors. 


Black text on a yellow background was found to be the best contrast of colours for those who had visual impairments and for people who suffered from conditions such as dementia and dyslexia.


‘Theatre Cap Challenge’

In 2018, the Theatre Cap Challenge came about and there were mixed responses from

theatre staff wearing their names on their hats.  Some people thought the idea was fantastic, improving teamwork and communication. Some people refuted the change, with differing opinions that they preferred to remain ‘unknown’ when in surgery and various other objections such as feeling silly wearing their names on their hats were also brought up!


Some staff wanted to choose the colour of their hats and objections were given in one trust based on the football teams they liked. Some clinicians wanted to correspond their hats with the colour of the football team they supported!  Sometimes, when a choice is given to a lot of people, the variance of opinion can be vast, and it is difficult for everyone to agree and be of the same thought so the outcome will be to remain with current practice (disposable hats) and not change anything. Sometimes, the champion or leader for the project can run out of motivation after hitting so many differing opinions and move on to another challenge.


Disposable theatre caps have been used for over 30 years now and despite many objections over the years, there has been no other choice, so acceptance has been widespread!

 

Accepting Change

Clinical procurement specialists know this only too well as their roles involve consistently changing products in healthcare. One clinical procurement specialist I know had a very stressful time once when changing to a different type of glove on one occasion and to different paper towels on another occasion and the backlash he received was colossal and very stressful.


Accepting change can often take time and there are many reasons why people can be

resistant to change, including being comfortable with routine, fear of the unknown, cognitive dissonance, social influence, a lack of motivation and negativity due to past experiences which can lead to scepticism and reluctance.  Familiarity provides a sense of security and people often prefer what they know! 


Change can bring uncertainty, leading to anxiety about potential outcomes and fear of losing something which once worked can outweigh the potential benefits of change.  People may struggle with conflicting beliefs and behaviours, making it hard to adopt new habits and group norms along with peer pressure which can discourage change if those around them are resistant to begin with!


Without a clear incentive or personal reason to change, individuals may not value or embrace it, so education about the plethora of benefits of changing to a new product like our theatre badge hats is crucial.


We understand that being concise and fun is a great way to educate staff so we have made an informative video cartoon about the benefits of our theatre badge hats and how they can work in place of disposables within the operating theatre:

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