Facilitating the transition towards desired behaviour in the ICU

Abstract

The Intensive Care Unit (ICU) of the Leids Universitair Medisch Centrum (LUMC) focuses on vitally threatened patients, who cannot survive without daily intensive treatment. As the patients in this department could easily deteriorate and (potentially) pass away, the staff members of LUMC’s ICU often need to act rapidly and make decisions within a short period of time, while they experience severe (time) pressure. This pressure causes stress and increases the chance of human errors by the staff members, which eventually could lead to adverse events (incidents that caused irreversible damage to patients). In order to minimise the human errors made by the staff members and thereby, the amount of adverse events, the ICU physicians and nurses of the LUMC currently need to participate with two training exercises, called Advanced Life Support+ (ALS+) and Crew Resource Management (CRM). Despite the fact that they are encouraged to reflect on- and expand their non-technical skill set, the (ALS+/CRM) trainers still notice that the non-technical skills of the staff members differ with their expectations. Initially, they believed that the difference in desired behaviour (by the trainers) and shown behaviour (by the staff members) is caused by the current set-up of the ALS+ and CRM training. However, it was found that this difference is mainly caused by two other factors. First, although they need to participate with the ALS+ and CRM training, the staff members still have little awareness about their behavioural impact on acute procedures, meaning that they do not precisely know how they can stimulate effective teamwork. Second, the staff members are barely triggered to reflect on their behaviour or to apply their learnings/action points (in practice) once they participated with the ALS+ and CRM training. As a result, (sustainable) behavioural change is not established and the staff members continue to show their old behavioural patterns. Based on these two factors, I developed the iCare-initiative. The iCare-initiative consists of four product solutions: an application, renewed (digital) patient boards, pocket cards and debriefing-flyers.
In the short term, the staff members can reflect more structuredly on their behaviour with the use of the debriefing-flyers. Next, they are reminded of their action points and other important behaviours (during acute procedures) via the pocket cards. In the long term, once the staff members feel more comfortable to think about- and reflect on their behaviour (in teams), the application and renewed patient boards will be launched. The application offers a platform to the staff members to individually develop/train their non-technical skill set and reflect more consciously on their behavioural impact. Furthermore, the patient boards aim to create continuous awareness amongst the staff members to reflect on their behaviour, but also to encourage them to share useful insights via a convenient (accessible) platform. Although the iCare-initiative consists of four separate product solutions, they all work together in one integrated system. This system mainly aims to prepare the staff members for acute procedures, to expose which non-technical skills they should improve, and to allow the staff members to individually develop their non-technical skills. Eventually, these new opportunities will accelerate the transition towards desired behaviour in LUMC’s ICU.