Men do more things through habit than through reason

Citation

(2001), "Men do more things through habit than through reason", International Journal of Health Care Quality Assurance, Vol. 14 No. 6. https://doi.org/10.1108/ijhcqa.2001.06214faa.001

Men do more things through habit than through reason

If we believe this proverb then our pursuit for quality healthcare means that we are looking for quality to become a habit rather than something we have to constantly assign a reason to. Therefore taking the necessary action to provide quality healthcare needs to be something we do regularly and consistently, in a mindless fashion, and not something we have to think about doing, over and above our daily routine. In other words habits (quality actions and behaviours) need to be ingrained into every practice and not add-ons or after thoughts. Nevertheless, there is an implication that taking steps to develop a quality related habit often requires an initial reason for doing so and that reason may be internally generated or externally imposed.

In contrast, however, I believe that to truly develop a habit the reason needs to be internally generated as externally imposed reasons are not conducive to permanent changes of behaviour. Particularly as the shelf life for external influences is not usually as long as the internal reasons for change. This poses a particular challenge for healthcare personnel as often pursuits relating to quality, continuous improvement and excellence are mainly externally imposed or suggested rather than internally generated, thereby rendering many efforts towards quality tenuous rather than robust.

I assert this because there have been a number of events recently which have led me to believe that many healthcare personnel need an external reason for embarking upon actions aligned to the concepts of quality as they do not readily engender the internal stimulus for continuous improvement. Given this to be the case efforts towards quality healthcare continue to be predominantly add-ons and fail to become habits of a lifetime, a vital component for success. As a consequence quality has a bad name and is repeatedly associated with failure or adverse experiences.

So what are these events, you ask, that have made an editor of a quality journal question the values of healthcare personnel. I have a number of them, which I will now explain in brief.

A few months ago I was providing consultancy for a senior healthcare team (chief executive and directors) and in doing so made enquiries about their existing people satisfaction survey. When asked repeatedly why they had done the survey the answer always demonstrated that it had been done for an external reason, i.e. because local, regional and/or governmental guidelines/legislation suggested or demanded that "their" healthcare organisation undertook a people satisfaction survey. Not one senior leader expressed that it had been done because the values of the team and therefore the organisation was to ensure people had the relevant skills and working environment to promote people satisfaction within the workplace. Consequently, should that external reason be removed so too presumably would the efforts towards surveying people satisfaction levels.

Another example came to me this week when I received a letter from the organisation where I undertake bank midwifery. The correspondence was making enquiries into my status with regards to attendance at cardiotocographic (CTG) lectures. The stated reason for wanting this data was that in order to gain a reduced insurance premium for the healthcare organisation, it had to be demonstrated that each midwife had attended a CTG lecture within the last 12 months. Nowhere in the letter did it state that the organisation is committed to providing quality maternity care for women and that annual CTG training was seen as conducive towards this endeavour, despite it being the case. As a result, one has to question whether annual CTG training would have become habitual practice in the absence of the insurance company's demand.

I have also received similar messages from a vast number of healthcare departments whose organisations are using the European Foundation for Quality Management (EFQM) Excellence Model. For instance, I have observed:

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  rheumatology teams start to look at outcome data and the impact of their treatments on customer experiences and independence status;

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  clinical pathology departments undertake self-assessments;

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  maternity, surgical, capital development, and clinical and diagnostic units determine their key results areas;

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  training and development departments consider collecting data regarding desired changes in behaviour of healthcare personnel;

solely because the chief executive was in the driving seat of the quality journey. Not one of these actions was taken from an internally generated stimulus, which indicates to me that should the chief executive leave or cease to promote quality, the teams quoted above would cease their efforts towards making healthcare better for their customers, staff and other key stakeholders. Therefore, we need to change this "habit" (only "doing" quality because it has to be done) if delivering quality healthcare is to become the norm.

Hence, I suggest that an early pursuit of the champions of quality healthcare (i.e. readers of this journal) is to transform the external stimulus for quality into an internally owned goal. One way of doing this could be for teams to embark upon customer satisfaction surveys because despite the views I have given above, I do believe that all healthcare personnel want to deliver a quality service, they are just not sure what actions they need to take to do this and so do not always leave the starting block until an external stimulus forces them to. However, my experiences also denote that the external stimulus is not always the right one and so progress towards quality and ultimately success is tenuous.

One thing that is for sure though is that reason informs habit and good habits within healthcare practice strengthen the likelihood of achieving quality, continuous improvement and excellence, a goal all healthcare personnel should all be committed to and working towards.

If you have any other views (supportive or otherwise) or experiences related to the above then please share them with us by way of using this editorial space or submitting an article for publication. Sharing our learning and views are what make this journal a success and a source of stimulation and knowledge for many healthcare personnel embarking upon or needing encouragement to continue their journey towards delivering quality healthcare.