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Healthcare safety expert: culture of PPE use and actively caring is critical

14-Apr-2020 3:15 PM EDT, by Virginia Tech

A Virginia Tech researcher and teacher who has spent decades studying the psychology of safety says it’s more important than ever for frontline workers such as healthcare providers to look out for one another, keeping each other accountable in an effort to help everyone get home safely at the end of the day.

“Really what we’re talking about is: How do you help people stay safe and not take unnecessary risks?” said E. Scott Geller, a Virginia Tech expert in applied behavioral science and the human dynamics of injury prevention. He and his students initiated the Actively Caring for People (AC4P) movement in 2007. The movement is now worldwide, and Geller said it's needed now more than ever.

“Some workers take risks because they only want to help,” Geller said. “Many will say in defense, ‘Oh, it won't happen to me.'"

Geller referred to published studies and reports from the 2014 Ebola outbreak in West Africa, where healthcare workers who consistently wore appropriate personal protective equipment (PPE) had significantly lower rates of infection. Those who rushed in with the best of intentions to help critical patients, but without PPE, were very often infected with the virus themselves.

“Healthcare workers have seen major negative consequences when not immediately helping somebody — their courage to actively care is enviable, but they're taking a huge risk when doing it without PPE,” Geller said. “We want them to slow down, put on their personal protective equipment. And yet, we know there are other honorable AC4P motivations driving them.”

[More: Find additional Virginia Tech expertise related to COVID-19 here.] 

Geller pointed out that a common issue in healthcare systems are administrators and supervisors who may be pushing for efficiency to meet quotas.

“They're not even thinking about safety” in certain cases, he said. "Effectiveness takes more time but will save more lives in the long run.”

Geller noted that another issue ever-present in the U.S. response to the pandemic is apparent shortages in PPE which many hospitals are struggling to overcome.

Because people tend to naturally get in a flow of dealing with immediate issues, "we often fail to be proactive and prepare for the possibility of something like a pandemic. This is the same issue seen in keeping workers safe in various other industries: efficient production too often wins over time-consuming safety."

Geller developed an interpersonal coaching perspective that helps colleagues actively care for each other, and he encourages what’s known in the medical and other fields as cultivating a “just culture.” Geller refers to this as an AC4P culture, using the acronym COACH to describe it:

  • C - Care. “Know that I care and you’ll care what I know. I care so much I'm willing to observe you and note how I can help.”
  • O - Observe. “I’m watching to observe if you're wearing your PPE, to see if you’re doing what we all need to do to keep ourselves and others safe—to actively care for people.”
  • A - Analyze. “I'm also looking at the circumstances, the situational factors that might be influencing the observed behavior — the safe behavior or the at-risk behavior.” 
  • C - Communicate. “This is the heavyweight. This is where I need to give you supportive feedback as a colleague and friend. I need to give you that thumbs up when you're wearing the PPE, and I need to give you corrective feedback when you're not. But corrective feedback needs to be nondirective so the person will accept the correction and adjust their behavior appropriately.”
  • H - Help. “If you do it right, you're going to be helping people stay healthy and safe.”

Geller acknowledged that the stress of being on the front line — especially during a crisis — can influence additional feelings of guilt and helplessness, perceptions that motivate some healthcare workers in particular to avoid taking the time to put on the appropriate PPE.

“They consider the impact of saving a life or of not saving one,” Geller said. “‘Don't ask me to do something so menial like putting on a mask,’ some will think. 'I have serious life-saving work to do.'”

While healthy and productive safety protocols can seem less necessary during an emergency, Geller said that during a crisis it is especially important to stop and remember why a safety protocols exists.

He noted the concept of a “timeout,” a period where one or more healthcare workers pause before a procedure or certain action to make sure the proper steps are being taken. That’s not just an administrative imperative, but one necessary for every first responder.

“It's hard to tell a nurse or a doctor or a therapist to break away for a day to get some sleep, for example,” Geller said. “You get into the flow of the task and sometimes you’re not mindful about what you're doing and not doing, and before you know it you’ve forgotten a key action because you're so into the flow of the routine.”

About Geller 

E. Scott Geller is an Alumni Distinguished Professor of psychology and Director of the Center for Applied Behavior Systems at Virginia Tech. Throughout five decades of teaching and research at the university, Geller has focused in part on the psychology of safety as well as his global movement, Actively Caring for People. Among other subjects, his work focuses on the development and evaluation of behavior change strategies to improve quality of life on a large scale. See his bio.

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