How are your 2023 resolutions coming along so far? Have you already given up on them? Why do new year resolutions fail so predictably? What do new year resolutions have got to do with safety?

Like new year resolutions, many new safety initiatives require individuals to modify their existing routines and behaviours. Not too long ago, we would forget to bring a mask before heading out or boarding public transport. Companies, such as childcare centres and finance institutions, use proprietary phone apps to communicate important messages that often end up being overlooked. We implement new checklists and expect clinicians to use them all the time, but compliance remains limited. 

What's often overlooked is how these new instructions disrupt existing work habits, which are automatic behaviours formed to help people function efficiently. As Jen Rasmussen's SRK Model explains, automatic behaviours stem from habitual practices, allowing us to perform activities on autopilot mode and use minimal mental effort to achieve satisfactory results. Automatic behaviours make life easier in the face of high workload and time pressure.

Of course, not all automatic behaviours are good. For instance, I've seen too many men neglect to wash their hands after using the bathroom (yes, I'm watching…consider yourself warned). Automatic behaviours are usually formed over months and years of repetition, and reprogramming them would require more than just posters, reminders, and emails. Whether it's your own quirks or the actions of others, old habits die hard.

So then how?

We begin with something within your control: reducing friction. Place face masks near high-touch areas so they won't be forgotten. Make food court apps simple and rewarding to use, particularly for the elderly. Design checklists that are user-friendly and genuinely helpful. Reducing friction makes compliance easier. Achieving this requires empathizing with the needs and challenges of all parties, and not a manipulative, heavy-handed “nudge” from the top. 

Piggybacking, or stacking, can also be helpful. This technique involves using existing habits as triggers to cue the new behaviour. For instance, if gargling with mouthwash is new to you, try doing it after brushing your teeth. Brushing serves as a reminder to use the mouthwash. Naturally, piggybacking won't be as effective if you have to position the new action before the memory cue. This is also why people are better at remembering to clean their hands after touching a patient, rather than before.

Lastly, habits form through repetition, and we become what we repeatedly do. New protocols can evolve into routine practices if we repeat them enough times, such as returning food trays and wearing seat belts. While it is debatable whether we should induce repetition through rewards or punishments, it's undoubtedly easier for anyone to habituate an effortless activity (see: reducing friction). 

It's important to be mindful that implementing a new safety protocol may require individuals to break long-standing habits, habits that were formed over a long period of time and under dynamic operational pressures – regardless of whether these habits are good or bad. By taking a collaborative and empathetic approach, you can help individuals adapt to the new protocol and ensure its success.

What are some behaviour-change interventions that you liked or loathed, and why? Let me know! 

Commonly referred to by his initials, SQ, Dr Shanqing is Assistant Director, Human Factors & Systems Design, KKH, and serves as the resident human factors specialist within SGH and KKH. For over 13 years, he has applied human factors principles and methodologies to healthcare research, innovation, and quality improvement. He welcomes anyone to consult him on problems or projects that might require human factors insights.