Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.


35th Annual Convention; Phoenix, AZ; 2009

Event Details

Previous Page


Symposium #294
Improving the Quality of Healthcare and Reducing Medical Errors: Contributions from Behavior Analysis
Sunday, May 24, 2009
4:00 PM–5:20 PM
North 224 A
Area: CBM/OBM; Domain: Service Delivery
Chair: R. Wayne Fuqua (Western Michigan University)
Abstract: In the United States, estimates indicate that instances of medical harm occur at a rate of approximately 15 million per year (40,000 per day). Additionally, an estimated 90,000 deaths per year occur due to errors in the delivery of health care services. These alarming statistics indicate the need for further research and intervention in the healthcare arena. This symposium presents four papers which address patient safety issues throughout the United States by applying behavior analysis principles and procedures. The first talk will discuss applying simulation to pre-hospital pediatric care in order to identify and correct errors. The second paper describes the use of simulation and other elements (e.g., modeling, feedback, role play) to train team coordination and communication skills to hospital healthcare workers. The third paper addresses the importance of infection control by way of proper hand hygiene. Finally, the last paper discusses a study that applied Organizational Behavior Management techniques to various safety concerns throughout a hospital system. Through these presentations, authors will show the effectiveness of various behavioral interventions to decrease medical errors, presumably increasing patient safety.
Medical Error in Pediatric Pre-hospital Emergency Care
AMY GROSS (Western Michigan University), Krystyna A. Orizondo-Korotko (Western Michigan University), R. Wayne Fuqua (Western Michigan University), Richard Lammers (Michigan State University, Kalamazoo Center for Medical Studies), William Fales (Michigan State University, Kalamazoo Center for Medical Studies)
Abstract: Pre-hospital health care providers (i.e., emergency medical technicians and paramedics) face numerous obstacles delivering quality medical services, including the presentation of highly diverse and serious symptoms, lack of history with presenting patients, emotionally charged and difficult working conditions and intense time pressures. These obstacles are further complicated by the need to operate in highly variable, unstructured environments in which medical support is not readily available. Pediatric patients may be particularly challenging to pre-hospital care providers due to the relatively infrequent occurrence of childhood medical emergencies (thus allowing skills to degrade as a function infrequent practice). This presentation describes the development of simulation based training program to provide pre-hospital healthcare workers the opportunity to practice and improve emergency pediatric medical skills. We also describe the manner in which these simulations allow for the identification of errors and the factors that contribute to the occurrence of errors.
The Use of Simulation for Team Training in Healthcare
KRYSTYNA A. ORIZONDO-KOROTKO (Western Michigan University), Amy Gross (Western Michigan University), R. Wayne Fuqua (Western Michigan University)
Abstract: In the United States, an estimated 90,000 deaths per year occur due to errors in the delivery of health care services. Many of these deaths are traceable to failures in team coordination and communication among health care workers. We suggest that the health care industry can utilize simulation-based training and quality control strategies to address this issue. We describe the development of a simulation-based assessment and training system for heath care workers which includes the development of simulation scenarios designed to challenge critical health care skills (e.g., problem solving, team coordination, and error detection and correction). Simulations are conducted in the health care setting in an effort to increase the fidelity of the surrounding environment and to sample the real-world interface between health care workers and support services (e.g., lab and blood services). We explain the development and validation of a taxonomy of skills that we use to guide the training and evaluation of health care teams. We also describe our training model that includes facilitated debriefing (with detailed feedback), instruction, self-evaluation, and role play.
Adherence with Infection Control
MOLLI LUKE (University of Nevada, Reno), Mark P. Alavosius (University of Nevada, Reno)
Abstract: Recently in the state of Nevada, health and safety risks associated with the health care industry have become a major concern with the apparent use of questionable safety practices. Difficulty in maintaining a healthy environment in health care settings is nothing unique to Nevada. Within this setting, the importance of proper hand hygiene and infection control procedures are vital to the health and safety of patients and staff. Infection control procedures, such as washing hands and wearing gloves, are imperative in decreasing the spread of infectious diseases in a setting that is easily vulnerable to transmission of bacteria. Despite this, the literature indicates frightening low adherence rates, issues with data collection, and ambiguous definitions of "adherence". This presentation will describe direct observation used to define and record adherence with infection control procedures by health care personnel in a community clinic. This includes the procedures used to train observers and checks of inter-observer agreement. The effects of immediate, personalized feedback delivered by an investigator, aimed at increasing adherence with hand hygiene behaviors are examined.
Fool me once, shame on the system - fool me twice, where is the intervention? Improving patient safety through responses to error.
THOMAS R. CUNNINGHAM (Virginia Polytechnic Institute and State Universit), Remmie LeRoy Arnold (Virginia Tech University), Phillip A. Randall (Virginia Polytechnic Institute and State University), E. Scott Geller (Virginia Tech)
Abstract: Instances of medical harm are estimated to occur at a rate of approximately 15 million per year in the US, or 40,000 per day. There remains a lack of patient-safety-focused behavioral interventions among healthcare workers. OBM interventions are often applied to needs already identified within an organization, and the means by which these needs are determined vary across applications. The current research addressed gaps in the literature by applying a broad needs assessment methodology to identify patient-safety intervention targets in a hospital and translating OBM intervention techniques to identify and improve the prevention potential of corrective action for reported medical errors. A content analysis of 17 months of error report follow-up action descriptions for the nine types of most-frequently-occurring errors was conducted, and follow-up actions were coded according to a taxonomy of behavioral intervention components, with accompanying prevention scores based on criteria developed by Geller et al. (1990). Two error types were pinpointed based on highest frequency of reporting and lowest average follow-up prevention score. Over a three-month intervention period, managers were instructed to respond to these two error types with active communication, group feedback, and positive reinforcement strategies. Results indicate improved prevention potential for responses to targeted errors.



Back to Top
Modifed by Eddie Soh