NON-REFLECTIVE PROCESSES AND HEALTH CARE QUALITY

One viewpoint is that translating research evidence into clinical practice to improve care involves having health care professionals adopting new behaviors and changing or stopping their existing behaviors. As noted in a paper appearing in the April 2022 issue of the journal Social Science & Medicine, however, changing professional behavior can be difficult, particularly when it involves altering repetitive, ingrained ways of providing care. Consequently, an increasing focus is being made on understanding health professionals’ behavior from the perspective of non-reflective processes, such as habits and routines, along with more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding professional behavior, but to date, each perspective has only been applied in isolation.

The objective of a study that was undertaken by investigators was to combine theories of habit and routine to generate a broader understanding of health care professional behavior and how it might be changed. The study involved having a group of experts meet for a two-day multidisciplinary workshop on how to advance implementation science by developing a greater understanding of non-reflective processes. From a psychological perspective, ‘habit’ is understood as a process that maintains ingrained behavior through a learned link between contextual cues and behaviors that have become associated with those cues. Theories of habit are useful for understanding an individual's role in developing and maintaining specific ways of working. Theories of “routine” add to this perspective by describing how clinical practices are formed, adapted, reinforced and discontinued in and through interactions with colleagues, systems, and organizational procedures. The researchers concluded that combining theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors operating at multiple levels of analysis, which can have an impact on the behaviors of health care professionals and on the provision of quality care.