Determinants of intention to deviate from clinical practice guidelines

Abstract

The volitional nature of procedural violations in work systems creates a challenge for human factors research andpractice. In order to understand how violations are caused and what can be done to mitigate them, there is a need to determine the influence of workers' beliefs about rules and guidelines. This study demonstrates the use of a social psychological approach to investigate the beliefs of anaesthetists about clinical practice guidelines. A survey was completed by 629 consultant anaesthetists, who rated their beliefs about deviation from three guidelines (performing pre-operative visits; checking anaesthetic equipment; handling intravenous fluid bags). Regression analysis indicated that the belief ratings predicted self-rated intention to deviate from the guidelines. Implications for understanding anaesthetists' adherence to guidelines are discussed.

Statement of Relevance: This study builds upon previous work by the authors, presenting a more detailed insight into potential causes of procedural violations in healthcare. The study also demonstrates the use of a social psychological method to the investigation of violations. Hence, it is of interest to researchers and practitioners interested in human reliability, especially in healthcare.

Keywords:

• anaesthesia
• patient safety
• psychology
• theory of planned behaviour
• violations

Acknowledgements

The research described in this paper was funded by the Engineering and Physical Sciences Research Council under Grant Number EP/C513339/1 and is an extension of work presented at the Improving Patient Safety Conference, Cambridge, 18 July 2008. The authors would like to thank Elisah Pals and Chidozie Nsoedo for their assistance with questionnaire design and data collection.