Day one of the third and final week at the Telluride Patient Safety Educational Roundtable and Student Summer Camp was not even officially underway when I had a conversation with Wendy Madigowsky MD, a medical educator and longstanding Roundtable faculty member from Denver, CO, about healthcare leaders having to first recognize the need for change in the way healthcare is delivered, in order to start implementing some of the ideas we are discussing here in the mountains. To that point, Dr. James Prochaska, who developed the Transtheoretical Model of Behavior Change and has authored over 300 papers on behavior change for health promotion and disease prevention, defined 5 stages of behavior change which include:
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
Those unaware of the need for change are considered Precontemplators in Prochaska’s model, and are defined as:
Participants at this stage do not intend to start the healthy behavior in the near future (within 6 months), and may be unaware of the need to change.
Participants here learn more about healthy behavior: they are encouraged to think about the Pros of changing their behavior and to feel emotions about the effects of their negative behavior on others.
Precontemplators typically underestimate the Pros of changing, overestimate the Cons, and often are not aware of making such mistakes. These individuals are encouraged to become more mindful of their decision-making and more conscious of the multiple benefits of changing an unhealthy behavior.
Prochaska then goes on to explain in order to move from one stage to the next, an individual has to perceive the pros of moving forward to outweigh the cons related to staying in the current stage. The question then, is how do we as a group create enough energy, enough data, a loud enough collective voice and proof of concept to convince as many as possible that there exists real and immediate need for change in healthcare before the next harm event occurs? Moving from precontemplation to action because a medical error occurs is not in the best interest of patient or provider. What actions can those aware of the need for change in healthcare take today, in order to move forward on the change continuum? This is the challenge–to take the learning from Telluride, and turn it into action on behalf of patients!