Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups

Abstract

Introduction: Important culture-change initiatives (e.g. improving hand hygiene compliance) are frequently associated with variable uptake among different healthcare worker (HCW) categories. Inherent personality differences between these groups may explain change uptake and help improve future intervention design.

Materials and methods: We used an innovative personality-profiling tool (ColourGrid®) to assess personality differences among standard HCW categories at five large Australian hospitals using two data sources (HCW participant surveys [PS] and generic institution-wide human resource [HR] data) to: a) compare the relative accuracy of these two sources; b) identify differences between HCW groups and c) use the observed profiles to guide design strategies to improve uptake of three clinically-important initiatives (improved hand hygiene, antimicrobial stewardship and isolation procedure adherence).

Results: Results from 34,243 HCWs (HR data) and 1045 survey participants (PS data) suggest that HCWs were different from the general population, displaying more individualism, lower power distance, less uncertainty avoidance and greater cynicism about advertising messages. HR and PS data were highly concordant in identifying differences between the three key HCW categories (doctors, nursing/allied-health, support services) and predicting appropriate implementation strategies. Among doctors, the data suggest that key messaging should differ between full-time vs part-time (visiting) senior medical officers (SMO, VMO) and junior hospital medical officers (HMO), with SMO messaging focused on evidence-based compliance, VMO initiatives emphasising structured mandatory controls and prestige loss for non-adherence, and for HMOs focusing on leadership opportunity and future career risk for non-adherence.

Discussion: Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection control-related culture-change uptake. Personality profiling based on HR data may represent a useful means of developing a national culture-change "blueprint" for HCW education.

Fig 1. ColourGrid^® principles and summary profiles.

The principles of ColourGrid are based on Hofstede’s cultural dimensions theory (see text). The principles include: Power distance: relates to the extent to which the less powerful members of organizations and institutions accept and expect that power is distributed unequally. It suggests that a society’s level of inequality is endorsed by the followers as much as by the leaders. Uncertainty avoidance: indicates to what extent society tolerates uncertainty and ambiguity, and it shows how comfortable its members feel in unstructured situations which are novel, unknown, surprising or different from usual. Individualism: is the degree to which individuals are integrated into tight groups (collectivist) or loose groups (individualist). Long-term orientation: reflects long-term pragmatic attitudes versus short-term normative attitudes. Cultures scoring high on this dimension show emphasis on future rewards, notably saving, persistence, and adapting to changing circumstances.

Fig 2. Projected personality profile of HCWs compared to the Australian population, based on HR data.

HCWs were projected to have the following features: Higher than average levels of career minded professionals and post-secondary education; more affluent. Quick to take up new technology and new experiences. Very well informed, but often cynical about advertising messages and are generally difficult to convince. Assess issues then make their own decision. Challenging to others who do not share their interests or concerns to make a difference and leave a heritage of success.

Fig 3. ColourGrid^® profiles for each HCW clinical-contact category based on HR and PS data.

The number of HCWs analysed in each group (Doctors, Nursing-Allied Health, Support Services) are shown in the lower right-hand corner of each matrix. Derived personality profiles and messaging strategies are shown in Table 3.

Fig 4. ColourGrid^® profiles for each of the three doctor categories based on PS data.

The number of HCWs analysed in each group are shown in the lower right-hand corner of each matrix. Where box sizes >150%, the percentage is stated. Derived personality profiles and messaging strategies are shown in Table 4.