It All Begins With... PERCEPTION

1. Speaking the Language of Medicine: The Larger Benefits of Evidence Based PracticeJim Shea MS, CTRStjshea@bpthosp.orgBridgeport HospitalBridgeport CT

2. It All Begins With...PERCEPTION • The recognition and interpretation of a stimuli that serves as the basis for understanding or for motivating a particular action or reaction

3. Bottom Up • Direct input creates our perception • Each fact we receive builds the case • What you see is what you get

4. Top Down • We make inferences about what we see and try to make a best guess • Prior knowledge and past experiences are critical • We develop a PERCEPTUAL HYPOTHESIS based on this prior knowledge

5. The First Way Errors Can Occur • We actively construct our perception of reality • Input enters and is combined with what we already know

6. The 2nd Way Errors Can Occur • When things are presented in a familiar context, we rapidly judge • When we rapidly judge, we no longer look for details that we assume to be present

7. The 3rd Way Errors Can Occur • Hypothesis testing occurs to make sense of the input coming in • The formation of an incorrect hypothesis will lead to errors in perception • Filtering incorrectly validates this hypothesis

8. How did this error occur?(prior knowledge) • Previous experience working in a nursing home • Diversion • Quantity = Quality

9. How did this error occur?(prior knowledge) The word RECREATION • Implies diversion • Implies fun, non clinical…….. • Para professional provide recreation • He saw some of the similar activities being conducted that he saw being offered in the nursing home

10. Some Was Our Own Doing • Treatment Team Meetings • Too much emphasis was placed by the CTRS in discussing the details of the activity and not enough emphasis on the outcome example: baking

11. Words That Worked Against Us • The patient played... • The patient had fun doing… • The patient enjoyed...

12. Despite efforts to educate and highlight the therapeutic nature of what we were doing, the hypothesis was established filtering confirmed the hypothesis • “Patients have told me…”

13. This Created Cognitive Dissonance For Us • On the one hand, we believed that we were a good department that provided high quality, effective therapy. • On the other hand, we were being told we were nothing more than a service that is providing diversional activities to keep people busy.

14. We Had Three Choices • Focus on more supportive beliefs that outweigh the dissonant belief or behavior (He doesn’t know what he is talking about) • Reduce the importance of the conflicting belief (What he believes is not important) • Change the conflicting belief so that it is consistent with other beliefs or behaviors

15. What to do? • Part of the answer was close by (music therapy) • Part was to pay attention to what was valued

16. The Language of Healthcare • Evidence • Outcomes • Best Practice

17. Interventions were selected using traditional considerations • Mission/purpose of unit • Length of stay • Available resources (space/budget/staff) • Assessment • Activity Analysis • A belief that there was evidence

18. Decision was made to go through a process to validate (or invalidate) programming • To bring it in line with other disciplines • To improve patient care • To change perception

19. Examine the research that supports the treatment provided • Research to validate current interventions • Research (or lack of research) that does not support the use of some interventions • Research to add additional interventions

20. Some practical challenges • Limited studies to directly link specific RT interventions with desired outcomes • Diagnosis • Interdisciplinary treatment goals • Setting

21. Look for studies that are as close as possible to the ideal • Studies that directly connect an intervention with the exact desired outcome for the exact population • Studies that show an intervention with similar characteristics linked to the exact desired outcome for the exact population • Intervention • Outcome • Population

22. Once The Evidence Was Established, We Validated The Results • Creation of an outcomes tool that consisted of 4 questions • The Therapist Was Respectful • Goals Of The Session Were Explained • The Session Kept My Interest • The Session Helped Me Make Progress Towards My Treatment Goals As Well As Patient Comments

23. There were 204 surveys completed in a 3 month period • A report was created that summarized the findings • The overall rating was 4.6/5

24. The report examined the 4 variables for each intervention (group). • Particular attention was paid to the question asking the patient to rate to what degree the session helped them achieve their overall treatment goals (4.5/5). • There were 46 patient comments made and 44 were positive comments (95.65%).

25. How Did Perception Change? • Formal presentation of evidence to support clinical practice to psychiatric leadership team • Outcome Measure • Each session for 3 months • Development of departmental treatment team report guidelines

26. Words Matter • The patient played... • The activity • The game • The patient came to recreation • The patient engaged in… • The session • The structured task • The patient came to therapy

27. How Did Perception Change? • Invited MD’s to monitor report in treatment team (forced filtering) • Recent Vacancy

28. How Did Self Perception Change?