CAT | H1N1
What have we learned since the H1N1 scare took hold over the last several months?
Now that the incidence rate of the disease is steadily decreasing, looking back it seems that our collective fears outweighed the extant danger. I think that there is an important message here, namely, that we as individuals or as a society often miss the mark when it comes to perceiving danger. Psychologists use the term “heuristics” or aids in learning, in this case erroneous heuristics, to examine our biases when it comes to seeing danger. Let me review two of these biases in regard to the H1N1 scare.
#1 Bias; Discounting the Habitual.
As humans, we have heightened sensitivity to novel events, particularly those drenched in threat. Luckily though, as our bodies would not survive in a constant state of high alert, we adapt. Soon, constant exposure to a particular stimulus gradually becomes just another piece of the cognitive puzzle in our world of tonic stimulation. Our ability to discount recurrent bombardments of stimuli may be problematic however, when dealing with events laced with danger, as we tend to also habituate to their level of associated threat.
In my home province of Quebec, fifteen people will die today as a result of downplaying threat. In fact, 15 people died yesterday, the day before and throughout the year yielding a total of over 6500 annual deaths directly attributable to the particular threat of smoking. I don’t believe that any newspaper, TV station or any media outlet led their reporting with this fact. One could only image the media attention if 15 people per day were to die of global warming or radiation poisoning from the tailings of an uranium mine. Tobacco-related deaths are simply not news anymore, but smoking remains a significant and real danger.
… public health officials face a no-win situation with respect to future disease threats: any level of concern may seem unduly alarmist if an epidemic does not occur, but no level of preparation will be considered sufficient if an epidemic does occur.
Brown and Barrett, The Journal of Infectious Diseases 2008; 197:S34–7
Brown and Barrett’s quote highlights the dilemma faced by public health agencies as they prepare for H1N1. Clearly any form of action taken will be met with criticism, giving way to an inevitable “no-win” situation. The same prognosis may be made for even the best-conceived plans by Human Resource departments in organizations across North America. Their best efforts to develop contingency plans for potential absenteeism, promote vaccination among their employees and encourage hand-hygiene habits in the workplace might also be considered in the same negative light – damned if you do, damned if you don’t.
However, I would argue that the H1N1 threat has presented HR departments with an opportunity to promote a sure winner- wellness.
Whether the pandemic materializes or not, fit and healthy employees will be less susceptible to infection and in all likelihood will show faster recovery if stricken. However, under what is appearing as the most likely scenario, the worst of the influenza may have already passed. In either case, fit and healthy employees are more productive and less costly employees.
Shifting the HR focus to include Wellness, as well as H1N1 prevention/coping, will change the psychological gears in a very positive direction. Regrettably even the very best HR initiatives that I have seen are based on avoidance – that is, refraining from sneezing or getting vaccinated in order to AVOID the flu. (more…)
Hand Hygiene Compliance: The Workplace Environment
We continue our posts regarding the psychological aspects of the H1N1 flu by examining environmental aspects that can facilitate one of the best preventive measures – hand-washing.
#1 Easy Access; If it’s there, it’s used.
If companies want their employees to wash their hands more frequently, then they should ensure that sanitizers are easily available and that the washroom facilities are clean and well-stocked. Psychologists know that when barriers to entry for a desired behaviour are reduced, participation in that behaviour increases.
All forms of behaviour can be applied to this simple yet often underestimated phenomenon. Human behaviours are easily influenced by the availability or lack thereof of products. Most obviously, commodity providers make use of this principle to readily promote consumption. Rather problematic illustrations of this principle are replete in the literature on drug and alcohol consumption. For example, when access to beer and alcohol, either through lower price or increased store hours, is made easier, people buy more alcohol. When snack food is placed close at-hand either on the desk or close by, workers eat more. Conversely, when people have to get out of their chairs to walk to the food, less consumption occurs.
In theory, most people would use sanitizer, but rather than make people question whether a detour of several feet is worth the trouble, place the sanitizer on a stand in the middle of corridor or just after the door. Easy access promotes consumption, and making sanitizer readily available acts as constant reminder. I recently ran across a study in the American Journal of Infection Control, 2008, authored by an enterprising nurse-manager who borrowed an idea she saw in a mall –a large stainless steel tripod with automatic gel dispensers was placed outside the children’s play area with eye-catching publicity on each side. The manager modified the advertizing messages and placed the same impossible-to-miss hand hygiene dispenser mid-corridor resulting in dramatic improvements in hand sanitizing for hospital staff and visitors.
We all know that we should do it, our mothers told us to do it and now, our employers are telling us to:
Wash Our Hands
Thanks to a study by Grayson et al published in the Clinical Infectious Diseases 2009; 48:285–91, we have scientific proof that washing your hands with soap and water is a highly effective way of eliminating the H1N1 virus. In fact, in one measure of efficacy, soap and water actually bettered alcohol-based sanitizers.
That’s fine, but as a university professor and practicing clinical psychologist, I appeared not to know how to actually wash my hands. That’s before I read Dr. Carter’s definitive article in the Journal of National Medical Association that outlined the required steps:
Step 1 The Materials:
When using liquid soap, apply 3 to 5 milliliters to your hands and lather thoroughly.
If using bar soap, rinse the bar before and after using.
Use warm water, not hot, because hot water tends to open the pores and remove skin oils.
Step 2. The Action
Wash your hands, using vigorous friction, for at least 10
to 15 seconds, taking the time to wash between the fingers, on the palms and
backs of both hands, and under the fingernails.
If the hands are not visibly soiled, wash to about one inch
above the wrist. If the hands are contaminated, wash an
inch above that. After the wash is complete, rinse thoroughly
and blot with paper towels.
Step 3 The Finale
Touch nothing after the hands have been
cleaned. Use a paper towel to turn off the faucets and
open the door.
However, the question remains: now that we know how to do it, will we do it?
First of all, and long before H1N1 became an international preoccupation; hospitals were concerned about health care workers not washing their hands. Numerous reports were published about the surprisingly high percentage of medical folks who move from completing a medical procedure on one patient to the next patient without washing their hands. In one 2004 study by Girou et al, health care workers either failed to wash their hands &/or remove their gloves in 64% of caseswhere such action was required. Although some of the workers honestly believed that such hygiene was not required, most said that they were simply too busy or lacked access to a sink with soap and water.
In community studies, the data is equally grim. From observational research in public washrooms (Wirthlin Worldwide Research, 1996) – research that must have a disproportionate share of untoward events – international compliance for hand washing was approximately 50%. Numerous studies have shown that males were less compliant than females, that people often “wash” without using soap and that the time of washing is less than 5 seconds.
All these rather shocking revelations present a challenge to workplace campaigns to get employees to adopt proper hand hygiene.
In my next post, I’ll describe several helpful psychological tips that might improve the situation.
Welcome to my series concerning psychological issues related to H1N1 in the workplace.
The series is aimed at Human Resource or Occupational Medicine Departments that are now faced with developing policies and procedures to support their organizations as we head into the second wave of the H1N1 influenza.
H1N1 is a medical problem, but it’s a medical problem with built-in uncertainty. We’re uncertain about the stockpile of vaccine, the efficacy of anti-virals and most importantly, we’re uncertain about the potential penetration rate in the general population. Some government agencies have predicted 50% absenteeism from work due to the flu, others as low as 15%. When humans are confronted with decision-making under uncertainty, we tend not to do well. Studies examining everything from investment under financial uncertainty to predicting our happiness in retirement have highlighted our biases and susceptibility for self-delusion and emotional responding.
For these reason alone, H1N1 is a medical problem with a strong psychological component.
Furthermore, consider that besides vaccination, most of the preventive and containment measures are behavioural. Recommendations about hand washing, sneezing into one sleeve, the use of hand sanitizer and even quarantine etc are all mediated through cognitive filters affected by extant beliefs, attitudes, work-group norms and even environmental stimuli.
As a psychologist interested in work, I have been struck by how organizations are faced with the challenge of grafting public health measures into the work environment. More specifically, how does an organization limit disease propagation by keeping sick workers at home, or restrict co-worker contact while still maintaining their primary missions of productivity and profitability?
In the series of posts that follow, I will attempt to explore the numerous psychological facets of the current H1N1 influenza in the workplace. Where possible, I will draw attention to pertinent psychological research, but most importantly, I will offer specific suggestions to facilitate employee and organizational coping.
