You’ll hear six key principles for effective behavioral substitution, drawing parallels between healthcare and safety contexts. They discuss how these principles can guide both the removal of ineffective practices and the implementation of new ones, emphasizing the importance of considering practical needs, existing skills, and organizational resources when making such changes. The episode provides valuable insights for safety professionals looking to improve their organization's safety practices through evidence-based substitution strategies.

Discussion Points:

• ((00:00) Introduction and episode overview on swapping as a decluttering strategy
• (00:59) Background discussion on behavioral science and de-implementation
• (02:27) Understanding decluttering and de-implementation in healthcare context
• (05:08) Example of de-implementation in clinical practice and patient care
• (06:55) Introduction to the paper and authors' background
• (16:32) First principle: Evidence and rationale for substitute behaviors
• (19:49) Second principle: Meeting both clinical and practical objectives
• (24:51) Third principle: Clear explanability of new practices
• (26:29) Fourth principle: Time considerations for substitute behaviors
• (28:30) Fifth principle: Alignment with existing skills
• (31:40) Sixth principle: Cost implications of substitute behaviors
• (34:39) Three practical takeaways and implementation strategies, the answer to this episode’s question
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Quotes:

"You can't swap out something that people believe works for something that they don't believe works." - Drew Rae

"A lot of the safety, if not all the safety work we do in organisations is about anxiety reduction, not necessarily about improving safety.” - David Provan

"Rather than thinking about decluttering as just what we can reduce or take away, it may be more useful to think about it as a process of gradually swapping out each thing that's not working well." - Drew Rae

"If you can't explain the substitute behavior with the same ease which you can explain the behavior that you want to be implemented, then people have to work a bit harder and they might go. Why are we making this all so complex?" - David Provan

“That's the point they're making here, is like maybe the patient doesn't need care, but that doesn't mean that we shouldn't acknowledge their need for care and their need to be taken seriously.” - Drew Rae

Resources:

The Big Six: key principles for effective use of Behavior substitution in interventions to de-implement low-value care

The Safety of Work Podcast

The Safety of Work on LinkedIn

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