The Group Psychology of Infection Prevention
Have you ever thought about what drives human behavior? Have you ever wondered how extreme groups like the Nazi’s or Al-Qaeda were formed? Or how people make decisions in general? Or why we act one way in one situation and the complete opposite in another?
Are you stumped? That’s okay, when it comes to human behavior there are rarely any simple answers. My Social Psychology professor used to ask us yes or no questions all the time, and it got to be a running joke because the real answer was always, “It depends.”
I’ve heard a lot of ideas about what could be holding us back in infection prevention, and some of the discussions have reminded me of that Social Psychology class. Infection prevention is a group effort, and group dynamics can have a huge impact on behavior and, by extension, the quality of infection prevention. It doesn’t matter if there are infection prevention products and ideas of every size, shape, and cost. In the end, it is humans that using that technology and humans that are implementing those new ideas. And even though that copper table doesn’t care what the UV Flash thinks, the nurse using them both is susceptible to the effects of group dynamics.
Here are 5 Psychological Principles that could be hindering infection prevention in your healthcare facility:
1. Group Think
Do you remember, in school, when the teacher would randomly assign people to groups and have them create a presentation, paper, or work on some sort of project? It can be stressful. Everyone wants that group to get along and work well together because you all have a common goal and you’ll be more successful as a unit. “United we stand, divided we fall”, right? So oftentimes, you agree on one of the first ideas that is brought up. Any doubts or misgivings you have you keep to yourself because you don’t want to “rock the boat” or cause problems.
When it comes to infection prevention, workers, obviously, have a common goal: no infections. So if someone has an opinion contrary to what the group thinks, there is a chance they won’t want to risk causing problems and will keep quiet for the sake of group cohesiveness.
2. Group Polarization
Let’s say you stand outside Comerica Park in downtown Detroit before a Tigers baseball game, pick out 10 people wearing a shirt with Miguel Cabrera’s name on the back, put them in a room together, and tell them to talk baseball. We already know these 10 people like the Tigers. We already know these 10 people like Cabrera (for all the readers not into baseball, he is one of Detroit’s top players).
What the Group Polarization theory claims is when these people are put in a group and told to talk about something that they already agree on, they’re opinion will become polarized. In other words, they’ll feed off each other and come out of that room with a stronger and more extreme opinion than they started with. One person might say, “I think Cabrera is the best player on the team.” And other is going to say, “Yeah he’s the best player on the team. Heck, he’s the best player in the American League!” And a third will respond, “He’s the best player in the history of baseball!” And everyone will nod their heads and agree that, yes, Miguel Cabrera is the best baseball player in the history of baseball.
The same goes for infection prevention. If you get a group of hand washing advocates in the same room, they might say hand washing prevents the spread of MRSA. No, actually, hand washing is the BEST way to prevent the spread of MRSA. No, hand washing is the ONLY way to really prevent the spread of MRSA. In cohesive groups, members often get so fired up about one agreed-upon idea that they forget to consider alternatives.
3. Group Conformity
In 1951, Solomon Asch conducted an experiment. He would tell each participant they were taking a vision test with a group of about 5 other participants. However, the other participants in the group were actually confederates, or actors following the directions of the experimenter. The participants and confederates were then told to look at the line on the left and choose whether line A, B, or C on the right matched it most closely in length. Every time, the actual participant had to answer last, after hearing the confederates’ answers.
Now, I don’t want to influence your opinion, but line C is the correct choice, right? Well, what Asch would do is have every single confederate answer wrong, let’s say with Line A. And, even though Line A was clearly the wrong choice, the real participant almost always answered Line A, conforming with the group opinion.
Whether we admit it or not, we are all somewhat susceptible to the opinion of those around us. And if I’m a nurse in the Intensive Care Unit and every single other nurse appears to agrees that antimicrobial copper is a waste of time, I might bite my tongue to fit in with the group.
4. Social Loafing
Okay, everyone, admit it. We’ve all slacked off in a group before because we assume someone else will take step up and take responsibility. It’s common, but it’s dangerous, especially when it comes to infection prevention. What if I’m working in a Sterile Processing Department and I don’t scrub an instrument thoroughly enough because I assume it’s someone else’s job to make sure that instrument comes out clean? How do I know that’s not what everyone else is thinking? Then who is actually taking responsibility? Is anyone?
During WWII, the Nazis killed millions of people and carried out unimaginable acts of cruelty. On trial after the war, the most common defense was, “I was just following orders.” Obedience. Stanley Milgram tested this idea of obedience in one of the most famous psychological studies ever. I won’t into the details (read more about the experiment here), but he found that your average citizen was willing to administer dangerously high levels of electric voltage to another “participant” (actually a confederate following Milgram’s directions) just because a figure of authority told them to. Obedience.
If my supervisor tells me not to worry about cleaning that Operating Room, wouldn’t I assume that they know best since they’re in authority over me? If my boss tells me that new technology doesn’t actually work, wouldn’t I believe they know what they’re talking about? Blind obedience can be a huge obstacle to effective infection prevention.
Infection prevention still has to be a group effort, there’s no way to avoid it. But we do need to be aware of some of the possible negative effects that come from working in groups and how that could negatively impact infection prevention. But, as we always say, knowledge is power. And the more aware you are of these group dynamics, the less susceptible you are to them.