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Changing healthcare professionals' non-reflective processes to improve the quality of care

Lookup NU author(s): Dr Sebastian Potthoff, Dominika Kwaśnicka, Dr Leah Avery, Dr Tracy Finch, Professor Marie Johnston, Dr Gregory Maniatopoulos, Dr Marta Marques, Dr Justin Presseau, Professor Tim Rapley, Professor Luke ValeORCiD, Professor Jeremy Grimshaw



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 Rationale: Translating research evidence into clinical practice to improve care involves healthcare professionals adopting new behaviours and changing or stopping their existing behaviours. However, changing healthcare professional behaviour can be difficult, particularly when it involves changing repetitive, ingrained ways of providing care. There is an increasing focus on understanding healthcare professional behaviour in terms of non-reflective processes, such as habits and routines, in addition to the more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding healthcare professional behaviour, although to date, each perspective has only been applied in isolation. Objectives: To combine theories of habit and routine to generate a broader understanding of healthcare professional behaviour and how it might be changed. Methods: Sixteen experts met for a two-day multidisciplinary workshop on how to advance implementation science by developing greater understanding of non-reflective processes. Results: From a psychological perspective ‘habit’ is understood as a process that maintains ingrained behaviour through a learned link between contextual cues and behaviours that have become associated with those cues. Theories of habit are useful for understanding the individual's role in developing and maintaining specific ways of working. Theories of routine add to this perspective by describing how clinical practices are formed, adapted, reinforced and discontinued in and through interactions with colleagues, systems and organisational procedures. We suggest a selection of theory-based strategies to advance understanding of healthcare professionals' habits and routines and how to change them. Conclusion: Combining theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors, operating at multiple levels of analysis, which can impact on the behaviours of healthcare professionals, and so quality of care provision.

Publication metadata

Author(s): Potthoff S, Kwasnicka D, Avery L, Finch T, Gardner B, Hankonen N, Johnston D, Johnston M, Kok G, Lally P, Maniatopoulos G, Marques MM, McCleary N, Presseau J, Rapley T, Sanders T, ten Hoor G, Vale L, Verplanken B, Grimshaw JM

Publication type: Article

Publication status: Published

Journal: Social Science and Medicine

Year: 2022

Volume: 298

Print publication date: 01/04/2022

Online publication date: 23/02/2022

Acceptance date: 20/02/2022

Date deposited: 24/03/2022

ISSN (print): 0277-9536

ISSN (electronic): 1873-5347

Publisher: Elsevier Ltd


DOI: 10.1016/j.socscimed.2022.114840


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Funder referenceFunder name
GIFTS ID 7223The Health Foundation