Pain management

Successful innovation is about people changing what they do, their normal behaviours, their daily routines. It sounds simple enough in theory, but we all know that in practice, it’s not so easy. In many of Innovia’s holistic innovation projects, we design the behavioural interventions that will help make change happen. This is particularly important for complex products and services where the successful delivery depends on several stakeholders. There are many examples: hotel services, financial services, hospice care, transport services, or production line operations, to name a few. To effect change, we need a set of interventions working at different points of the process, for different stakeholders and for different timescales – a full intervention strategy, rather than one ‘magic bullet’. To understand change from the perspective of a range of stakeholders requires a holistic approach: the skills to see the world from the standpoint of their discipline and integrate their contribution into the wider system.

As an example, veterinary surgeon Guen Bradbury and behavioural scientist Katie Morton worked together to develop a range of interventions to drive better provision of pain relief in veterinary practice. Their work was published as “Using behavioural science to improve pain management,” in this month’s edition of the journal ‘In Practice.’

Guen says:
“Research shows that, even when human beings have the best of intentions, their behaviour does not always reflect these intentions. Veterinary surgeons like me try to do the right thing for our animal patients. We swear an oath to ‘ensure the health and welfare of animals committed to our care.’ However, the management of pain in animals is an example of where veterinary behaviour does not always align with our intentions, and the result is that animals do not always receive appropriate pain relief. There are various reasons for this, which I outlined in a previous paper (Malik and Bradbury, 2016, reported in the American Veterinarian). Vets may be unable to recognise pain (through lack of skills, lack of empathy or compassion fatigue), they may not have access to pain medications, or they may not be motivated to treat pain (due to concerns around side effects, costs, prejudice about the ‘worth’ of the species, or desire to restrict postoperative movement).

“I used to think that the solution to all of these challenges was better education. Teach vets why managing pain improved both animal welfare and clinical outcomes, I thought, and vets would prescribe more pain medications.

“However, the evidence does not support my instinct. When behavioural scientists analysed behaviour across the medical profession, they found that education alone was rarely enough to change behaviour. As vets, we like to think that we are highly rational, but we’re also human, and therefore we’re also irrational, as well as being affected by a range of factors within our wider environment.

“Here was a problem to solve. I wanted to explore how the whole practice team (vets, vet nurses, receptionists, and practice managers) could increase the likelihood of the vet providing appropriate pain relief. I worked with my colleague, Dr Katie Morton. Katie has a PhD in behavioural medicine, and is part of the behavioural science team here at Innovia.

“Once I’d specified the problem, Katie applied the COM-B model (Capability, Opportunity, Motivation, Behaviour) and the associated ‘Behaviour Change Wheel’ (Michie and others, 2011) to the behaviour of providing pain relief applied to each of the stakeholder groups. These provide a structured understanding of the barriers to a given behaviour, and suggest appropriate intervention categories to change the behaviour. We wrote a paper for In Practice to show the work in context, and make it relevant to veterinary teams.

“Our analysis showed how veterinary practices could identify the specific barriers affecting their team, and also how they could select and test appropriate interventions from the wide range described by the model. This range included enabling receptionists to raise the salience of pain with pet owners, empowering nurses to recognise and report pain, encouraging practice managers to set shared goals around pain control, and incentivising vets to make pain relief a priority.

“Our toolkit gives practices a way to understand their possible barriers to good pain management, and identify specific, testable changes they can make to improve the management of pain. Behavioural science can help to align veterinary behaviours with our rational intentions, and improve the welfare of the animals under our care.”

References
Bradbury, A.G. and Morton, K.L., 2017. Using behavioural science to improve pain management. In Practice, 39: 255-272

Malik, A. and Bradbury, A.G., 2016. How Can Nurses Improve Pain Management Within the Veterinary Clinic?. Veterinary Nursing Journal, 31(5), pp.140-143.

Michie, S., van Stralen, M.M. and West, R., 2011. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), p.42.