Wednesday, February 17, 2016

Sea spurge, compacts, and other descendants of Wipe off 5

Today's story is about how to implement a cultural change among a large group of people.  Stick with me, as this will take a moment.

Back in 2001 the Victoria Transport Accident Commission wanted people to slow down just a bit while driving.  They understood that "Speeding just 5km/hr over the speed limit can mean the difference between a close call and a serious accident."  The question was how to get people to do it, and do it consistently.  Of course, you could have police and traffic cameras trying to enforce the speed limit, but that is resource intensive and can never be pervasive enough to hold thousands of drivers accountable to this standard. It would be better if people would internalize the message and hold themselves accountable.

What resulted was the Wipe off 5 campaign.  TAC employed a simple statement of principle and combined it with an easily understood and remembered action that every driver could take.

The fact statement was pretty straightforward and incontrovertible:

Each year about 100 hundred people die on our roads every year in crashes where speed was a contributing factor. The TAC spends about $1 billion every year on support services for those affected by road trauma and accepts about 19,000 claims each year from people injured in crashes.

The ask from the public was widely publicized in forums that were frequented by people--standard media and social media.  Highly respected advocates (Footy stars!) lent their names and images.

Low level speeding is the target of this latest TAC campaign - the aim to make people aware that travelling only 5km/hr over the speed limit can have disastrous results.

Throughout the month of August, the Wipe off 5 message will be spread through social media, a Statewide roadshow that will tour Victoria and the commercial featuring famous AFL number 5’s, Carlton's Chris Judd and Collingwood's Nick Maxwell.

The results were both immediate and sustained:

Over time there has been a change in community attitudes towards speeding and also in behaviour. According to Sweeney Research, people who report they speed most, or all, of the time has dropped from 25% to 11%.

Market research surveys show that the Wipe off 5 concept is generally understood by Victorian motorists and is having a positive affect on their driving behaviour. Since the campaign began, Vic Roads has reported a drop in average travel speeds in 60km, 70km and 80 km/h speed zones.

Now another story, this time from the beach.  There is an invasive plant species, sea spurge (Euphorbia paralias), that has taken over many of the dune areas in Australia beaches.  As noted here:

Sea spurge can produce up to 5000 salt-tolerant seeds. These seeds can survive for a number of years on ocean currents that spread them from beach to beach. Once established, a sea spurge colony can spread rapidly, displacing the native vegetation and changing the structure of the beach. This can disrupt many native species including the endangered shorebirds (hooded plovers, little terns and oyster catchers) that use open sand spits for nesting.

Although the plant is not unattractive, its displacement of local species is troubling, and a number of people in the Cape Paterson region have banded together to try to remove it from the dunes in their area.  Work parties go out periodically to carefully pull up the plants.  (It has to be done carefully or, as seen above, the remaining root structure will spread into dozens of new plants.)

But two or three dozen stalwart volunteers alone cannot maintain several kilometers of beach front, and so the group has been encouraging other folks who use the beach to pitch in--to be part of the culture of removing the invaders.  But the trick was to make the job memorable and approachable, so that each person would take personal accountability to help out.  Rod Phillips, one of the organizers, suggested that the team adopt a take-off of the Wipe off 5 campaign, and "Take out 10" was born!  As people walk along the beach, they can easily pitch in by pulling up ten of the plants and walk on, knowing they have helped.  There are now several sections of the beach that remain remarkably free of the plant.

Finally, let's turn to a story that is in its early stages.  A group of senior administrators and clinicians at Royal Children's Hospital in Melbourne have spent several months engaging staff in the construction of a compact between and among the medical and managerial staff. Hundreds of people have spent thousands of hours constructing this document, which is meant to reflect the values that should govern behavior in the hospital.

The compact represents a personal commitment of those who sign on to it.  There is no enforcement mechanism.  It is the exemplar of self-accountability.  The as yet unanswered question is whether is will make a difference in changing the culture of RCH.

As one staff member noted:  "Getting the words down is just the first step.  It's all about the deeds."

Another, analyzing behavior patterns in the hospital, said: "We need to look at ourselves as a tribe, not at the tribes within the hospital."

Another noted that there is "a need to call out bad behavior in real time" in a way that is viewed as positive and constructive.

The best summary of one desired outcome was:  "We need to stop saying this is my patient and instead say that this is our patient."

And finally, the clincher: "We should look after each other."

So the question for RCH and other institutions that seek to raise the level of kindness in their delivery of medical care is how to translate excellent words into excellent action.  And it is here that perhaps the lessons of "Wipe off 5" and "Take out 10" might offer assistance.

If staff members at the RCH focus their efforts on the global behavioral change that is envisioned in the compact, the task may seem overwhelming.  There are so many sentences and so many words.  Which should get priority?  How should this affect my daily life?  Viewing such a large task might even be paralyzing.  Instead, what if the hospital were to implement the compact by adopting an analogy to a simple mnemonic, a daily standard that could be incorporated into each person's work flow and interactions?

I'm not clever enough to know what might work, but perhaps something like "Show five types of caring each day."  Or, "Offer ten kinds of kindness."  The point is to make the desired task clear, compelling, and practical--allowing each person to go home at the end of the day claiming success in helping to instill the culture so eloquently set forth in the compact.


Unknown said...

Great article, Paul! Culture change within a large group is incredibly hard, but I really like how you connected this to the Wipe Off 5 campaign. Often, culture is something brought to and instilled in an organization through it's leadership. Another note, the "need to call out bad behavior in real time" is a good thought, but like you said- it needs to be positive and creative in order to create and sustain a culture of safety. But I do believe that this should be true in healthcare for all clinicians and that physicians can't be held above this standard. This is a great way to prevent and decrease errors!

Anonymous said...


This is a great article about successful change. It reminds me of the very successful campaign in Texas to reduce litter on the highways, "Don't mess with Texas".

Gene Lindsey

Paul Levy said...

Thanks, Gene!

Joseph Chiweshe, MD said...

Interesting article Paul, and also enjoyed the analogy of the invasive plant. Sustainable culture is an all-encompassing effort that I believe starts with being able to establish a unified and shared vision that the large or small group can embrace and believe in. As you mention in concluding that an essential element is a clear, compelling and practical take away team members can carry with them. This is something I have been recently thinking about and mention in It may be of interest as well.