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the burgeoning team approach to health care.66, 67 Monitoring Errors Failure-to-rescue errors seem to warrant a call for increased vigilance among all levels of caregivers. This is a highly desirable, yet difficult to attain objective without clear definitions of what behaviors make up “increased vigilance.” Geller and Johnson31 propose using a list of behavior-based expectations to specifically target behaviors linked to a patient safety objective, in this case increased vigilance on the medical unit floor. Once these behaviors are defined, they can be observed and recorded, and once a baseline level of performance is established, they can be targeted for OBM intervention. Continued data collection indicates whether the intervention is effective and should be continued. Other types of monitoring errors may be addressed adequately by using process-based data for group feedback, which would also compliment a team-based approach. Group data allow for the diffusion of responsibility so individuals do not fear personal consequences from disclosing an error. Infection Control Errors Infection errors are best addressed by targeting behaviors, such as hand washing, glove use, sterile operating room entry, and other specific infection control practices (e.g., the Institute for Healthcare Improvement “Ventilator Bundle”74). The pinpointed behavior of hand washing is widely linked to infection rates in hospitals. With reported levels of hand washing varying from one institution to another, and self-report being an inflated estimate of compliance with hygiene protocol, OBM is called for at both group and individual levels. While not directly referring to OBM practices, some research reported in medical journals suggests hospitals have been implementing OBM strategies to increase the occurrence of appropriate hygiene behaviors among caregivers.75 Communication Errors Regardless of advances in information technology, medical care will continue to involve direct communication between individuals.4 Handoff errors are a major type of communication error affected by multiple factors, including staffing shortages and caregiver fatigue. Providing all relevant patient care data to oncoming physicians and nursing staff is an obvious target for OBM. With signs in the locker room or other salient locations, oncoming caregivers might be prompted to ask end-of-shift coworkers about each patient. Communication errors with the patient may also be addressed with a number of specific behavioral approaches. Patient education is one way to prevent medical errors.73 When patients know the questions to ask and feel they can effectively communicate with caregivers, they are providing prompts to activate safe health care behaviors. Effective communication between the empowered patient and receptive caregiver not only helps alleviate patient concern about experiencing a negative outcome,73 it also adds a patient-centered, customized set of cues to 13 prompt the occurrence of critical safety-related behaviors. Patient rating data gained from discharge surveys may also lead to pinpointing caregiver behaviors in need of OBM intervention. Conclusion Much of the patient safety improvement literature calls for moving away from a negative, punishment-governed culture of blame to a more empathic, interdependent, and positive context for discussing and preventing medical errors. However, for optimal patient safety improvement, the culture of health care needs to be modified so caregivers and their patients feel safe reporting and learning from medical mistakes observed or anticipated. OBM can increase and maintain desirable behavior, but it is necessary to define the behaviors that need to be avoided and those that need to be increased. If medical errors are to be fully understood and adequately addressed, a health care culture of interpersonal trust, success seeking, and positive behavior change is needed. The effective and achievement-focused technology of OBM enables the development of this type of culture within the context of continuous learning and beneficial behavior change. Author Affiliations Center for Applied Behavior Systems (CABS), Department of Psychology, Virginia Polytechnic Institute and State University,
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