Characterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle

Steinmo, Siri; Fuller, Christopher; Stone, Sheldon P.; Michie, Susan

doi:10.1186/s13012-015-0300-7

Implementation Science

Table 3 Characterising intervention content and mechanisms of action using the BCT taxonomy (v1); behaviour change wheel; capability, motivation, behaviour model; and TDF

From: Characterising an implementation intervention in terms of behaviour change techniques and theory: the ‘Sepsis Six’ clinical care bundle

Intervention component	Intervention content		Mechanisms of action
	BCTs	Functions	COM-B	TDF
Group introductory education and training sessions delivered to staff in groups
Discussion on severity and susceptibility of sepsis	Information about health consequences	Education	Psy C	Kn
Instruction on how and when to implement	Instruction on how to perform behaviour	Education	Psy C	Kn
Story of a young patient who had died from sepsis is told	Information about health consequences	Persuasion	Ref M, Auto M	B Con, Em,
Discussion of good implementation on other wards	Social comparison	Persuasion	Soc O, Ref M	SI, B Cap, S/P Id
Evidence for the efficacy of Sepsis Six for improving patient outcomes given	Information about health consequences	Education, persuasion	Psy C, Ref M	Kn, B Con
Sepsis Six simulation training (observation and practice)	Demo of behaviour, instruction on how to perform behaviour, behavioural practice, habit formation	Modelling, education, training	Phys C, Psy C	Sk, Kn, MAD, BR
Discussion on ease of implementation	Verbal persuasion about capability	Persuasion	Ref M	B Cap, Opt
Video provided instruction on six steps, patient story and praise for staff who had treated patient	Instruction on how to perform behaviour, information about health consequences, social reward	Education, persuasion, incentivisation	Psy C, Ref M, Auto M	Kn, B Con, Em, Reinf.
Ward target of SUI reduction by 50 % set	Goal setting (outcome)	Enablement	Ref M	Goal
Ward target of implementation for 95 % of patients set	Goal setting (behaviour)	Enablement	Ref M	Goal
Staff are encouraged to have legitimate authority to commence Sepsis Six using their clinical discretion (regardless of role)	Social support (unspecified)	Enablement	Soc O, Ref M	SI, S/P Id, B Cap
Staff are encouraged to seek support from superiors and facilitators regarding implementation issues	Social support (unspecified)	Enablement	Soc O	SI
Documents and materials provided to aid implementation
Sepsis trolley and sepsis bags contained all instruments required to implement pathway	Adding objects to environment, prompts/cues	Environmental restructuring, enablement	Psy C, Phys O	MAD, Env
Cupboards contained all antibiotics likely to be needed	Adding objects to environment	Environmental restructuring	Phys O	Env
Sepsis Six logo displayed throughout wards	Adding objects to environment, prompts/cues	Environmental restructuring	Psy C, Phys O	MAD, Env
Intranet resource provided instruction on implementation	Instruction on how to perform behaviour	Education	Psy C	Kn
Antibiotics protocol provided instruction on appropriate antibiotic selection	Instruction on how to perform behaviour	Education	Psy C	Kn
Six-step checklist provided visual prompt and included checklist for completion of each step	Self-monitoring, prompts/cues	Enablement, environmental restructuring	Psy C	MAD, BR
Smartphone app provided instruction on implementation and timer for monitoring step completion	Prompts/cues, instruction on how to perform behaviour, self-monitoring	Education, enablement	Psy C	MAD, Kn, BR
Ongoing group-level audit and feedback
Daily implementation rates displayed in staff room and updated daily	Monitoring of behaviour by others	Persuasion	Ref M	B Con, B Cap
Comparison of current performance with 95 % target made	Discrepancy b/t behaviour and goal	Enablement	Ref M	Goal
Verbal feedback implementation rates given	Feedback on behaviour	Education, persuasion	Psy C, Ref M	Kn, B Con
Generation of solutions for better implementation (staff and facilitator cooperative planning)	Problem solving	Enablement	Psy C, Soc O	BR, SI, B Cap
Reporting of patient outcomes data	Feedback on outcome of behaviour	Persuasion	Ref M	B Con
Clinical follow-up for patients who received Sepsis Six	Feedback on outcome of behaviour	Persuasion	Ref M, Auto M	B Con, Em
Discussion of past targets hit	Focus on past success	Persuasion	Ref M	B Cap
Praise from the board and facilitators for improvements made and targets reached	Social reward	Incentivisation	Ref M, Auto M	B Cap, Reinf.
Individual intervention for cases of non-implementation
Verbal feedback on individual performance given	Feedback on behaviour	Education, persuasion	Psy C, Ref M	Kn, B Con
Generation of solutions for better individual implementation (cooperative planning with facilitator)	Problem solving	Enablement	Psy C, Soc O, Ref M	BR, SI , B Cap

TDF domain abbreviations: Sk skills, Kn knowledge, MAD memory, attention and decision processes, BR behavioural regulation, SI social influences, Env environmental context and resources, Reinf reinforcement, B Cap beliefs about capabilities, B Con beliefs about consequences, S/P Id social/professional role and identity, Opt optimism, Goal goals, Em emotions
COM-B abbreviations: Phys C physical capability, Psy C psychological capability, Soc O social opportunity, Phys O physical opportunity, Ref M reflective motivation, Auto M automatic motivation

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ISSN: 1748-5908

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