Therapeutic behavior management

Therapeutic behavior management (TBM) is a technology for creating a clinical environment that brings out the best in staff while generating the highest possible compliance outcomes for patients. The techniques and practices of TBM are derived from the field of applied behavior analysis, the term describing the scientific study of behavior.

The field of applied behavior analysis was clearly defined by Baer, Wolf, and Risley (1968). Its subject matter is human behavior: why we act as we do, how we acquire habits, and how we lose them or change them, if change is needed. TBM is a branch of performance management that focuses on improving patient outcomes through improved compliance.

To understand behavior, behavior analysts use the same scientific methods that the physical sciences employ: precise definition of the behavior under study, experimentation, and consistent replication of the experimental findings. Basic research in this area has been conducted for over a century, however, applied research has been conducted only since the 1950s. Business, industrial, and government applications began in the late 1960s.

That non-compliance represents a threat to the future of patients and providers is demonstrated by the disastrous statistics related to direct costs, over use of the system, unnecessary health service provided, and needless deaths (125,000 in the US per year). Adherence to long-term therapies: evidence for action. Counseling and education models developed over the years to improve patient understanding and compliance have failed to move the needle. These models have been time tested and on the surface are straight forward, consistent, and logical. In spite of their clear appeal to "common sense" they are also not terribly effective. Compliance today is about the same as it was in the middle of the 5th century and in the US it is the same as in any other first world country.

The Affordable Care Act (2010) will continue to unfold and patient behavior will have a significant impact of the bottom line of care. Providers who fall below an arbitrary quality line can expect to have Medicare revenue recouped based on outcomes of care and will begin to look for ways to mitigate their risks. Developing and implementing a well-managed TBM program targeting the 50% who are non-compliant and working with them to change their behavior may represent the best path towards reducing risk.

TBM grew out of conversations between Dr. Robert E. Wright, a registered nurse and behaviorists,Aubrey Daniels, and Dr. Darnell Lattal as they looked for more efficient approaches to patient education and behavior change. From their initial conversations came a dedicated approach for developing behavior based training programs. TBM became a carefully developed method for teaching this specialized branch of performance management to health services providers, patient advocates, and family members.

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