The PPE Push-back Paradox
With the global pandemic of COVID-19 we have an opportunity to explore people’s behaviors in multiple ways. One behavior that has presented itself is the push-back on wearing masks (PPE) as we are asked to help prevent the spread of the virus. This push-back covers the entire spectrum of reasoning as people will say ‘it is like stopping a mosquito with a chain link fence’ or it stops so much that it becomes ‘as dirty as a diaper’. They will even use scientific studies to support their reasoning although the studies were designed to see if a mask prevented inhalation of a virus not trapping exhalation of the virus. This PPE Push-back Paradox is nothing new. We’ve seen it before with helmet laws for motorcycles and again for pedal bikes, with seat-belt laws and with the introduction of helmets, visors and other PPE in sports. With every new introduction of PPE to control energy this push-back behavior repeats itself. Its predictability allows us to understand the behaviors that drive this PPE Push-back Paradox so we can help aid cultural shifts when required.
Growing up I remember when seat-belt laws came into effect. I was just a child but I clearly recall how my parents opposed this law. They felt that being forced to wear a seat-belt was against their freedoms. They would say things like ‘it’s uncomfortable to wear one’ even though I’ve rarely noticed wearing one myself. Even to this day my dad has a clothespin on his seat-belt limiting how far it can recoil so that it provides slack and does not touch his upper body. This act alone confuses me as he will go to the extent to comply with the law but limits the effectiveness of the seat-belt.
This true and real scenario plays out daily across the world. Ask someone to protect themselves by using PPE and you will get push-back from certain individuals. Their reality is that choosing how we live is greater than choosing to live. This is not to say that if one refuses PPE they will most certainly die from an incident. Instead it is saying that our choices with handling risk can impact our ability to fully live if a life-altering injury occurs. An injury that was preventable with PPE.
To understand why there is a PPE Push-back Paradox we first must see PPE from the behaviors definition.
What is PPE?
The obvious answer is PPE is any device one might wear to prevent energy or substances from harming the body. This is more of a clinical answer then a behavioral answer. For a behavior to accept PPE the individual must first define the PPE as being something that would benefit them. Although individuals will define ‘benefit’ differently there is unity on how behaviors define PPE. This unity holds answers we can work with.
Let’s look at seat-belts to see how unity can be found in defining this PPE. If you were to impose a seat-belt law many people will push back and fight this law. In justifying this behavior they create a multitude of reasons on how seat-belts are harmful, it’s a waste of time or it is something that would strip away their freedoms. They’d tell that obscure story of a person that was thrown from a vehicle and lived because they did not wear a seat-belt. They’d claim it is uncomfortable. They would say the 0.5 second act to buckle up was an infringement of their rights. Yet, in no way, does a seat-belt prevent them from driving as they go about their day.
Take that same individual and put them in a formula 1 car with a 5-point seat-belt and they would eagerly buckle up. Give them the opportunity to fly in a cockpit of a plane and they happily use the seat-belt. Spend a day off-roading and they’d voluntarily use the seat-belt. Get on any ride at the annual fair and they will use all safety restraint while never once complaining it infringes on their freedoms.
Why is it when one is asked to use a seat-belt while driving in their car it’s an imposition on freedom and more dangerous but when put into a situation they would cherish or activity they love to do, the same safety device is now seen as a useful tool? What changed wasn’t the energy or the PPE but how the person defined the activity. By understanding that behaviors define PPE based on the activity and not on the PPE becomes the key to communicating to peoples behaviors.
Behaviors also define PPE by the way it is communicated. If you use the term ‘gear’, like in the military or sports, behaviors see PPE differently although the ‘gear’ is still considered PPE.
What this tells us is:
- that behaviors will define PPE by the task and not the energy or the PPE,
- by influencing how a behavior see the task we can influence how the behavior sees the PPE, and
- by using different terms like ‘gear’, we can improve how behavior’s view the PPE
Once we understand how behaviors define PPE it becomes important to then understand how the behavior perceives the PPE.
Personal Perceptions of Reality
On June 1, 1979 the National Hockey League (NHL) mandated helmets to be worn. In doing so they received push-back from the players who had played hockey their entire life without a helmet. Even goalies, whose job is to put their body between a puck and the net, often refused to wear helmets prior to 1969. They had all kinds of excuses too. “I can’t see as good’, ‘it’s hot’, ‘the sweat runs into my face’. From their perception, all of these reasons were true to them. The reality of each of these reasons came down to the same root cause. They simply did not want to wear a helmet because it went against their previously formed habits. It took almost 20 years after the NHL mandated helmets, when in 1997 Craig MacTavish retired and so ended the last NHL player to skate without a helmet (1)
Further, Jacques Plante, the goalie for the Montreal Canadians in 1969, was the first goalie to wear a mask full-time. He received peer-pressure from his coach, Toe Blake, to not wear a helmet even though Plante wanted too. Blake did not want Plante to wear a helmet during regular play as he felt it would impede Plante’s vision. (2).
Fast forward 40 years and the NHL, along with all other contact sports, are now dealing with the effects of concussions and the subsequent lawsuits brought forth by the same players that fought these helmet rules. The irony is that these same players once complained against helmet rules are now suing for damages from a preventable injury because they refused to wear a helmet.
This behavioral push-back pattern repeated in 2013 when the NHL, along with the players association, mandated the use of face visors. Again, player’s pushed back and wanted an exemption clause for those players already in the NHL to have the choice of wearing a visor. 7 years later 34 of 640 players skate without a visor as they were grandfathered into an exemption. The irony is, the same reasons for pushing back for helmet rules were used for the visors. (3) The push-back behaviors did not change.
The paradox to this perception is that many of the greatest players that ever played the game are those that wore helmets and visors. This would indicate that PPE did not stop or prevent players from playing or inhibit their ability even though the behavior claimed it would. This was also true with Jacques Plante who had an 18-game winning streak immediately after he wore his helmet continuously. This winning streak also helped alleviated his coach’s peer-pressure. We learn from these examples that behaviors which oppose PPE are formed based on perception and not performance!
What this tells us is five fundamental aspects of the human behaviors that further define PPE use.
- internal perception of habits and/or external reasons from peer-pressure define the PPE
- behaviors will see the need for PPE and even advocate for it after a preventable injury occurs
- PPE does not limit performance,
- successes while wearing PPE will adjust perception, and
- some individuals will always push-back as the evolution of this new behavior will not be complete until they retire or leave the organization.
Of these lessons we learn that by limiting negative peer pressure and by identifying how PPE does not limit their ability while celebrating their successes achieved when using PPE, we can help their behavior perceive PPE as useful.
Once the behavior starts to define and perceive PPE differently we now can address the paradox.
Risk/Reward of PPE
Every choice we make is balanced by risk and reward. We often may not want to do something but still will do it as the reward outweighs the risk and vice-versa. For instance, people do not like wearing masks right now as COVID-19 is not perceived as an immediate threat to them. They will use the reasoning that only the vulnerable should wear a mask. This reason clearly shows they do not perceive themselves as vulnerable, thus they do not see there is an immediate risk to them. Put the same individual in a room with hydrogen sulfate and they will demand a mask. Put them in a room filled with smoke or dust and they will instinctively pull their shirt over their mouth. Tell them there’s a highly contagious and deadly virus going around and they will oppose a mask. This teaches us that behaviors see the risk of the hazard by if it is immediate or not.
If a hazards risk is not immediate than we need to focus on the severity of the risk. As in the NHL, we learned from the concussion lawsuits, that when a risk of a possible concussion from repeated head trauma became an injury, the player’s definition of risk transferred from what was possible (immediate) to an actual injury (severity). From this we learn that behaviors are defined by immediacy of risk or severity of risk.
When addressing risk/reward, we also must look at the reward. The reward does not have to be solely preventing an injury. The rewards can be a condition of employment, an activity that is seen as an opportunity, a prize or award, a simple act of appreciation or celebrating a successful outcome that included the use of PPE. The key is to understand and applying which reward(s) impact behaviors in the most effective way. In the NHL they mandated any new athlete must comply with the new rules and they received buy-in. The government will use monetary punishments on individuals to curb behaviors. Awards and prizes can also help motivate behaviors.
To make the reward most effective it must be seen as something worth receiving. To increase the effectiveness of the rewards, have it include the coworkers (team projects) or the spouse/family and make them aware of any prize(s). This will transfer defining the behavior to the team or the family as they encourage the individual behaviors to adapt. This also helps to limit how much work you need to do.
When addressing the risk/reward of the behavior we must:
- help define the risk immediacy or severity,
- shape the reward to impact the behavior in the most impactful way, and
- find opportunities to involve others to help define the behavior
After identifying how behaviors define and perceive PPE differently by including risk/reward we must identify how we adapt to change.
The Constant of Change
Another aspect when introducing PPE is how people react to change. Just like in the NHL, there will always be people who adapt to change easier than others. When introducing change to people we should expect resistance as people hold onto ‘the way they’ve always done thing’s’. The behavior behind fighting change in itself is a paradox as change is a constant in our lives. This constant of change can be seen as a wanted event, as an interference or is not even noticed. The reality is, whether you see change or not, your life is changing at this very moment. Along with this constant of change also comes a fundamental behavior of how will individuals react to the change? There are really only two options a behavior has to react to change. Will we work with it or oppose it? Whether you choose to work with it or oppose it one thing remains true, you can’t stop change you can only have a hand in its outcome. So why not work with it?
Along with accepting the constant of change we also must understand that people do not accept change at the same time. By understand people’s reactions to change we can understand where in the process of change they are?
Imaging you’re at the starting line of the Boston marathon. Every year this marathon draws upwards of 30,000 racers from around the world. The starting line is so full of runners that they are lined up for blocks. When the starting gun is fired only the athletes at the very front have actually crossed the starting line. Most of the runners haven’t even started to run, as it takes time to get all the runners in motion, and even more time is required to have all the runners cross the starting line.
This scenario helps draw a good illustration on how people’s behaviors react to change. When we look at COVID-19 and the use of masks we can notice how some people have embraced this PPE as a useful tool and others have opposed it as an ineffective control. Those that embraced the use of a mask often had an underlying reason to promote this new way of being. They either were the vulnerable or worked around the vulnerable, they were leaders trying to ‘walk the walk’ and lead by example, they lived in densely populated areas, there were outbreaks in their area, they could not maintain social distancing and many other reasons. They effectively saw the risk as immediate and/or severe, accepted it and adjusted their lifestyle based on the reward of proactively prevent an illness to themselves or others. Those that oppose wearing a mask do not perceive the risk as immediate and/or severe to them.
Eventually, even those that oppose mask use will slowly adapt to this new PPE. This will occur as their behavior will continue to define the mask over time. Like in the Boston Marathon, they need to first understand they are in the race, then they need to start to run, finally then they need to cross the starting line. Of course, just like Craig MacTavish in the NHL, there will always people that will never adapt to this change.
What we learn from how change impacts behaviors is:
- All behaviors are in continuous change whether they realize it or not,
- Not all behaviors will adapt to change at the same time or urgency, and
- There will always be a small minority that will permanently resist change.
When introducing PPE to people their behaviors will follow a pattern we have seen time and time again with other similar changes. This pattern of behavior will be driven by how behaviors define, perceive and adapt to change. Not everyone starts the process of change at the same time or the same place. Adapting to change can be improved with external influences and leadership. Some of these influences are how the change was first communicated which shaped the individual’s definitions of the change, the perceived personal risk and rewards and if they see the PPE as useful.
Just like with seat-belts and just like with helmets, the vast majority of people’s behaviors will adapt and adjust to this new change. As they adapt they will come to see this PPE doesn’t prevent the task. It only controls the risk. At that moment we will have taken the PPE Push-back Paradox and turned it into an improved way of being.
God bless and stay safe,