Quality Improvement

Psychology of Change

In this article you will discover your own approach to change and how you can use this knowledge to your advantage when persuading colleagues. There is an additional short section on how to overcome barriers to change. Read the previous article on helping change spread for further help facilitate the adoption of your improvements.

Assessing your Approach to Change

The following tool was developed by Discovery Learning to provide feedback on your approach to change. Understanding your own approach will help you work with others who display different styles. It allows you to customise your approach with individuals who display different perspectives and therefore impacts your effectiveness in facilitating change.

Self-Assessment

Answer the following three questions, and keep track of your answers:

• When asked to brainstorm a whole new way of doing work, do you:
  1. Welcome the opportunity to wipe the slate the clean.
  2. Want to make sure the current processes that already work are retained.
  3. Try to balance new ideas with current practices.
• When you hear about new ways of doing things that might impact your work, do you:
  1. Talk with others right away about applying the new method.
  2. Wait and see how the new methods work somewhere else before trying them yourself.
  3. Go talk to someone using the new method to learn more.
• If you attended a conference and learned about new ideas, would you:
  1. Set up meetings to discuss the exciting new ideas you have heard.
  2. Wait and try to follow key developments you have learned about to see how they work for other people.
  3. Do some research on the developments and contact other people using them to learn more.
• When a problem in your unit/clinic/department is identified, do you:
  1. Approach the problem from a fresh perspective, developing a new solution.
  2. Wait to see if the problem will resolve itself as many problems do.
  3. Apply an approach that has worked well on a similar problem.

If your results were predominantly A, you are an originator. If it is B, you are a conserver. If it is C, you are a pragmatist. Review the definitions and characteristics of each term below.

A - Originator

Love new ideas. Prefers change that is transformational and feel comfortable challenging the current structure and processes. Love to brainstorm new ideas. They like to wipe the slate clean and imagine things completely differently. They enjoy some degree of risk and uncertainty.

B - Conserver

Prefer incremental change. They value precedent and tradition. The appear to be deliberate, disciplined and organized. Open to change but want it to fit in with the current system and be evolutionary. They don’t like surprises and uncertainty.

C - Pragmatist

Like change that is functional. They tend to be agreeable, flexible and care about getting work done. They want changes to be specific to the situation. Often operate as mediators between originators and conservers and will usually take the middle-of-the-road approach. Very team orientated and good at focusing the group on reaching a consensus.

Using the Results

Once you have understood your approach to change and taken time to familiarise yourself with the remaining two categories, you will begin to see why others behave as they do. Cast aside the “I’m right and you are wrong” mentality and try to reason out the different perspectives people have. This variety of perspectives brings value to your team. An effective leader will need to stretch themselves beyond their comfort zone to accommodate these differing opinions and perspectives. Ultimately you must be able to understand your own preferences and the resulting strengths and weaknesses this brings as well as respect the preferences, perspectives and opinions of others while putting their own strengths into play.

Read more from NHS Improvement on understanding differences between individuals.

Barriers to Change

There are many different barriers to change. While you are not expected to know them all, it can be useful to recognise a few of the important ones. Forewarned, you may be able to do something about them and therefore increase the change your intervention will be successfully adopted. Important barriers to consider include:

Take a moment to consider the barriers to change we have outlined above. Can you see how any of them would apply with your own quality improvement project? Perhaps there is something you can do to help overcome or circumvent the problem? Examine your current situation with these specific issues in mind and try to find ways to overcome the barriers you have identified.

Tips for Overcoming Barriers to Change

Healthcare workers should see quality improvement as a responsibility of their job. It is a part of what they do every day! They should be encouraged to spend time thinking about how they can make patient care better. Begin by instilling this into the teams from an early stage.

One important tool for achieving change is communication. An easy but effective trick is to use story telling. Story telling has the effect of evoking human emotions leading to a powerful way to persuade others, even if the logical argument doesn’t resonate with them. NHS Improvement has written a guide on utilising the public narrative. Put this into practice while using the emotional aspect of story telling to your advantage. Give your project a human face and engage with your adopters at an emotional level. Patients can help you do this! Get them involved and use them to share their story and how your intervention has helped them. Try to combine logic into these stories by using your data mixed in with a real-life story. NHS Improvement has written a guide to help include patient stories.

The manner in which you frame your idea plays a large part in determining whether or not it will be accepted. If people misunderstand your goal and see it as a punitive change, then it will be difficult for them to adopt the intervention. Instead, take time to show them what you are trying to achieve and the reasons it would be beneficial. Help them understand that improvement is about creating a culture of learning from both success and failure. Help them to recognise the value of learning from defects and that judgement or blame have no role within improvement. In this manner, people will help you continue to improve your interventions, rather than be reluctant to use them.

Read more from NHS Improvement on overcoming barriers to change.

References

• Institute for Healthcare Improvement: Psychology of change
• NHS England: The how to guide for measurement for improvement
• NHS Improvement: Differences between individuals
• NHS Improvement: Public narrative
• NHS Improvement: Patient stories
• NHS Improvement: Overcoming barriers to change