Academic Pediatric Association

QUALITY

IMPROVEMENT TRAINING: Module #2

This work is supported by a grant from The Centers for Disease Control & Prevention and in-kind contributions from Children’s Mercy Hospital in Kansas City, MO.

Leading Change

Module 2 Objectives

After viewing this segment, you will be able to:

1. Describe 5 key ideas for integrating change into an organization

2. Illustrate the curve showing the rate of adoption of innovation

3. Explain 5 attributes for embracing change

1. Key ideas for

integrating change

Inter-related

Key Ideas for Integrating Change

1. Taylor the presentation of a proposed change to the audience

2. Seek to understand the motivation underlying behavior

3. Avoid making the fundamental attribution error

4. Make people part of the solution5. Think carefully about using

motivators

Taylor the presentation of a proposed change to

the audienceMotivated by

evidenceInfluenced by

authorityInspired by

heart and emotions

Show them data or other evidence

Have strong leadership support for the change

Tell them the human story

Seek to understand the motivation underlying

behaviorWe tend to think that the behavior we

observe, gives us a clear window into other people’s motivation

But the truth is that we see others through our own “lens” (created by our assumptions)

http://crisasantos.com.br/com/interpersonal-communication-cartoon

http://crisasantos.com.br/com/interpersonal-communication-cartoon

“Understanding what is motivating someone rather than relying on the interpretation of the behavior can help us take appropriate actions to build commitment to change.”

From The Improvement Guide: A Practical Approach to Enhancing Organizational Performance

Fundamental Attribution Error

Tendency to place an undue emphasis on internal characteristics to explain someone else's behavior in a given situation, rather than thinking about external situational factors

Fundamental Attribution Error

Tendency to place an undue emphasis on internal characteristics to explain someone else's behavior in a given situation, rather than thinking about external situational factors.

“He’s just not that bright.”

“He’s not working hard.”

Fundamental Attribution Error

Tendency to place an undue emphasis on internal characteristics to explain someone else's behavior in a given situation, rather than thinking about external situational factors.

“There’s zero tech support.”

“The work flow is designed to give us these results.”

Me

Because of the tendency toward the fundamental attribution error with others, we’re likely to assume that a pep talk or a good chewing out is the solution

But if the problem is the system, these are not the solution

Attract people to the change by making people

part of the solution  There is more to change than

the tangible and technical aspects.

Workers may resist change if They do not feel included or They have not truly understood

the change’s expected benefits to the organization or themselves

Communication throughout the process

Types of Motivation Disincentive: punishment

Extrinsic Motivation: material reward

Intrinsic Motivation: person is socially or personally fulfilled by their involvement in an activity Moral incentivesNatural incentives

3 Key Intrinsic Motivators

For interesting reading on motivators, see Drive, by Daniel Pink

Competence

Relatedness

Autonomy

Too often, planned QI approaches diminish at least one of these.

When you’re planning your project, try to appeal to the key intrinsic motivators

or at least, try not to disrupt them.

Rate of Adoption of Innovation

Everett Rogers, The Diffusion of Innovations, 5th Edition

Rate of Adoption

Adapted from Rogers, Diffusion of Innovations (1962), www.ihi.org/openschool

Cumulative

Incidence

Categories of AdoptersInnovators : Risk takers Early Adopters (Opinion Leaders):

Willing to try the ideaEarly Majority: Try after many have

accepted itLate Majority: Skeptical Traditionalists (Laggards): Adopt

when there is no other alternative

https://lsuagcenterode.wordpress.com/2011/08/26/extension-educators-as-change-agents-riding-the-adoption-curve/

Attributes to facilitate

change

Everett Rogers, The Diffusion of Innovations, 5th Edition

Relative advantage: “Is this idea clearly better than what’s in place

Compatibility: “Does this meld with existing values, past experiences, and the needs of potential adopters?”

Simplicity: “Is this idea easy to understand and use?” 

Trialability: “Can we test this?”Observability: “How visible to

others are the results?” Adapted from Rogers, Diffusion of Innovations (1962), www.ihi.org/openschool

Attributes to facilitate change

Think back to when you were confronted with a new process

in a familiar setting…The 1st time you used self-checkout

1. Relative advantage2. Compatibility3. Simplicity4. Trialability5. Observability

Other Factors Influence Adoption of

Change

http://blog.anneadrian.com/2007/07/individual-adoption-of-change.html

Summary Key ideas for integrating change include:

Taylor your presentation to the audience Seek to understand the real motivation

behind behavior Avoid making the fundamental attribution

error Include end users in the planning phase Intrinsic incentives tend to be more long

lasting than extrinsic incentives or disincentives.

People can be grouped in categories based on how willing they are to try a new innovation

Innovations are easier to adopt if they are perceived as improvements; compatible with the existing values, past experiences, and needs of potential adopters; simple to understand and use; easy to test; and have results that are easy to observe.

Your vision is at the heart of QI.

The End of QI Module #2

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