IHI 2018: Why it’s crucial to tap into the ‘psychology of change’ to sustain quality improvement efforts

Doctor with patient
Providers are really looking to see more of the humanity restored in healthcare, researchers at IHI found. (Getty/wutwhanfoto)

ORLANDO, Fla.—As providers push quality improvement initiatives, a key part of making those changes stick is emphasizing the human element.

With that in mind, the Institute for Healthcare Improvement released a framework this week aimed at getting to the “psychology of change” when it comes to effectively motivating staff around quality improvement projects.

In particular, the framework addresses five the most important elements when it comes to engaging clinical staff: Tap into intrinsic motivation, collaborate on change that’s people-driven, be authentic, distribute power and be adaptive in action.  It’s built on thinking that many quality improvement teams were already putting into practice—they just lacked formal vocabulary and a model for it, Kate Hilton, faculty at IHI and one of the framework’s authors, told FierceHealthcare.


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“Many improvement leaders talk about the psychology of change but never had a shared understanding or vocabulary that was explicit,” Hilton said.

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The framework was a spotlighted initiative at the IHI’s National Forum this week. Hilton and co-author Alex Anderson, a research associate at IHI, said the key element in motivating staff is to inspire agency and courage—the power to take purposeful action and the emotional drive to act in uncertain situations.

Because these concepts are universal, Hilton said the model was designed without a specific audience in mind, so it can be used to engage with any stakeholder in quality—including patients and the C-suite.

To best involve patients, Hilton said it’s crucial to ask them what they value and what matters to them, and to ensure they feel that they’re genuinely being listened to. Make patients active partners in determining their care and creating better outcomes, she said, and be sensitive to the individual concerns that may shape their perspectives.

Anderson said that the guidance has also been received positively by executives, who are just as frustrated as frontline clinicians on how technical and almost robotic healthcare has become.

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Stakeholders at all levels of healthcare are asking for a bit more of the human touch in the work they do, and that includes leaders at the top, he said.

“We’re very intentional in the framework about doing this for creating that humanity,” he said. “That transparency is really refreshing.”

The guide notes that there is no set way to measure the impact that tapping into these factors can have. Instead, providers will have to consider the best way to track progress as it relates to a specific quality improvement initiative.

For example, a solution could be regular surveying to monitor if team members feel as though their work is contributing to shared goals and purpose. Drilling down to specific units, departments or disciplines may also be a useful way to track these trends, according to the framework.

“I think it was really critical for us to shift focus to one of person and the who and the why,” Hilton said, “and help people access and activate both their power and their courage.”

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