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 solution 5. Think carefully about using motivators

Taylor the presentation of a proposed change to the audience Motivated by evidence Influenced by authority Inspired 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 behavior We 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)

“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 incentives Natural 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), Cumulative Incidence

Categories of Adopters Innovators : Risk takers Early Adopters (Opinion Leaders): Willing to try the idea Early Majority: Try after many have accepted it Late Majority: Skeptical Traditionalists (Laggards): Adopt when there is no other alternative

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), 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 advantage 2. Compatibility 3. Simplicity 4. Trialability 5. Observability

Other Factors Influence Adoption of Change

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 hey-girl-i-love-the-way-you-explain-the-fundamental-attribution-error-62b7c5.jpg