Improving the Quality of Care Delivered to Children Served by State Agencies

Motivating Organizational Change

Presenter: Shan Cretin, Ph.D., M.P.H., Senior Scientist, RAND Health, Santa Monica, CA.

Motivating change in organizations relies on three factors that increase employees' willingness to make changes:

• Expectancy: Members of the organization believe, "With effort I can change my performance." Understanding what is being requested, and having the needed skills and organizational support are necessary.
• Instrumentality: Members believe, "The new performance will improve my results." Having needed skills and recognizing the alternative as effective are necessary ingredients.
• Valence: Members believe, "I place value on achieving these improved results." Recognizing a problem and having organizational support are needed.

Multiple inputs create motivation in an organizational change model, including:

• Creating a tension for change through baseline data on a problem area.
• Identifying effective alternatives from the literature and from data gathered from pilot projects.
• Providing social support.
• Developing self efficacy skills.
• Obtaining feedback (both process and performance data).

Endorsement by and continuing attention from senior leaders will drive coordination of effort and commitment of resources for change. Continued commitment to the change will be more likely if the process and performance measures show improvement over the baseline data.

Organizational improvement relies on performance data to answer:

• What are we trying to accomplish?
• How will we know that a change is an improvement?
• What changes can we make that will result in an improvement?

Communicating about change can be difficult and create confusion. This communication involves three facets:

• What happened? including facts, intention, and impact.
• Feelings, such as those related to attachment and ownership.
• Identity can be threatened, particularly when people are asked to change without explanation or buy-in.

One strategy for wide-scale change is to start small then expand as successes are demonstrated. Pilot change strategies with people and groups known to be innovators. Diffusion and integration occurs when early adopters of the change influence their "neighbors" through both data and stories. Institutionalization of the change occurs when the majority are convinced that the new way is the easy way.

To motivate and manage change, use a coordinated, multifaceted approach. This approach phases in various changes, rather than attempting to make multiple changes simultaneously. Pieces of the approach include:

• Effective communication to increase "readiness to change."
• Collaborative experimentation with new ideas.
• Judiciously selecting target populations for introduction and diffusion.
• Using measurement and feedback to communicate and to adapt.

References

Gustafson DH, Cats-Baril W, Alemi F. Systems to Support Health Policy Analysis: Theory, Models, and Uses. Ann Arbor (MI): Health Administration Press, 1992. Chapter 14.

Stone D, Patton B, Heen S. Difficult Conversations: How to Discuss What Matters Most. New York (NY): Viking Press; 1999.

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