Academic Pediatric Association QUALITY IMPROVEMENT TRAINING: Module #2 Improvement Cycles & the...
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Transcript of Academic Pediatric Association QUALITY IMPROVEMENT TRAINING: Module #2 Improvement Cycles & the...
Academic Pediatric Association
QUALITY
IMPROVEMENT TRAINING: Module #2
Improvement Cycles &Improvement Cycles &
the Psychology Of Change the Psychology Of Change
This work is supported by a grant from The Centers for Disease Control & Prevention.
National Partnership for Adolescent Immunization
PI: Peter SzilagyiCoordinators: Christina Albertin, Nui
Dhepyasuwan
Ed MarcusCindy RandJan Schriefer (QI
expert)Stanley SchafferJanet SerwintWilliam Stratbucker
Donna D'AlessandroWilliam AtkinsonPaul DardenSharon Humiston
(moderator)Keith Mann (QI
expert)
FACULTY & CONSULTANTS
This is part of the APA series on Quality Improvement. The examples focus on adolescent immunization, but the principles are widely applicable. The series includes:1. Overview: The Model for Improvement and
Deming’s System of Profound Knowledge 2. Improvement cycles and the psychology of
change 3. Initiating a QI project4. More tools to better understand the
system5. How will we know that a change is an
improvement? An introduction to QI measurement
6. Changes we can make that will result in improvement
Module 2 Objectives
After viewing this segment, you will be able to:
1.Describe 5 key ideas for integrating change
2.Contrast incentive types (intrinsic, extrinsic, and dis-incentives)
3.Explain Everett Rogers’ 5 attributes to facilitate change
5 key ideas for
integrating change
Based on The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Langley GJ, et al. 2nd Editionwww.josseybass.com
5 Key Ideas for Integrating Change
1. The differences in people2. Behavior is driven by motivation3. Fundamental attribution error4. Attracting people to the change5. Intrinsic, extrinsic, and dis-
incentives
The Differences in People
Individual preferences, aspirations, motivations, learning styles, levels of need, beliefs, values
What appeals to one individual does not appeal to another
No appeal people unwilling to make the change
Behavior Is Driven by Motivation
Observed behavior does not give us a clear window into motivation
We see through our own “lens” (created by our assumptions)
ExampleWhat I sawThe story I made up about what I sawThe truth
Seek to understand the motivation underlying the behavior
“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.”
The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Langley GJ, et al. 2nd Editionwww.josseybass.com
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.
Does not explain interpretations of one's own behavior—where situational factors are more easily recognized and can thus be taken into consideration.
If the problem is the system, a pep talk is not the solution.
Attracting People to the Change
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
“Make people part of the solution.”
The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Langley GJ, et al. 2nd Editionwww.josseybass.com
123 - EasyABC - EasyQI - Not easy
Question #1: The fundamental attribution error is best described by which of the following?A. Tendency to attribute fundamental
errors to laziness and stupidityB. Tendency to place an undue emphasis on
internal characteristics to explain someone else's behavior
C. Tendency to to place an undue emphasis on system problems to explain observed phenomenon
D. Tendency to attribute QI quotes to Dr. Deming
Question #1: The fundamental attribution error is best described by which of the following? B is correctA. Tendency to attribute fundamental
errors to laziness and stupidityB. Tendency to place an undue emphasis on
internal characteristics to explain someone else's behavior
C. Tendency to to place an undue emphasis on system problems to explain observed phenomenon
D. Tendency to attribute QI quotes to Dr. Deming
Intrinsic incentives,
extrinsic incentives,
and disincentives
Disincentive
A person can expect that the failure to act in a particular way will result in some form of punishment
Extrinsic MotivationAgent can expect some form of material reward – especially money – in exchange for acting in a particular way Often very
effective at first
Difficult to sustain
Intrinsic MotivationMoral incentives – “ the right
thing to do” or a particularly admirable thing to do
Natural incentives – E.g., curiosity, mental or physical exercise, admiration, joy, the pursuit of truth, or control (over oneself, others, things in the world)
3 Key Intrinsic Motivators
AutonomyMastery Purpose
Too often, planned QI approaches diminish at least one of these.
Drive, Daniel Pink
Usually intrinsic incentives are more sustainable than extrinsic incentives.
QUESTION #2Ron despises anything associated with “quality improvement” so, when faced with his team’s low adolescent immunization rates he announces: “We are not doing any of that QI balderdash. I’ll fix this problem myself in one minute flat. Here is a $100 bill and it goes to the nurse who gives the most vaccines to patients 11-18 years of age this month.”
Which of the following is FALSE about Ron’s approach to the problem?A. It’s unlikely to be sustainableB. It ignores some important potential “side
effects” (e.g., adolescent patients being brought in from the waiting room preferentially, decrease in nursing staff morale, sabotaging other people’s efforts to vaccinate teens)
C. It creates constancy of purpose for continual improvement at the clinic
D. It relies primarily on extrinsic motivation
Which of the following is FALSE about Ron’s approach to the problem?
5 attributes to facilitate
change
Everett Rogers, The Diffusion of Innovations, 5th Edition
5 attributes facilitate change:
1.Relative advantage2.Compatibility3.Simplicity4.“Trial – ability”5.Observability
Relative AdvantageThe extent to which the innovation is better
than existing practicesA key indicator of adoptionBut not the only indicator…good ideas do not
sell themselves because "good" can be A matter of debateNot immediately evidentComplex to understandCircumvented by economic/business/political
circumstances Considered as morally abhorrentDifficult to implement
Compatibility
Innovations are easier to adopt if they are perceived as being consistent with:Existing valuesPast experiences Needs of potential adopters
Simplicity
Innovations are easier to adopt if the end user perceives the innovation as easy to understand and use
Trial-ability
Innovations are easier to adopt if they can be tried out in part, on a temporary basis, or easily dispensed with after trial.
Observability
Innovations are easier to adopt if we can easily observe relative advantages of the change.
Summary Key ideas for integrating change include: recognizing and
responding to people’s different motivations (which are not always apparent); discerning when something is a system problem & when it is personnel problem; communicating with everyone involved in the change to make sure they feel included & understand the change’s expected benefits.
Intrinsic incentives tend to be more long lasting than extrinsic incentives or disincentives.
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 implement; easy to test; and have results that are easy to observe.
Your vision is at the heart of QI.
Quality improvement is not for the faint of heart.
The End of Module #2of Module #2