Table 3

Illustrating the psychological conditions for motivating changeā€”a case example from Unicef UK

What was the change?What was the policy-practice paradox?
The Baby Friendly Initiative (BFI) is a set of best practice standards and the BFI award is a nationally recognised mark of quality care in maternity and health visiting services. Services implement the standards in stages over a number of years and at each stage they are externally assessed by Unicef UK. When they pass all stages, services are accredited and can ultimately go on to a Gold Award for the permanent embedding of BFI standards. Although services will have already been doing BFI, the requirements for the Gold Award are a significant step up. This requires considerable changes to the leadership, culture and systems within a service to enable BFI to be maintained in the long term.East Lancashire Hospitals Trust was the first service to achieve the Gold Award. Having successfully increased breastfeeding initiation rates from 27% to 74% since the beginning of the BFI project, the service felt ready to start work on the Gold Award. However, the prospect of doing the work was daunting and there was a perceived mismatch between the high expectations of the Gold Award and the capabilities of the local context. The requirements of the Gold Award initially felt unobtainable because of local system inadequacies, for example, inefficient data collection processes, poor communication channels and lack of trained managers.
How did we motivate staff by providing a convincing argument for change?
There was already convincing evidence of the impact of BFI in the service so far, particularly on breastfeeding initiation. This in itself provided a convincing rationale for putting in the hard work to make BFI sustainable.
A survey of staff at the outset of the process assessed how staff felt about the culture within the service in relation to BFI, including how valued it was and the opportunities to improve care. This helped to convince staff that their concerns and priorities were listened to and would inform the change process.
Parents were asked to make specific suggestions for improving the service they received. This increased staff motivation for change because they could see the direct link with improving the experiences and outcomes of mothers, babies and families. It also convinced staff that the change process would take account of the needs of service users right from the outset.
How did we motivate staff by turning evidence of change into evidence for change?
Ongoing service user feedback was collected virtually (via websites and social media) and via audit data where parents were asked directly for feedback about the impact of BFI on their direct care and outcomes. This helped to convince staff and managers of the difference the standards were making to the experiences of mothers, babies and their families and the need to sustain BFI.