Table 6

The MotivatingChange framework

What is the innovation or change being made?
Briefly describe the change
Who are the key stakeholders?
Briefly describe who is involved. Who is involved in leading the change? Who is affected by it?
The psychological conditions for motivating change
Is there a policy-practice paradox? What is it?
Is the change externally imposed? What disconnect exists, if any, between the proposed change and the perceived need in the local context? Is there a disconnect between the proposed change and staff’s intrinsic values?
How will you motivate people by providing a convincing argument for change?How will you motivate people by convincing them that the change is working?
What evidence can we use to convince them that the change is needed in the first place?
How can we appeal to their intrinsic values (eg, person-centredness, human rights, etc)?
How can we convince them that the change is working once it is underway?
Is seeing the change in action winning people over and garnering more motivation for the change?
What data can we use to convince staff that the change is effective?
The social conditions for motivating change
How will you use leadership to create a flow of trust between stakeholders?How can positive peer pressure shape motivation for change?
How can leaders use recognition and reward?
What data can they use to show that change is working?
How can they use negative results to motivate change?
How can they appeal to individual motivations?
How can leaders model enthusiasm and motivation for change?
Is there a healthy competitiveness between staff or departments?
How will you use champions to convince others?
Can staff be relocated to other areas to lead change and share good practice?
Are there any problems, for example, with unhealthy competition?
How will you deal with infectious negativity?How will you harness constructive resistance?
Are there any problems with people being very negative about the change? Why is this? Is it because the change conflicts with their own values? Or are they just not receptive to any change?
What impact could this have on how well we implement the improvement? How will we persevere?
How can we harness negative views constructively? How will we go about listening to the sceptics? What impact will this have?
The structural conditions for motivating change
How will you use the physical environment to motivate change?
How can we use physical cues to motivate change? How will these work? What impact will it have?
What financial resource is available?How will you use incentives?
Who has control over the finances available—is it locally held or externally controlled? What impact does this have?
Are financial savings reinvested in the service and used to sustain the improvement activity? Or are there no direct financial gains?
Either way, how does this affect staff motivation for improvement?
What incentives are in place, for example, accreditation, awards?
How will we ensure that our incentives match staff’s intrinsic motivations?
Is there any disconnect between the incentives (eg, government targets) and what matters to staff in local contexts? How will we deal with this?
Could incentives ever have a perverse effect?
What is the impact of timing?How will our methodology support change?
How do we create time for improvement? For example, set aside dedicated time? How do we free up time in the schedules of busy practitioners?
How will we think strategically about the timing of introducing the change? For example, wait until we have all resources in place?
How much is planned? How much is opportunism?
Describe if you will use a structured process, either a local model or an existing approach like Lean or IHI. What impact will this have? For example, does it support motivation for change? Does it create a shared language? Is it a good structure or is it too rigid?
  • IHI, Institute for Healthcare Improvement.