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Improving the Quality of Care Delivered to Children Served by State Agencies
Motivating Organizational Change
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
- 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
- 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.
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
Stone D, Patton B, Heen S. Difficult Conversations: How to Discuss What Matters
Most. New York (NY): Viking Press; 1999.
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