Harnessing motivation for sustainable practice change: From passive receivers to active co-creators

Abstract

Objectives: The challenges of implementing clinical practice changes are well recognised. Prevailing approaches to tackling them have largely relied on increasing control and standardisation, but with limited impact. We examine research from the behavioural sciences in an attempt to (a) build a clearer understanding of why the implementation of change in clinical settings has proved so elusive and (b) provide practical guidance on how organisations can create a climate that can nurture sustained behavioural change in their workforce. Method: We undertook a review of the behavioural science literature to gain a better understanding of the circumstances under which staff might willingly pursue goals that are externally generated. Three studies, derived from the mental health literature, are outlined to illustrate how the manner in which change is introduced can have a significant effect on its uptake and sustainability. Results: Research suggests that human behaviour is not as unpredictable as it might at first appear; rather, there are some deeply rooted, psychological processes at play. Self-Determination Theory, a theory of human motivation with an extensive body of research supporting its effectiveness, suggests that the manner in which change is introduced and implemented is critical. Conclusion: While improvement methodologies and the use of implementation strategies are necessary, experience would suggest that by themselves they are not sufficient. Overcoming the challenges of implementing change will require a significant shift in our thinking about organisational leadership and the way that change is introduced. Some practical ways leaders can foster staff buy-in for organisational change are proposed.