This work is supported by a grant from
The Centers for Disease Control & Prevention
and in-kind contributions from Children’s Mercy
Hospital in Kansas City, MO.
Academic Pediatric Association
QUALITY IMPROVEMENT
TRAINING:
Module #2
Leading Change
Module 2 Objectives
After viewing this segment, you will be
able to:
1. Describe 5 key ideas for integrating
change into an organization
2. Illustrate the curve showing the
rate of adoption of innovation
3. Explain 5 attributes for embracing
change
Inter-related
1. Key ideas for
integrating
change
Key Ideas for Integrating Change
1. Taylor the presentation of a proposed
change to the audience
2. Seek to understand the motivation
underlying behavior
3. Avoid making the fundamental attribution
error
4. Make people part of the solution
5. Think carefully about using motivators
Taylor the presentation of a
proposed change to the audience
 Motivated by
evidence
 Influenced by
authority
 Inspired by heart and
emotions
 Show them data or
other evidence
 Have strong leadership
support for the change
 Tell them the human
story
Seek to understand the
motivation underlying behavior
 We tend to think that the behavior we
observe, gives us a clear window into
other people’s motivation
 But the truth is that we see others
through our own “lens”
(created by our assumptions)
http://crisasantos.com.br/com/interpersonal-communication-cartoon
http://crisasantos.com.br/com/interpersonal-communication-cartoon
“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.”
From The Improvement Guide: A Practical Approach
to Enhancing Organizational Performance
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 factors
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 factors.
“He’s just not that bright.”
“He’s not working hard.”
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 factors.
Me
“There’s zero tech support.”
“The work flow is designed
to give us these results.”
Because of the tendency toward the
fundamental attribution error with others,
we’re likely to assume that a pep talk or a
good chewing out is the solution
But if the problem is the system, these
are not the solution
Attract people to the change by
making people part of the solution
 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
Types of Motivation
 Disincentive: punishment
 Extrinsic Motivation: material reward
 Intrinsic Motivation: person is socially or
personally fulfilled by their involvement in an
activity
 Moral incentives
 Natural incentives
3 Key Intrinsic Motivators
Competence
Autonomy
Relatedness
For interesting reading on motivators, see Drive, by Daniel Pink
Too often, planned QI approaches
diminish at least one of these.
When you’re planning
your project,
try to appeal to the
key intrinsic motivators
or at least,
try not to disrupt them.
Rate of Adoption of
Innovation
Everett Rogers, The Diffusion of Innovations, 5th Edition
Rate of Adoption
Cumulative
Incidence
Adapted from Rogers, Diffusion of Innovations (1962), www.ihi.org/openschool
Categories of Adopters
 Innovators : Risk takers
 Early Adopters (Opinion Leaders): Willing to try
the idea
 Early Majority: Try after many have accepted it
 Late Majority: Skeptical
 Traditionalists (Laggards): Adopt when there is no
other alternative
https://lsuagcenterode.wordpress.com/2011/08/26/extension-educators-as-change-agents-riding-the-adoption-curve/
Attributes to
facilitate change
Everett Rogers, The Diffusion of Innovations, 5th Edition
Attributes to facilitate change
 Relative advantage: “Is this idea clearly
better than what’s in place
 Compatibility: “Does this meld with existing
values, past experiences, and the needs
of potential adopters?”
 Simplicity: “Is this idea easy to understand
and use?”
 Trialability: “Can we test this?”
 Observability: “How visible to others are
the results?”
Adapted from Rogers, Diffusion of Innovations (1962), www.ihi.org/openschool
Think back to when you were confronted
with a new process in a familiar setting…
The 1st time you used self-checkout
1.
2.
3.
4.
5.
Relative advantage
Compatibility
Simplicity
Trialability
Observability
Other Factors Influence
Adoption of Change
http://blog.anneadrian.com/2007/07/individual-adoption-of-change.html
Summary

Key ideas for integrating change include:
 Taylor your presentation to the audience
 Seek to understand the real motivation behind behavior
 Avoid making the fundamental attribution error
 Include end users in the planning phase
 Intrinsic incentives tend to be more long lasting
than extrinsic incentives or disincentives.
 People can be grouped in categories based on how willing they
are to try a new innovation
 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 use; easy to test;
and have results that are easy to observe.
Your vision is at the heart of QI.
The End
of QI Module #2
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