RACP - Intervention >> Changing practice and maintaining it

Intervention >> Changing practice and maintaining it

To gain support for changes to practice and the maintenance of change it is important to understand the motivations and behaviour of clinicians working in your care system. Without such an understanding, there is little chance that your project will result in widespread, enduring improvements in the processes and systems of care. Your core team can support the project team by implementing strategies to support behavioural change at different phases during the change process.

When planning strategies to support behavioural change, it is useful to consider the following three phases of behaviour change:

Predisposing to change
Predisposing to change involves increasing the readiness of clinicians to accept the need for change by raising their awareness of identified problems in current standards of care. This can be done via objective feedback and evidence-based indicators. This acts as a ‘wake-up’ call that things could be better.
Enabling change
Enabling change involves providing practice improvement intervention(s) to support clinicians in making the required change in practice (for example: guidelines or pathways; new approaches to patient self-care; interactions with opinion leaders). Overcoming barriers to change can be assisted by redirecting resources and redesigning work practices that hinder effective practice.
Maintaining change
Maintaining change can be assisted by rewarding positive behaviour with congratulatory feedback (e.g. certificates of achievement), public recognition, and dissemination of results.

Factors which do not support successful practice improvement, and should therefore be avoided if possible, include:

Low levels of commitment from key clinicians due to perceived hidden agendas (primarily cost-cutting) in your project imposed by managers or other non-clinicians.
Perceived irrelevance, or total lack of feasibility, of your project activities to the every-day care of individual patients.
Insufficient time or resources to properly implement your project design.
Paucity of credible and timely clinical data.
Lack of support from clinical peers and senior executive office-holders.
Perceived loss of clinical autonomy and direction within large, dysfunctional teams.
Excessive use of jargon, zealotry, or autocratic approaches in designing and implementing project activities.
Reliance on single interventions, led by single individuals, for the project’s success.
Lack of flexibility on the part of the core team in re-thinking and re-formulating project methods in the context of changing circumstances, or less-than-expected levels of success with planned interventions.