Breckenridge Jenna P, Gray Nicola, Toma Madalina, Ashmore Sue, Glassborow Ruth, Stark Cameron, Renfrew Mary J
School of Nursing and Health Sciences, University of Dundee, Dundee, UK.
Scottish Improvement Science Collaborating Centre, School of Nursing and Health Sciences, University of Dundee, Dundee, UK.
BMJ Open Qual. 2019 Jun 14;8(2):e000553. doi: 10.1136/bmjoq-2018-000553. eCollection 2019.
Various theories provide guidance on implementing, sustaining and evaluating innovations within healthcare. There has been less attention given, however, to personal theories drawn from practice and the expertise of managers and front-line staff is a largely untapped resource. In this paper, we share learning from experienced improvement organisations to provide a conceptual level explanation of the conditions necessary to facilitate and sustain improvement at scale.
Staff (n=42) from three leading change organisations in the UK, spanning health, education and social care, took part in three consultation meetings with the aim of sharing knowledge about sustaining large-scale change. This included one government organisation, one National Health Service Board and one large charity organisation. Using a participatory grounded theory approach, the workshops resulted in a co-created theory.
The theory of Motivating Change describes the psychosocial-structural conditions for large-scale, sustained change from the perspectives of front-line staff. The theory posits that change is more likely to be sustained at scale if there is synergy between staff's perceived need and desire for improvement, and the extrinsic motivators for change. Witnessing effective change is motivating for staff and positive outcomes provide a convincing argument for the need to sustain improvement activity. As such, evidence change becomes evidence change. This is only possible when there is a flow of trust within organisations that capitalises on positive peer pressure and suppresses infectious negativity. When these conditions are in place, organisations can generate self-proliferating improvement.
The theory of Motivating Change has been co-created with staff and offers a useful explanation and guide for others involved in change work that capitalises on front-line expertise.
各种理论为医疗保健领域创新的实施、维持和评估提供指导。然而，来自实践的个人理论却较少受到关注，管理人员和一线工作人员的专业知识在很大程度上是未被开发的资源。在本文中，我们分享来自经验丰富的改进组织的经验教训，以从概念层面解释大规模促进和维持改进所需的条件。
来自英国三个领先变革组织（涵盖健康、教育和社会护理领域）的42名员工参加了三次咨询会议，目的是分享有关维持大规模变革的知识。这包括一个政府组织、一个国民健康服务委员会和一个大型慈善组织。通过参与式扎根理论方法，这些研讨会形成了一个共同创建的理论。
“激励变革理论”从一线员工的角度描述了大规模、持续变革的社会心理结构条件。该理论认为，如果员工感知到的改进需求和愿望与变革的外在激励因素之间存在协同作用，变革更有可能在大规模上持续下去。目睹有效的变革会激励员工，积极的成果为维持改进活动的必要性提供了令人信服的论据。因此，证据变革变成了证据推动变革。只有当组织内部存在信任流动，利用积极的同伴压力并抑制传染性的消极情绪时，这才有可能实现。当这些条件具备时，组织可以产生自我增殖的改进。
“激励变革理论”是与员工共同创建的，为其他参与利用一线专业知识进行变革工作的人提供了有用的解释和指导。
