The Perspective of the Individual is Pivotal - One of the Seven Interconnected Principles

The recently launched Guide, Leading the Spread and Adoption of Innovation and Improvement: A Practical Guide, offers seven interconnected principles. This blog is the third in a series of blogs, each focusing on one of the seven principles. 

These principles represent important aspects to consider for spread and adoption and are explained in the Guide. All the seven principles are important; they are interconnected, each will have a different importance and require different actions in different settings. Relational, interpersonal elements of spread and adoption – looking at how people can work together – is a common thread within each of the principles.

The Individual - What Needs to Happen?

Consider spread and adoption from the perspective of the individual in the system – this may include patients, carers, and staff – and what the impact of the innovation might be on them. 

• What does the innovation mean to these individuals? 
• What will these individuals gain and what may they lose? 
• What can they contribute? 

Some points to think about:

• Understand the importance of motivation, engagement and providing a supportive, safe [psychological safety] setting to enable the behaviour change needed for spread and adoption. Appreciate that resistance, as an inevitable part of change, may reflect a missing relevance that warrants exploring. 
• Appeal to hearts and minds, connect with people’s emotions through their values to enable action. Health and social care are value driven systems, so connecting to individuals’ values can be a powerful way to motivate, activate agency and enable spread and adoption. See benefit principle for more information.
• Spread occurs through developing relationships and trust which may take time to form and the depth of the relationship needed may vary depending on the shared purpose.
• Build and maintain intrinsic and extrinsic motivation, aligning motivators, to generate personal and team energy for change and agency to create a pull, to enable spread.
• Understand the impact of the innovation on work routines and the implications of this impact. Behaviours are deep rooted and embedded in work routines. This means the more work routines are affected by the innovation, the greater the spread and adoption challenge.
• It takes energy and motivation to learn the new knowledge needed to change routines and behaviours, build this energy for change.
• Changing behaviours is hard! It is a social process dependent on human relationships, identity, attitudes, and situated knowledge. Support relationship development, connectivity and personal growth. See networks principle for more information.
• Support staff to develop the required practical skills to adapt and adopt the innovation and to gain confidence in the new way of working. 
• Incorporate participation in innovation spread and adoption as part of staff roles [to provide capacity and time].
• Aim for short term progress to maintain buy-in while building longer term partnerships to enable spread and adoption.
• Recognise involvement in spread and adoption activities as a core activity.

Applying This Principle To Practice

The Guide offers a list of questions to help apply this work to practice. The questions will be of varying relevance depending on the particular context. Some of the questions are:

• How will you involve patients and carers? What is their perspective of the innovation and the how it could impact their care?
• How will you include staff? What is their perspective of the innovation and the way it could impact their role?
• Who will gain what and who will lose what?
• How can you build motivation, energy and connect with personal values to create a pull?
• What short term progress can help build relationships and partnerships?
• What can you do to maximise individual and collective agency
• What can you understand and learn from any resistance to adoption to help you increase the relevance of your work?
• How is the usual way of working [routines] impacted by the innovation? What are the resulting implications? What actions need to occur to address these implications?
• Who will require new skills and what support will be provided?
• What roles need to have spread and adoption as core?
• How will involvement in spread and adoption of innovation be recognised?

You may find the following tools and methods helpful:

• Energy for change
• Shared purpose
• New power: see Agency and Models of spread
• Resistance to change 

also see practical tools and methods, further resources and systems convening sections in the Guide. 

These seven interconnected principles can be used by individuals, or by a team, and at all levels; local, regional and national and settings where the spread and adoption of complex change is needed. These principles can be used to inform planning and to inform ongoing reviews.

This blog Introduction to the Seven Interconnected Principles for Spread and Adoption offers an overview of all seven principles.

Details of how these principles apply to the work we do are described in How the Seven Spread and Adoption Principles Work in Practice: the Continuing Healthcare Improvement Collaborative case study. 

Want More Information? 

More details on the Individual principle is in the Guide here and in the further resources – change section.

More information on the seven spread and adoption principles and system convening, including blogs and videos, is available on the NHS Horizons website.

If you're interested to read more there are previous blogs and further blogs to follow. Please do subscribe to this blog and follow @DianeKetley @HorizonsNHS, #nhsspread.

We would love to hear your feedback about the guide, and how you will use it. Send a tweet to @DianeKetley @HorizonsNHS #nhsspread. If you prefer email, get in touch at England.si-horizons@nhs.net.

Photo by Tommy on Unsplash