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Earlier this year I took part in my first ever #QIHour tweet chat as part of the Psychology 4 improvement (P4I) Q Exchange 2019 project, which aims to help make improvement more effective by developing a body of curated knowledge, practical resources and networking events.

What does Psychology 4 Improvement mean to the QI Twittersphere?

The Psychology 4 Improvement (P4I) Q Exchange project aims to develop a community to lead, develop and role model the importance of psychology for improvement in delivering human-centred, sustainable improvement in health and care.

COVID-19 may have had an impact on how the project delivers its aims, but has also provided new opportunities for virtual interaction: in my case, to be part of a conversation about psychology for improvement across a large network of improvers from the comfort of my own sofa!

The tweet chat was kindly hosted by Lou Waters and the team at Gloucestershire Safety & Quality Improvement Academy (GSQIA), with the aim of incorporating the information captured into the Psychology for Improvement work.

Over the course of the hour we explored experiences and understanding, the feelings and psychological barriers we experience as we engage with improvement, and tools and techniques to support the psychological side.

I was blown away by the richness of ideas and experiences captured within just 60 minutes – and 280 characters! We saw 60 participants generating 555 tweets and over 900k Twitter impressions within the hour, reaching a total of 805 tweets and 121 participants in the 24 hours that followed.

Conducting a thematic analysis of over 800 tweets was a somewhat daunting task, but a great opportunity to revisit the contributions I had missed during the fast-paced tweet chat.

Findings from Twitter

It was widely recognised that psychology for improvement is fundamental to improvement success, with the key themes as:

  • Connecting people and building relationships
  • Understanding why change fails, in order to address challenges
  • Building the will for change
  • Understanding people and their values and motivations
  • Self-reflection and awareness of one’s own motivations and feelings

The importance of understanding and talking openly about feelings was seen as key to being able to overcome difficult emotions and build psychological safety.

A wide range of emotions were reported at different points in the improvement journey. This ranged from excitement, enthusiasm and hope to anxiety, frustration and anger.

The importance of understanding and talking openly about feelings was seen as key to being able to overcome difficult emotions and build psychological safety.

The psychological barriers for improvement practice included fear of blame, failure, change, loss and the unknown. Other contributions discussed the ego and being inner rather than other focused. Change fatigue, and the need to have time to stop and reflect, was another recurring theme.

Psychological safety was frequently noted as one of the key conditions of change, created through:

  • Encouragement to contribute
  • Education and encouragement to be involved in QI
  • Openness, honesty and building trust
  • Good leadership behaviour
  • Fostering a culture that supports failure, learning and innovation
  • Sharing innovation
  • Celebrating success, learning and small wins
  • Listening and engagement
  • Understanding the mindset and power dynamics of those involved
  • Coaching skills
  • Embedding psychological safety into daily processes

A wide range of tools and techniques to support the psychological part of improvement were shared:

  • Social proof – spreading ideas through informal networks, key ‘influencers’ and enthusiasts
  • Building and mapping relationships and networks
  • Establishing ground rules for a QI session
  • Creating shared ownership and input through co-production
  • Asking questions, active listening and appreciative enquiry
  • Mind mapping and idea generation tools
  • Storytelling to build will and understanding
  • Measurement for improvement
  • Our expertise and passion as QI leads

And finally, ideas to help include more about psychology for improvement in your learning and improvement projects:

  • Sharing experiences and successes
  • Practical tools, training and resources
  • Building P4I into our environments
  • Mapping relational coordination

The full transcript, links and resources from the tweet chat is available, including all resources, articles and tools shared.

What struck me the most as I analysed the themes further, was the spectrum of emotions related to the challenges of change.

At first sight, the findings appear to map nicely to the existing evidence base around QI. However, what struck me the most as I analysed the themes further, was the spectrum of emotions related to the challenges of change. It was clear that different stages of the improvement journey prompted a wide range of feelings and behaviours. It was reassuring to see that improvers everywhere have faced similar struggles on the improvement rollercoaster!

How can we make navigating this journey easier for ourselves and the improvers we support?

Practical resources would be helpful, but to see these mapped to the different stages of that QI journey of emotions may feel more relational and tangible – while helping us understand we are not alone in some of the more challenging feelings.

We set out to explore the emotional journey of QI further in a follow-up P4I #QIHour tweet Chat and will be sharing more of what we’ve learned from the QI Twittersphere soon.

If you’re interested in this work, check out our project page to be a part of the conversation.

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