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  • Matt Ploszajski posted an update in the group Psychology for Improvement 1 year, 1 month ago

    I thought I would pose a question to the members of this group: At the Aneurin Bevan Continuous Improvement (ABCi) hub, we are keen to deliver more specific training on psychological concepts that will help people to be creative and succeed at innovation within the high stress environment of the NHS. It is encouraging that there are so many ways in which we can approach this problem, but unfortunately there are SO many ways in which we can approach this problem that we are finding it difficult to know where to begin.
    So, we wondered if anyone else has found training on specific psychological concepts to be useful in QI training, what these concepts were and in what ways did it help your trainees?
    Many thanks in advance for your help.

    • Hello

      I have done training looking at applied complexity in organisations via Cognitive Edge. An awareness of psychological concepts are most useful in aiding people with their improvement / innovation projects, rather than teaching it to them in my opinion. It takes translating that knowledge into something with utility.

      I don’t think this is a problem , this is a positive side of variation – but there is a lot of guff out there.

      Have you started with the evidence that shows training professionals in the NHS doing QI with psychological concepts works? The Tripdata base uses AI to help with a literature search.

      Psychological concepts being applied in the design of workshops or coaching people is how I have found material like ‘Thinking fast, thinking slow’ (evidence based) useful, now being the person doing the helping invaluable.

      Is there more evidence in training the trainer in these concepts? I’d suspect so – as this is what was coined Organisational development (not HR) and I was lucky to learn from senior national OD practitioners where I now work through more of an apprenticeship model ( HT MW who is in the group I think)

      I wouldn’t limit the search to Qi – as I feel the definition of that is improving what you have through a process engineering approach.

      I’d broaden the search to include systems dynamics (Peters) and social complexity (Stacy) which I explore to help people with issues that aren’t process orientated.

      Hope this helps



      • Hi Andy, I think you’re so right to point to the challenge of ‘translating’ psychological knowledge into something with utility.
        It’s interesting that a lot of the complexity/networks theorists (like Snowden and Stacey?) tend to propound very anti-individualist models that reject the idea of individual psychology as falling into the error of being ‘entitative’, or suchlike.
        I think we need their complexity insights along with those of psychologists who still retain more of a role for individual psychology. I’ve yet to see a good synthesis of these contrasting views, despite the odd the attempt…

      • @matthewmezey Really? I haven’t come to that conclusion about Snowden or Stacey. Emergent behavior through individual agents interacting with each other might sound removed from identify the agents as individuals, but I wouldn’t call it anti-individualist. I wouldn’t call them theorists either as Snowden worked and observed his teachings at IBM.
        Through his work, being able to examine individuals person views and insights drives a wisdom of crowd approach.

        I mentioned these approaches to do with scope of a literature search and that applying psychology in these others realms might have more evidence compared to QI (otherwise it wouldn’t be a good Q Exchange bid), rather that advocating their methods for training. Although I would.

        Regarding your comment below – immunity of change :- people like change. Its the systems around them and how they implement change people don’t like, the psychology explains this. So you are right – we need both.

      • Hi Andy,
        It’s great that there seems to be growing interest in Snowden’s SenseMaker in the NHS – I completed a SenseMaker-based survey for NHS Horizons only last week. Will be fascinating to see the results of it.
        And one of the SenseMaker offshoot orgs just concluded its court battle with SenseMaker, so is now presumably going to be available to others to use, as an alternative to SenseMaker.

        The ‘rejection of individual agency’ was a section in Grint et al’s comprehensive overview article on complexity and leadership theories recently, pretty sure individual psychology tends similarly to get downplayed (I know Dave Snowden can’t stand models that focus on the psychology of individuals, like Maslow or Myers-Briggs, though that could be because he prefers different models for the same thing).
        This book ‘Advancing Relational Leadership Research: A Dialogue among Perspectives’ actually compares the more common individual (‘entitative’) approaches to leadership with the the more more network-based views that come from complexity theorists.

      • @andrewware Many thanks for the suggestions. These are some excellent avenues to explore and I have not used tripdatabase before, so thank you also for pointing me towards that.
        There is currently a debate in our department over whether we should provide specific psychoeducation (so things like the Kubler-Ross Change Curve, or the pitfalls of the Karpman Drama Triangle, etc.), or deliver more traditional QI activities, but with a greater focus on providing them with psychologically informed guidance relevant to their situation. It sounds like you advocate more along the lines of psychologically informed guidance rather than psychoeducation?

      • Hi @matthewploszajski

        Kubler-Ross change curve is ok, in the context of QI it would be for us to have an awareness of it and to ensure people don’t read frustration, denial and ‘depression’ as resistance to change. Sometimes there is resistance because it is just a crap idea.

        A collaborative approach usually negates this but there will be people on the periphery going through these. Putting that person in charge of ‘policing’ crap ideas brings them in. I’m not trivialising, I genuinely do this. Coherence and consensus are important.

        The Dunning- Kruger effect plays well to a clinical audience. We already knew it but good to have reflected in real evidence. It crosses over the professions and if the ‘messenger’ has legitimate experience, playing on the messenger effect can negate resistance to change. Also how can we use naïve confidence (said with all the respect in the world). These are the people early in their career will ask why and should not be ignored. If these voices are silenced, this leads to the rocky road of complacency induced failure for projects or indeed organisations .

        I’m not a fan of the drama triangle. Rather than focus on the problems, an opportunity approach makes the drama triangle almost irrelevant.

        How can you deliver traditional QI activities bespokely to different situations? Unless the situation is – doing a project. The psychology I employed to help have asthma patients turn up in primary care, was different to the psychological methods for patients seeing antibiotics in primary care.

        So I think its both. Weaving it into the training, and they can always go off and learn more for their project , specific projects might want more support and therefore guidance via coaching is the way to go. So the coaches need an appreciation and applied the principles in the real world themselves.

        I have an awareness of the Com-B model, and I appreciate its utility. Do I use it myself? No. However, a presentation at bath university grabbed my attention with the idea of the ‘implementation gap’ and adapting the Com-B model. I have the slides somewhere, which I think I have permission to share. if you want them.

    • Hi @matthewploszajski
      I think a bunch of people at Swansea Medical School all did training in Profs Kegan and Lahey’s ‘Overcoming Immunity to Change’ approach, and found it very valuable. (You could contact Prof Judy McKimm to find out more about what they did).

      I think the ‘Immunity to Change’ tool is an easy-to-use approach to unlocking the psychological knots that too often keep us from achieving the changes we want to make.
      It would be great to see it in wider use across the NHS – and not just for individuals, the next step is a group to use it (or even two groups that are failing to see eye to eye).
      I think it also boosts our self-efficacy by making more elements of our own psychological make-up visible to us – meaning we can act on them, not be derailed by them.

      Hope you spotted my comment under your posting of the Prof Mary Uhl-Bien video Matt. I’m trying to arrange a second Q Zoom call with her. No luck quite yet…

      • Thank you. These are all excellent suggestions I’m sure. I had not come across them before, and it is really helpful to have some extra avenues to explore.
        I’ll keep my fingers crossed that you can arrange another Prof Uhl-Bien talk, because I found the last one to be highly informative and it is something that I have disseminated widely around our department.

    • Hi Matt,
      I think the NHS England/Improvement report on innovation and spread (written by Diane Ketley from NHS Horizons) will draw strongly in Prof Uhl-Bien’s framework. It’s been put back from September to early next year.
      I should be seeing her at an event tomorrow, and will check on developments…!

    • Hi,
      I’ve found that considering narrative psychology and being able to articulate the change in a way that has personal meaning and impact is really popular. It helps people really connect with why their change is important and to be able to communicate this effectively. Other useful concepts are Bridges transition model, going into depth about what people might need at each stage and any tool that helps people understand how differences in personality type can impact upon communication, relationships and individual drivers for change.

      • That’s a really interesting point. I have been taking a greater interest in narrative psychology recently too, and I really like the work coming out of mental health circles about the how the themes drawn out of people’s autobiographical memories has a huge impact on their wellbeing. I think it is absolutely something that could be applicable to people’s self-concepts as autonomous/ effective workers in an organisation, although I don’t know of anyone specifically doing this kind of work in QI.
        Thanks for the suggestion.

    • Anyone forming their career over the past 20 years will have been subjected to the cult-like coffee-shop level psychobabble that has exploded into organisational life. There’s a load of evidence free claptrap touted by all kinds of people selling the atomistic old yarn about ‘know thy self’. Read deceit and self deception by Robert Trivers. The prefix-Leaderists are the worst culprits, with absolutely no evidence for whichever flavour of medieval beliefs are being touted; typically, a narrow range of behaviours that are universally successful – this week. It’s mostly the Barnum Effect on a set of lovely slides, or in a book that’s for sale. Where am I going, you might think, well this egomaniacal fallacy inevitably found it’s way into Healthcare Improvement. That improvement requires one narrow range of behaviours and a common language that you must teach to people. Everyone else is stereotypified into some blunt catch all of resistor or laggard, mostly touted by people without a profession of their own. So we teach nurses to be data analysts, doctors to draw logic models and therapists to be psychobabblers and they all aspire to be superhuman Improvementologists. No they don’t, they already have a profession.

      You got to be really careful on this ground as amateur psychologists are dangerous. Instead, sit an analysts in with your team, the team learn all they need tacitly and the data remains rigorous. Put a designer (me) next to your Dr and the critical thinking will rub off with a better approach. Finally get a psychologist (they are therapists) to actually join in. The most important bit is not the mostly trivial initial QI project they all get involved in, but the relationships they form that will lay the foundations for something much more amazing to emerge over the next few years that no individual could ever achieve. It’s the quality of the relationships not the parts, that determines success.

      So teach people psychology within improvement? NO, because for example MBTi is nonsense and Kubler Ross doesn’t really exist. So before you go any further buy Steven Novella’s Great Course on the Mind and if you’re really committed read Dan Dennett’s Intuition Pumps, before you get into any of the juicy and very addictive Psychology, in order to understand why you think you need it.

      In my career I have never met, not once, a single person who resisted change, because nothing does not change. They will resist an idiot trying to change them and I worry that deploying psychological techniques opens the door to the idiots, manipulators and psychopaths. Along with a psychologically informed practice comes the ethical and moral obligation that nobody seems to teach, outside of the profession. Of course for me, the most annoying part of QI is that Medicine (using the term in the round) is the original science of improvement. Tell a team that their ward is the patient and they suddenly realise that most of them already have a degree in how to make it healthier and happier. Now this is the area of psychology (an absolutely enormous field) that we needs to explore, to get away from the old individual motivation and personality nonsense. When you study the psychological concept of Attitudes and that we can hold lots of them, even opposing ones at the same time you get away from the prejudice of embodied stereotypes.

      Don’t get me wrong, I’m so looking forward to this project taking off. We’ve got years of crap in the back of the cupboards to clean out before we can appreciate the psychological concepts, methods and tools we’ve already got, let alone the ones we need to develop in an industry centred on nurturing the places where the psychology lives.

    • Hi Matt,

      Apologies for coming late to the group. I’ve recently been looking at Mindsets and coaching.

      I believe the ability to effectively improve has to start with yourself. Carol Dwecks insights into a growth minset helps shift from I can’t do this to I can’t do this yet…

      The Arbinger institute makes a more profound insight regarding mindset, in that your mindset influences your behavior. Critically being open in your mindset seeing others as humans rather than object makes collaboration more likely and being closed results in justification often subconsciously which will drive conflict. So two identical behaviors can produce dramatically different results depending on the mindset you are in when delivering the behavior.

      Highlights the pyramid of change and makes the point we spend too much time at the top of the pyramid attempting to correct things that have gone wrong. Rather than investing time in the bottom half of the pyramid supporting things to go right.

      I have limited experience myself at present (work in progress) but would hope that even if a fraction of what the Arbinger institute claims are as effective as they make this sounds like a very promising avenue to explore.

      I hope by bringing the attention of the teams I work with and train to the ability to chose mindset and influence behavior in a positive manner will be effective at building the ability to form relationships necessary for effective change to occur…