Executive Summary
This white paper is a guide for all leaders interested in understanding the underlying psychology of
change and leveraging its power to impact quality improvement efforts: to achieve breakthrough
results, sustainably, at scale. Improvement science has given health care improvers a theoretical
framework and the applied technical skills to understand variation, study systems, build learning,
and determine the best evidence-based interventions (“what”) and implementation strategies
(“how”) to achieve the desired outcomes. Yet, health care improvers worldwide still struggle with
the adaptive side of change, which relates to unleashing the power of people (“who”) and their
motivations (“why”) to advance and sustain improvement — two commonly cited reasons for the
failure of improvement initiatives.
The paper presents a framework and set of methods for the psychology of change — five
interrelated domains of practice that organizations can use to advance and sustain improvement:
• Unleash Intrinsic Motivation;
• Co-Design People-Driven Change;
• Co-Produce in Authentic Relationship;
• Distribute Power; and
• Adapt in Action.
Building on the legacies of W. Edwards Deming, Everett Rogers, and many others, a renewed focus
on the human side of change increases the likelihood that efforts to improve health and health care
will succeed in the short term and be scaled and sustained over time.