Hvad betyder motivation i forbedringsarbejdet?

Opening the ‘black-box’ of organisational change when using improvement methodology and discovering the role of ‘motivation’

Af Simon Tulloch

Simon Tulloch er psykolog og chefkonsulent i Dansk Selskab for Patientsikkerhed. Her reflekterer han over begrebet motivation i forbedringsarbejdet med udgangspunkt i en artikel i BMJ Open Quality, Motivational Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK

Over the last few years of delivering educational programs on the subject of improvement science, I have always tried to emphasise the important role that psychology plays in contributing to successful (or unsuccessful) improvement projects. From my experience, when the four elements of Deming’s ‘System of Profound Knowledge’1 are presented and taught, the psychology element (or ‘human side of change’) often receives the least attention.

As such, I try to dive a little deeper into some of the key factors I believe to be important in helping us understand the role that psychology has when we engage in improvement work. Typically, I would include Kahneman and Tversky’s ‘Dual processing model’2, the impact of psychological safety in the development of a learning culture3, and the role of communication4. One of the critical components of this ‘dive into the human side of change’ is developing of an understanding of what motivates individuals in the workplace. Typically, I introduce participants to Daniel Pink’s Book ‘Drive’5 and refer to the large body of evidence which indicates the importance of intrinsic factors, e.g. autonomy, mastery and purpose, over (traditional) external factors, e.g. ‘carrot or stick’. Much of which is based on the work of Richard Ryan and Edward Deci and their ‘Self-determination Theory’ of motivation6.

The Institute for Healthcare Improvement publication ‘The Psychology of Change Framework7 has been a useful contribution to the ‘re-balancing’ of the four elements, however, I still think more literature, evidence and examples are needed. Which is why I was pleased to see an article in BMJ Open Quality by Jenna Breckenridge and colleagues8 which also emphasised the importance of the ‘human side of change’ when using improvement science to test, implement and sustain change in organisations.

Their paper – Motivational Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK – describes “the psychosocial-structural conditions for sustained, large-scale change… by confirming the importance of context, collective action, cognitive participation, leadership, attitudes and organisational fit”. Critically, by emphasizing the “centrality of motivation” in determining successfully sustained change, their ‘motivating change’ model challenges predominant discourses which focus on ‘structural processes’ and ‘workforce characteristics’.

The authors draw upon ‘real-world’ examples from three improvement organisations to develop their model, and include a useful ‘Motivational Change Framework’ along with an overview of the primary and secondary propositions of the theory, i.e. “Turning evidence of change into evidence for change” and “Sustained change at scale requires organisations to be self-improving” respectively.

Overall, I find the paper is a helpful reminder that all change ultimately requires individuals to change, and by understanding the importance of individual and collective motivation, organisations will increase their chances of implementing and sustaining change.


  1. Edwards Deming, The System of Profound Knowledge: https://deming.org/explore/so-pk
  2. Kahneman, Daniel, (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux: https://us.macmillan.com/books/9780374533557
  3. Psychological Safety in Healthcare: https://patientsikkerhed.dk/psychological-safety-in-healthcare/
  4. Quality Improvement and Communication: https://patientsikkerhed.dk/new-charter-aims-to-make-strategic-communications-an-essential-part-of-quality-improvement/
  5. Pink, D. H. (2009). Drive: The surprising truth about what motivates us. New York, NY: Riverhead Books: https://www.danpink.com/drive./
  6. Ryan & Deci (2000) Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being: https://selfdeterminationtheory.org/SDT/documents/2000_RyanDeci_SDT.pdf
  7. Hilton K, Anderson A. (2018) IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, Massachusetts: Institute for Healthcare Improvement: http://www.ihi.org/resources/Pages/IHIWhitePapers/IHI-Psychology-of-Change-Framework.aspx
  8. Breckenridge JP, Gray N, Toma M, et al. (2019) Motivating Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK. BMJ Open Quality: https://bmjopenquality.bmj.com/content/bmjqir/8/2/e000553.full.pdf


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17. december 2019

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