Abstract
BackgroundHealth and social care organisations globally are moving towards prevention-focussed community-based, integrated care. The success of this depends on professionals changing practice behaviours. This study explored the feasibility of applying a behavioural science approach to help staff teams from health organisations overcome psychological barriers to change and implement new models of care.MethodsAn Organisational Participatory Research study was conducted with health organisations from North West England, health psychologists and health workforce education commissioners. The Behaviour Change Wheel (BCW) was applied with teams of professionals seeking help to overcome barriers to practice change. A mixed-methods data collection strategy was planned, including qualitative stakeholder interview and focus groups to explore feasibility factors and quantitative pre-post questionnaires and audits measuring team practice and psychological change barriers. Qualitative data were analysed with thematic analysis; pre-post quantitative data were limited and thus analysed descriptively.ResultsFour clinical teams from paediatrics, midwifery, heart failure and older adult mental health specialties in four organisations enrolled, seeking help to move care to the community, deliver preventative healthcare tasks, or become more integrated. Eighty-one managers, medical doctors, nurses, physiotherapists, midwives and other professionals contributed data. Three teams successfully designed a BCW intervention; two implemented and evaluated this. Five feasibility themes emerged from the thematic analysis of qualitative data. Optimising the BCW in an organisational change context meant 1) qualitative over quantitative data collection, 2) making behavioural science attractive, 3) co-development and a behavioural focus, 4) effective ongoing communication and 5) support from engaged leaders. Pre-post quantitative data collected suggested some positive changes in staff practice behaviours and psychological determinants following the intervention.ConclusionsBehavioural science approaches such as the BCW can be optimised to support teams within health and social care organisations implementing complex new models of care. The efficacy of this approach should now be trialled.
Highlights
Health and social care organisations globally are moving towards prevention-focussed communitybased, integrated care
We worked with Vanguards A and C to design, implement and evaluate a Behaviour Change Wheel (BCW) intervention over 18 months, Vanguard D designed but did not implement a BCW intervention over 12 months, Vanguard B worked with us over six months and did not finish designing a BCW intervention
In most behaviour changes people must be aware of what behaviours to change: our findings illustrate that staff did not know what the new model of care meant they should do differently and this would certainly lead to a lack of change
Summary
Health and social care organisations globally are moving towards prevention-focussed communitybased, integrated care. The success of this depends on professionals changing practice behaviours. This study explored the feasibility of applying a behavioural science approach to help staff teams from health organisations overcome psychological barriers to change and implement new models of care. Implementing new models of care is a complex behaviour change intervention [6], requiring commissioners, managers, practitioners, and service users to do things differently [7]. Service transformation at scale requires macro, meso and micro level organisational change to be viewed together, in the context of day-to-day staff practice [9]
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