© Riemer &Bickman, 2003

Improving organizational improvements General Introduction © Riemer &Bickman, 2003

In this presentation you will learn … Improving organizational improvements …about the basic idea and the logical structure of the Contextualized Feedback Intervention Theory © Riemer &Bickman, 2003

I. Idea When do individuals change? • When they have an important goal they want to accomplish & • They notice a significant discrepancy between the goal and their current status regarding the goal & • They believe they can reduce the discrepancy G O A L Current Status Significant discrepancy © Riemer &Bickman, 2003

When Do Individuals not Change? A) When the goal is not important enough Current Status G O A L Significant discrepancy © Riemer &Bickman, 2003

When Do Individuals not Change? B) When the perceived discrepancy between the current status and the goal is smaller than a significant discrepancy G O A L Perceived Current Status Current Status Significant discrepancy © Riemer &Bickman, 2003

When Do Individuals not Change? C) When they believe they have no control over changing the current status G O A L Current Status Significant discrepancy © Riemer &Bickman, 2003

Example: Changing Practice Behavior • Your goal is to help your patients • You are unlikely to change your practice if you think you are already doing your best to help • However, if you find that you are not helping them as much as you thought and you think you could potentially change • Then it is more likely that you will change your practice

You need a theory that explains processes and important factors of behavior change => CFIT Question • How can you influence each of these factors? © Riemer &Bickman, 2003

II. Description © Riemer &Bickman, 2003

Cognitive Dissonance • Two cognitive elements that are dissonant cause psychologically uncomfortable feeling • Significant discrepancy between desired goal status and perceived goal status constitute dissonant cognitions • Uncomfortable feeling creates motivation to reduce dissonance • This motivation can be channeled into motivation to change • => self-persuasion more effective and persistent than coercive approaches to change © Riemer &Bickman, 2003

Feedback © Riemer &Bickman, 2003

Feedback • Function: Close gap between perceived status and actual current status to create significant discrepancy G O A L Perceived Current Status Current Status Significant discrepancy © Riemer &Bickman, 2003

Feedback • Function: Close gap between perceived status and actual current status to create significant discrepancy Perceived Current Status G O A L Current Status Significant discrepancy © Riemer &Bickman, 2003

Example: Changing Practice Behavior • You do not notice any significant discrepancy when there is no external feedback. “My patients are doing fine” • You receive feedback that your patients are not doing as well as you thought • These two thoughts are dissonant with each other.

Factors That Affect Feedback • Attention • Competing feedback sources • Perceived feedback validity & utility • General feedback propensity • Goal commitment • External pressure to attend to feedback (conditional) • Acceptance • Relative importance of feedback • Current perception of reality & self-evaluation skills © Riemer &Bickman, 2003

Goal Commitment (GC) • GC is "the determination to try for a goal and the persistence in pursuing it over time” (Hollenbeck, Williams, & Klein, 1989, p.18 ) • Goals are hierarchically structured • Assumption of CFIT: There is a higher level goal that all members of the target group share (e.g. improving the health status of clients) • The target goal should be instrumental for accomplishing the higher level goal (e.g. improving therapeutic relationship) • GC should be high to increase the chance of experiencing significant dissonance © Riemer &Bickman, 2003

Factors That Affect Goal Commitment • Goal attractiveness • Perceived instrumentality • Goal expectancy • Self-efficacy • Competing goals and activities • Supporting factors © Riemer &Bickman, 2003

In order for the feedback about your patients to cause a change in your practice you need to • Notice the feedback about your patients • Believe that the feedback is valid • Be committed to the goal of helping your patients • Believe that changing your practice will result in better outcomes for your patients. • Believe that you are capable of changing your practice based on your own sense of efficacy, the feeling of sufficient support and few competing goals

Causal Attribution • Action plans are based on the perception of the cause for the current status • 3 Dimensions of Attributions • Locus of causality: internal vs. external • Stability: stable vs. variable • Controllability: controllable vs. uncontrollable • If minor changes are needed (e.g. effort, attention): • Internal, controllable, and variable • If major changes are needed (e.g. learning new skills): • Internal, controllable, and stable © Riemer &Bickman, 2003

Example: Changing Practice Behavior • Your specific plans to change will depend on whether you see your practice behavior determined by • Stable factors -- your skill level • Variable factors – your effort or attention • Internal factors -- your intelligence • External factors --- insufficient time • Controllable – you can make time • Uncontrollable -- you don’t control your time

Our Web Page Provides More Information On the Theory and How It Is Applied To Both Changes Based On Outcomes Feedback and The Introduction of New Procedureshttp://www.cfit-solutions.org/ © Riemer &Bickman, 2003

© Riemer &Bickman, 2003