The diagram above shows a typical continuum that accompanies change. As explanation, change occurs in three phases:
Inform of the problem/need for change/rationale
Educate about what the change is, and help learners understand the change in terms of their own practice. What is it, how will they accomplish it, can they do it.
Commit: Once they understand the change, learners can commit to performing it.
The graph indicates stages in change and also the necessary factors for commitment.
On the graph above, you also see 'down arrows', which indicate places and ways that instituting change can go wrong, not occur, or be ignored. It was said last week that most commitment to change is lost before it is instituted. Consider that and also the graph as you begin to work on changes, even very small ones.
Prochaska's change model (described also on the page entitled Change)
This model is very interesting in that it is more flexible and applies to much of the change that occurs in medicine both for individuals and practices.
The stages are:
Precontemplation
This stage is involved with consciousness raising, evaluation of the environment and practices with assessment of the effect of change in practices. Most are unaware that change is being considered or how it will effect them.
Contemplation
Clarification of the change, its need, and implications. Self-reevaluation includes how a change will effect one's habits and life. Most are aware of a possible change, but do not understand its implications. At this stage role models may be helpful or 'guided imagery' to visualize the concurrent change in self image. This is a frightening stage at which one needs to recognize a potential change, its effect, and how it will occur.
Preparation
Following clarification and explanation of the change, the person may recognize it is useful and be willing to sustain that belief and make a commitment. This requires seeking out the needed learning and skills for it to occur.
Action
At this stage the change and its needed accessory learning and support are undertaken. Contingencies and barriers must be recognized and managed.
Maintenance
The change is part of the fabric of the person or organization. However, refinement to fit it into practice and reinforcement for its use are still important. Support of the team or the collaborative is required, and differing individuals require different levels of support to sustain and build on the change. Here, self efficacy is important to support belief that one can successfully handle the change and automate it into practice.