2. Healthcare professional behaviour and organisational change

In order to help health and social care professionals change their practice in new models of care, we must be sure we understand it. Although this is complex and dynamic, sometimes it is useful to think of the individual behaviours that make up parts of professional practice and what causes health and social care professionals to behave in the ways that they do. This can help us understand why change can be tricky and help to overcome barriers to teams adopting new models of care.

What do we know about why healthcare professionals practice in the way that they do?

Healthcare professional practice is very complex and cannot entirely be broken down into separate behaviours.  However, sometimes it is useful to think of the individual behaviours that make up parts of professional practice and what causes healthcare professionals to behave in the ways that they do.

Scientists and social scientists have studied what determines people’s behaviour for many years.  The study of behaviour has led to a number of hypotheses which can be summarised as:

  • Behaviour is what we do.  It is influenced by what we think and feel but it is not the same as what we think and feel.  Our attitudes and beliefs are not the same as our behaviours, although they are obviously linked to each other.
  • People do not make rational decisions about all of their behaviours.  Some behaviours happen automatically with very little weighing up of the costs and benefits of either the behaviour or of the potential outcomes of behaving in that way.
  • Behaviour is influenced by internal factors, such as our impulses and our previous experiences and external factors, such as what is going on around us and who is with us.
  • There is no direct line between what a person CAN do and what they WILL do.  We need to be able to do something in order to do it, of course, but even if we are able we might not, depending on many other factors.

How does this link to what healthcare professionals do?

Watch this animation to find out more about what we know about healthcare professional behaviour.

What is the science behind COM-B?

Some of the psychological theories and constructs which you may have come across that have been used to study healthcare professional practice for many decades include: Theory of Planned Behaviour; Social Cognitive Theory; Self-Regulation Model; Learning Theory; Implementation Intentions; Knowledge; Attitudes; Behaviour Model; Precaution-Adoption-Process Model.. Other models and frameworks used to study healthcare professionals and implementation include Promoting Action on Research Implementation in Health Services (PARIHS); PRIME Theory; Burnout theories. These can be split and summarised in many ways. COM-B is one way of summarising these and even more theories and different determinants. It was systematically developed by health psychology colleagues at University College London to help make psychology more accessible to non-psychologists. COM-B forms part of a user-friendly intervention development method called the Behaviour Change Wheel which has been applied to helping professionals change several key behaviours. Other comprehensive approaches for intervention development include Intervention Mapping.

For more details about the Behaviour Change Wheel and COM-B model, see http://www.behaviourchangewheel.com/ or Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science6(1), 42.

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