© riemer &bickman, 2003 general introduction improving organizational improvements
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© Riemer &Bickman, 2003
General IntroductionGeneral Introduction
Improving organizational improvements
In this presentation you will learn …
…about the basic idea and the logical structure of the Contextualized Feedback Intervention Theory
© Riemer &Bickman, 2003
Improving organizational improvements
I. IdeaWhen 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
GOAL
Significant discrepancy
CurrentStatus
© Riemer &Bickman, 2003
When Do Individuals not Change?
A) When the goal is not important enough
GOAL
Significant discrepancy
CurrentStatus
© 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
GOAL
Significant discrepancy
CurrentStatus
PerceivedCurrentStatus
© Riemer &Bickman, 2003
When Do Individuals not Change?
C) When they believe they have no control over changing the current status
GOAL
Significant discrepancy
CurrentStatus
© 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
Question
• How can you influence each of these factors?
You need a theory that explains processes and important factors of behavior change
=> CFIT
© Riemer &Bickman, 2003
II. Description
Actual status -desired goal status
discrepancy
Perceived status -desired goal status
discrepancyDissonance Action plan Action
Feedbackabout actual
status
Attention Acceptance
Goalcommitment
Causalattribution
© 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
Actual status -desired goal status
discrepancy
Perceived status -desired goal status
discrepancyDissonance Action plan Action
Feedbackabout actual
status
Attention Acceptance
Goalcommitment
Causalattribution
© Riemer &Bickman, 2003
Feedback
• Function: Close gap between perceived status and actual current status to create significant discrepancy
GOAL
Significant discrepancy
CurrentStatus
PerceivedCurrentStatus
© Riemer &Bickman, 2003
Feedback
• Function: Close gap between perceived status and actual current status to create significant discrepancy
GOAL
Significant discrepancy
CurrentStatus
PerceivedCurrentStatus
© 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
Actual status -desired goal status
discrepancy
Perceived status -desired goal status
discrepancyDissonance Action plan Action
Feedbackabout actual
status
Attention Acceptance
Goalcommitment
Causalattribution
© 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
Actual status -desired goal status
discrepancy
Perceived status -desired goal status
discrepancyDissonance Action plan Action
Feedbackabout actual
status
Attention Acceptance
Goalcommitment
Causalattribution
© Riemer &Bickman, 2003
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 Procedures
http://www.cfit-solutions.org/
© Riemer &Bickman, 2003