Technological advances in healthcare raise the question of the behaviour changes required of people for the successful implementation of the technology. The biggest obstacles to healthcare system evolution may not be technological, but human – the thoughts, feelings and relationships of the people working in and on healthcare. Without behaviour change strategies to address these human factors, innovations in technology and processes may have limited impact.
Thesis number one. Those who aspire to be innovators should expect their genius to create bother for people. Sure, the world will come to thank us one day but until then, the world will act like ungrateful Luddites. Chances are, our innovation will require people to change their behaviour and as a general rule, people don’t like to change their behaviour, even if it is problematic to them. “The devil you know . . .” etc.
Thesis number two. Innovations have no real value independent of the people who use them. This is a matter not just of whether value will be realized but also of what that value actually looks like. The inventor of the screwdriver intended for it to be used to twist screws, not lever objects apart. The screwdriver is not designed to be a jemmy bar and it is not particularly good at it. But if I need a jemmy bar, have no jemmy bar but do have a screwdriver and it might do the job, I will re-purpose it without further thought. The realised value of the screwdriver, qua jemmy bar, was clearly determined by me, not the innovator.
Thesis number three. No-one comes to an innovation as a blank slate, no matter how never-before-seen it might be. Established conceptual schemas and habits will be automatically applied to the novel situation – even to the extent that a person might not recognize the innovation as being something of relevance to them. If we attempt to tell them what it is, why it is a good idea and how to use it, their response will still be mediated by their prior learning. Do they see us as trustworthy? Are they ready to adapt to something new? Do they have the capability to utilize the innovation? And so on.
To give a bright idea the best chance of delivering on its potential, we must think of the end-users as collaborators in our project. We need an implementation plan that focuses clearly on their pivotal role in the final success of the idea. We must be aware of the behaviour change burden that we are asking of them.
Michie et al (2011) have proposed an interesting conceptual framework for behaviour change that I think could be useful here. Although their work has the health-related behaviour of patients in mind, I think its conceptual framework is useful to our strategic thinking and its behaviour change principles are very relevant to behaviour changes required by innovations of clinicians, administrators and others involved in healthcare.
The model, called the Behaviour Change Wheel (Figure 1), arranges the factors that moderate behaviour change into three zones: policy instruments, intervention processes and individual characteristics.
Figure 1. The Behaviour Change Wheel. From Michie et al (2011).
At the heart of the system lie the individual’s motivation, ability and opportunity to change their behaviour. Each of these factors can be influenced by a range of intervention processes, targeting whichever individual characteristics are presenting obstacles to change.
These intervention processes are subject to an environment shaped by policy instruments which empower, support and signal the behavioural outcomes required.
Successful behaviour change strategy involves accurate identification of the individual characteristics to be targeted and alignment of the congruent intervention processes and policy settings. This is not usually simple and straight-forward but it is eminently achievable. We already have plenty of knowledge, tools and capability in every component of this model and investment in research that treated end-users as active participants in product development would surely yield more.
It seems to me that the three sectors of the Wheel demarcate three groups of people with differing powers and responsibilities; politicians, planners and policy-writers work in the Policy zone, healthcare scientists and professionals devise and apply the interventions, and the end-users (whether patients, healthcare workers, or others) of course are ultimately responsible for their own behaviour.
The three sectors are intertwined and constitute a ‘system’, so the implications of an innovation should be considered in all three sectors – what behaviour-change demands does it make of the patient, the clinician and the administrator? Does each of these collaborators in our innovation have the capability, motivation and opportunity to make the required changes? What interventions can we apply to assist them with the changes and how does the policy environment affect our ability to apply these interventions and the behaviour-changes themselves?
 For a detailed discussion of how technological value is a co-creation of the innovators and the end-users in healthcare, see Mol, A. (2008). The Logic of Care: Health and the Problem of Patient Choice, Oxford, Routledge Press.
 Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science : IS, 6(1), 42.