Change? or behavioral change?

Abstract

Literature on change proliferates. Literature on change in the context of health management has also been extensive and diverse throughout the past two decades. Yet, the actual concept of ‘change’ has deserved little attention. It has become widely acknowledged that if we do not clearly understand and define what we mean by ‘change’ it is very difficult to assess the validity of all the alleged and desired change processes in healthcare as widely announced by health leaders in the vast majority of developed health systems. My proposal in this short text is that researchers and practitioners focus their thinking and structured observation of ‘change’ on human change. Rather than the sole focus on intentional change processes reflected on organizational issues, we need to produce more knowledge and examples of good practice on the natural development of human change and consider it as a key strategic objective of health management programs and intervention. As recent population movements and social events in the Middle East demonstrate, the most important opportunities for change are those that were never anticipated and turn out to be dependent on natural human change. Overall, it is often a set of ignored human concerns considered peripheral and secondary by leaders that have the major consequences on change dynamics. This can be viewed in a number of societies in our days. This can be observed in organizations and in health systems. Unlike some viewsmay seem to have been arguing with a certain degree of ‘wishful thinking’, it seems like human change may not be solely dependent on change of processes. Indeed, we may be in need to review our approach to change. Change of processes and procedures, policies, and flows is well known to all our community in management and marketing in healthcare activities. Yet, should we also not look, and primarily, into human change? Human change is about human behavior. However, unlike changes, for instance, in administrative procedures, the behavior of human beings offers none of the administrative change features or the analytical simplicity that managers aim at with pragmatism when planning change. Our current understanding of the causes of behavioral changes and of the methods of changing behavior are in need of further certainty to support our understanding of how they may be brought about to support the implementation of health systems and organizations’ objectives. The universal nature of change poses an additional conceptual challenge – that of connecting change elements and the state of constant change of health systems and organizations with factual change of behaviors. This is a key idea for further debate and improved practice. So much so that it is widely viewed that health systems have been struggling with the same behavioral issues for decades in spite of several organizational healthcare reforms implemented in the meantime. In this sense, I would like to leave three ideas for debate and hopefully to motivate the production of articles for our journal. Firstly, we must assume that we need to better describe the relation between changes in behavioral patterns as an indicator of other changes in health systems and organizations. Secondly, we must accept the enormous complexity of interdependent ‘people systems’when we aim at a better understanding of networks as an essential element of interaction and influence on behavior. By focusing on structured analysis of target audiences and social networks for this purpose we may support managers on a better understanding of unknown influences and potential impacts from hidden and unforeseen behavioral phenomena. Thirdly, by introducing the behavior factor in our daily management discourse, we focus on intended change on what concerns change. Setting aims of intended change should put managers on track for a new set of strategic development objectives for healthcare organizations and should give room for disciplines like social marketing and related behavioral science practitioners and researchers. It is about time for some health systems to further develop this approach and learning from existing experiences is clearly an opportunity that we should pursue.