March 2022 - Improvement Academy Newsletter

March 2022                                                                                               

Welcome to our third Improvement Academy Newsletter for 2022.

In this edition, our feature article will be on the role of behaviour in leading change where we will be introducing the COM-B model with some useful top-tips and downloadable guides to support you and your teams with your improvement work. Our second improvement story of the year to share with you is from Amina Juma and the Preston Ward team at the Kingswood Centre in north west London. Each month we will be sharing great examples from across CNWL where individuals and teams are improving systems and processes to ensure that we deliver the best evidence-based service user and carer experience where ever teams are delivering care across the trust. We also have exciting updates from the Improvement Academy and share great educational opportunities that are coming up.

The role of behaviour in leading change:

An introduction to the COM-B Model

In this month’s newsletter we would like to highlight the major role that behaviour plays in leading change.  The COM-B model and Behaviour Change Wheel can be used to unpick the role that behaviour plays in tackling some of our most stubborn service issues (see Figure 1) (Michie et al. 2011, 2014).

Figure 1 – The COM-B model and Behaviour Change Wheel

The COM-B model and Behaviour Change Wheel align perfectly with the Model for Improvement (the framework we use for structuring improvement projects at CNWL) and can be used to help us understand the messiness of our problems, map our systems, design change ideas in a systematic and evidence-based way and then communicate and share what works and why (see Figure 2).

Figure 2 – How to use the COM-B model Behaviour Change Wheel within Quality Improvement work

Use COM-B to identify barriers and facilitators to change

The COM-B model proposes that there are three components to any Behaviour (B): Capability (C), Opportunity (O) and Motivation (M). Those three areas are the key drivers of behaviour (Figure 3a+b).

Figure 3a – The COM-B Model

Capability refers to whether we have the knowledge, skills and abilities required to engage in a particular behaviour. Its two components are:

• Psychological Capability: our knowledge/ psychological strength, skills or stamina
• Physical Capability: our physical strength, skill or stamina

Opportunity, in the context of this model, refers to the external factors which make the execution of a particular behaviour possible. Its two components are:

• Physical Opportunity: opportunities provided by the environment, such as time, location and resource
• Social Opportunity: opportunities as a result of social factors, such as cultural norms and social cues

Motivation refers to the internal processes which influence our decision making and behaviours. Its two components are:

• Reflective Motivation: reflective processes, such as making plans and evaluating things that have already happened
• Automatic Motivation: automatic processes, such as our desires, impulses and inhibitions

Figure 3b – The COM-B Model explained

If we were to apply this behaviour change model to a simple example relating to improving health through healthy eating and we can briefly break down some of the influences on that behaviour using the COM-B model so you get an idea of how to use this model with teams when planning improvement work (Figure 4).

1. If the goal behaviour (B) was to ‘eat healthily’
2. Someone would need to have the capability (C) to understand how to eat healthily. This may be related to the knowledge of what is and isn’t healthy, what forms a balanced diet as well as the skills needed to eat healthily, such as having the ability to cook.
3. The next thing they would need is the motivation (M), for instance understanding the positive and negative consequences of eating healthily and what each of these choices would mean for them.
4. The final element of this model that is needed to change behaviour is opportunity (O). This may be related to the physical opportunity to eat healthily e.g. do they have the time to shop and cook healthily? Do they also have the financial resource to eat healthily and are there shops geographically nearby that sell healthy food? Alongside the physical opportunity, there is also a need of the social opportunity. This is related to things like cultural norms etc. If their family all order take-out food every night, then this may disrupt their ability to eat healthily.

Figure 4 – The COM-B Model applied

Therefore, as you can see, you can use this framework to map the barriers and facilitators to your identified behaviour in a comprehensive and methodical way, ensuring you have thought about all the areas that may influence behaviour.

The team who created the COM-B model have also created the Behaviour Change Wheel as a tool that can be used in conjunction with it (Figure 5). The green section in the middle of the wheel is the COM-B model that we have just explored. The red section outlines the different types of interventions that you could consider and is explained in greater detail in Figure 6. As a side note, the grey area on the outer perimeter of the circle is focused at an organisational or policy level and concentrates on the bigger influences of behaviour such as legalisation and regulation.