Get Your Recommendations Implemented Every Time

Have you ever had a project in which you have conducted research, written a report and provided recommendations, but found that your recommendations weren’t implemented and the report sat on a Managing Director’s shelf gathering dust?

In this article I look at how we, as advisors and experts in the health and safety and ergonomics field, can target our recommendations and interventions to increase the likelihood of them being implemented effectively and efficiently whilst satisfying the client and their employees.

It may be that the client is simply unwilling to change or that the work was conducted just to tick a box.  However, it is just as likely that:

• the client did not understand the need for this change
• the client did not understand how to implement the recommendations
• employees were not ready for the changes. 

Recent research suggests that by understanding the clients’ readiness to change we can design our interventions to increase the chance of successful implementation. (Haslam et al 2000).

What are the stages of change?

Targeting interventions according to a person’s readiness to change is not a new idea in the world of health promotion.   Prochaska and DiClemente (1982) developed the “stage of change model” in the field of psychotherapy.  The model is often considered as cyclical because most people attempting to change their health behaviour will relapse and have to repeat stages in order to learn how to maintain their behaviour.  The cyclical model is shown in the diagram below.

Central to this model is the idea that people move through pre-defined stages when trying to improve health-related behaviour.  The stages are:

• Pre-contemplation (no consideration of changing)
• Contemplation (thinking about changing)
• Preparation (making plans to change)
• Action (actually in the process of changing)
• Maintenance (working to prevent relapse)

This model is often used to design a course of action to encourage people to give up smoking. 

For example, a smoker who is in the pre-contemplation stage will need to be given graphic information about the health risks (Haslam et al 2000) and may benefit from shock tactics.  However, those smokers in the preparation stage will benefit from encouragement, practical advice on how to change, information to reinforce their motivation and perhaps skills training. 

The same principles can be used for a client with musculoskeletal disorders amongst staff.  If the client has asked for help because of the problems with musculoskeletal disorders, we could presume that they are past the pre-contemplation stage.  However, any successful intervention will depend on the stage of change of both the managers and staff.

How do I assess my clients' stage of readiness to change?

For example, a client who is aware there is a problem but has no remedial plans in place or who understands the benefits of improving working conditions for the staff whilst seeing the associated costs is at the contemplation stage.  They will need further information about the benefits and practical recommendations on how to tackle the problem.

Prochaska et al (2001) suggest that if employees are within the first two stages (pre-contemplation and contemplation) they will feel any changes that are made have been imposed on them.  Therefore, any recommendation should indicate that employees need to be prepared for the change.  In other words, the more involved employees are in the change process, the more likely they are to accept it. 

But, how can we, as consultants, assess which stage the client is at?

How would this work in practice?

Well, it is actually quite simple. It can be implemented quickly at the kick off meeting of any project and it works surprisingly well.

There are a set of closed questions based on research being conducted at Loughborough University (Personal Communication, Whysall 2003).  Using musculoskeletal disorders as an example, we could ask the following questions until we get a negative response.  The last positive response gives us the clients’ stage of readiness to change.

• Precontemplation – Are you concerned about musculoskeletal disorders?
• Contemplation – Are you planning to do anything to reduce musculoskeletal risks in the next 6 months?
• Preparation – Have you got definite plans to address the issue within the next month? If so what are they?
• Action – Have you taken any action to reduce the musculoskeletal disorders already?
• Maintenance – Are you planning to continue this action?

Prochaska et al (2001) believe that stage matched interventions can have a far greater impact than a one-size-fits-all programme and that they increase the likelihood that the client will progress to action. 

So, if ergonomic and health and safety advisors use this technique, as well as the usual observations and interviews, to gauge an understanding of how ready the client, the managing director and the employees are to change, reports gathering dust could be a thing of the past.
 
Katherine Lee

Katherine Lee is co-author of a paper “Assessing attitudes and beliefs using the stage of change paradigm – case study of a health and safety appraisal within a manufacturing company” by Barrett et al which will be published in the International Journal of Industrial Ergonomics.
 
Haslam, C and Haslam, R.A., 2000. A stage specific approach to improving occupational health and safety. In: Proceedings of the XIVth Triennial Congress of the International Ergonomics Association and 44th Meeting of the Human Factors and Ergonomics Society, 29 July – 4 July 2000, San Diego (Human Factors and Ergonomics Society: Santa Monica, California), volume 6, pp253-255

Prochaska, J.O., and DiClemente, C.C., 1982. Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory Research and Practice, 19, 276-288

Prochaska, M., Prochaska, J.O., and Levesque, D.A., 2001. A transtheoretical approach to changing organisations. Administration and Policy in Mental Health, 28(4), 247-261