Enhancing quality and safety in hospitals: AMO for starting, sustaining and spreading service-improvement change

Healthcare is inherently risky, necessitating ongoing investment in different types of change: starting new ventures to enhance existing practice; working to sustain improvements and avoid decay; and scaling-up successful... [ view full abstract ]

Healthcare is inherently risky, necessitating ongoing investment in different types of change: starting new ventures to enhance existing practice; working to sustain improvements and avoid decay; and scaling-up successful initiatives. Whilst the challenges are clear, strategies for addressing them are less so – with particular gaps in knowledge regarding how to support embedding and spreading change. As a result, this paper draws upon data from four hospital case-studies in two countries (Scotland and Ireland), to identify HRM supports for starting, sustaining and spreading service-improvement change. Qualitative analysis of interviews with seventy managerial and clinical staff is informed by the AMO (ability, motivation opportunity) model. The contributions of the paper are twofold. Theoretically, it highlights that the skills and abilities, sources of motivation, and types of opportunities required by staff vary according to the type of change they are pursuing. Pragmatically, discussion details people management supports tailored to meet these demands.