http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(3): 273–275 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2014.950725
SHORT REPORT
Outcomes of commitment to change statements after an interprofessional faculty development program Voula Christofilos1, Dale DeMatteo1, and Rick Penciner1,2 1
North York General Hospital, Centre for Education, Toronto, Ontario, Canada and 2Division of Emergency, Department of Family & Community Medicine, University of Toronto, Toronto, Canada Abstract
Keywords
Commitment to change (CTC) statements have been shown to have a useful role as an instrument of change. We explored the experiences of six health professionals at a large community teaching hospital in making and keeping CTC statements in the context of a foundational interprofessional education (IPE) faculty development program. As part of program evaluation, a qualitative study, applying a grounded theory approach, was conducted to gain a deeper understanding of using CTC statements in the context of a paradigmatic organizational change project. This paper explores the effectiveness of an IPE faculty development program at a community teaching hospital. Participants identified personal/ professional and interpersonal/interprofessional changes related to CTC statements. The study highlighted a range of issues surrounding implementation of collaborative actions connected to participants’ ability to follow through on commitment to change statements made during the program.
Commitment to change, faculty development, grounded theory, interprofessional education, interviews, reflection
Introduction To begin the process of organizational change towards interprofessional education (IPE) and practice, a longitudinal faculty development program was developed at a large community teaching hospital in Toronto, Canada. The program consisting of four 90-minute workshops over four consecutive months was open to all professional staff interested in expanding their knowledge and skills to be effective teachers and leaders in an interprofessional education (IPE) setting. The program, developed and facilitated by an interprofessional team of educators from the hospital, consisted of topics on principles of IPE and reflective practice; collaboration and teamwork; facilitation in IPE; and conflict resolution and feedback. Incorporated into the program, was the change strategy of commitment to change (CTC) as a method of measuring and enhancing learning by reinforcing the teaching points having the greatest impact on the individual learner (Dolcourt, 2000). Commitment to change tools have been used in continuing health professional education in order to assess course effectiveness (Lockyer et al., 2001); document unintended changes (White, Grzybowski, & Broudo, 2004); provide feedback (White et al., 2004); identify/reinforce behavioral change (White et al., 2004); develop committed leaders (Overton & MacVicar, 2008) and facilitate reflective practice (Lowe, Rappolt, Jaglal, & Macdonald, 2007; White et al., 2004). This paper describes findings from a qualitative study that was part of the evaluation of the program. The question guiding the
Correspondence: Ms Voula Christofilos BASc, MEd, RD, North York General Hospital, Centre for Education, 4001 Leslie St, Toronto, Ontario, Canada M2K 1E1. E-mail: [email protected]
History Received 20 May 2013 Revised 26 May 2014 Accepted 29 July 2014 Published online 26 August 2014
research was did participants apply the knowledge that they gained during the program and follow through on their CTC statements?
Methods The study employed a grounded approach (Glaser & Strauss, 1967) to understand issues related with the implementation of IPE and collaboration commitment to change statements from an IPE faculty development course. Data collection and analysis At the end of each IPE session, participants were asked to individually write down at least one action (CTC statement) that they were willing to incorporate into their practice as a result of their learning. Six months after the program, semi-structured interviews with consenting participants were used to explore experiences in acting upon their CTC statement(s). During individual interviews each participant was asked: if they addressed each CTC statement; if something helped to facilitate the change; if they experienced barriers to change and whether there had been unexpected changes related to follow through (or not) to the committed action. We asked for their thoughts about making written CTC statements and whether they felt it was a useful tool for IPE programs. The interviews were taped, transcribed, and analyzed in an inductive manner. This involved a line-by-line review of each transcript using a multi-step process going from open to focused coding, applying the constant comparative approach (Glaser & Strauss, 1967) until no new codes were identified. Codes were grouped into discrete categories or themes and relationships among the different themes were further explored using axial coding.
274
V. Christofilos et al.
Ethical considerations Ethical approval for all phases of the evaluation research was obtained from the hospital’s research ethics board.
Results Twenty-four health professionals from nine different professions attended the four workshops. Six participants representing five different professions (social work, nursing, physiotherapy, medicine, and medical radiation technology) agreed to be interviewed. Participants ranged in age from 35 to 63 years with 15 to 40 years of experience in their respective professions. Four participants held leadership positions and four also provided front-line service. Among the six individuals interviewed, a total of 22 CTC statements were identified with 15 of these being implemented in their professional practice. The statements were related to change at personal, interpersonal, and social levels. They reflected both IPE content and structure (such as flattened professional hierarchy) and identified both professional and student-related issues. Individual changes Personal changes reported by the participants included: the use of reflection and journaling; increased awareness and appreciation of other professions; viewing situations from others’ perspectives; and behavioural changes to reflect interprofessional values and goals. Interpersonal changes were most often related to incorporating management or leadership techniques and tools to further interprofessional collaboration such as conflict resolution, facilitation methods, non-directive teaching/
J Interprof Care, 2015; 29(3): 273–275
leadership, preparing students interprofessionally, and building/ supporting inclusivity (Table I). Factors facilitating change Participants identified supporting factors at different levels which helped to facilitate their CTC statements. The first of these was environmental factors (e.g. hospital moving in the direction of interprofessional learning/care; administrative permission to take time for interprofessional interaction with students, staff; working/learning in a ‘‘safe’’ environment; seeking the help of others due to increased workload). The second was personal factors (e.g. use of reflection, increase in confidence, application of new/enhanced IPE skills, and heightened level of sensitivity/empathy). The third was social factors (e.g. high level of cooperation/engagement; new/enriched relationships, greater openness towards others, being part of an experienced team). The final were educational factors (e.g. parallel course reinforcing and building on IPE; reading; having good facilitators/mentors). Participants noted special challenges for successful implementation of IPE and interprofessional collaboration (IPC). These challenges included the stressed and fast-paced hospital work environment, the importance of introducing IPE/IPC in a non-threatening manner to physicians, and the need to build a ‘‘strong foundation’’ for IPE/IPC to grow and flourish (Table I). Barriers to change Participants described some type of barrier for approximately half of their 22 CTC statements. Frequently, these barriers were linked to lack of time and/or workload. Other barriers identified included
Table I. Data quotes. Individual changes
Profession
‘‘not making assumptions about people; it’s the basis of negotiations and a whole bunch of other things. I listen more. I do try to put myself in their shoes . . . .looking through their eyes at the scenario . . . .my perspective too.’’ ‘‘what I did find, I started taking up more leadership roles’’ ‘‘I think people are appreciating the knowledge and skill of other disciplines and people are starting to reflect on other disciplines’ contributions to the department and patients. ‘‘I have been more self aware . . . I try and think of how another person may perceive my expression or my body language . . . I’ve passed it on to staff. I think I’ve become a better manager or leader because I’ve been able to sort of step back and look at the situation . . . from different sides.’’
Medicine Social work Nursing Medical radiation technology
Factors facilitating change The biggest thing through the course is having permission to do it (taking the extra time to interact and communicate with others). It’s actually a requirement as opposed to a frill.’’ ‘‘I think part of the confidence is (people) meet you and say oh, this is what you do and you sort of feel valued, and that increases your confidence.’’ ‘‘We are getting a cohort of students who learn differently . . . the intensity . . . the feedback . . . . the constancy of it. They require feedback! They demand a voice, an equal voice, which is not the way most of us learned.’’ ‘‘There needs to be external support from people in the organization who help you grow but you also need opportunities to be who you are and to grow. It’s not only the people we work with but management helping support you through change.’’ ‘‘it has something to do with everybody being together and being able to hear from everybody and everybody’s voice being heard.’’ ‘‘when you get together on more of an almost social basis it just makes things more . . . it helps people work together.’’
Medicine Medical radiation technology Medicine Social work Nursing Medical radiation technology
Barriers to change ‘‘I only have so much authority . . . it’s the manager who sets the tone on the unit and what the expectations are.’’ ‘‘You hear it over and over again. People are stressed. They’re jobs are hugely busy . . . they just have to carve more time out of the day which is just impossible. It’s a shame, you know, there’s huge potential for personal growth and improvement.’’ ‘‘There are some mindsets and I have to say the physicians . . . they are independent. You have to not overcome, but emphasize to them that it’s (IPE) not a threat.’’ ‘‘I am nervous about conflict between disciplines because it’s risky. The benefits could be huge but it’s risky.’’
Physiotherapy Medicine Medicine Nursing
DOI: 10.3109/13561820.2014.950725
lack of confidence or skill; not having the opportunity to apply new knowledge; limited authority to make needed change; the unwillingness of others to respond/open up. One person said she did not think in terms of barriers, viewing CTC facilitation as a ‘‘process’’ (Table I).
Discussion As noted above, participants were positive about the use of CTC statements in this program. CTC statements have been identified as a way to ensure both educators and learners have a stake in educational goals and outcome (Dolcourt, 2000; Dolcourt & Zuckerman, 2003). A connection was made between the use of CTC and the fact that IPE is all about change – in how health professionals think, behave, relate to others, and practice their profession. There was indication that the CTC statement is not simply an individual act, but one that occurs within a context that must be acknowledged and understood. Although unstated, the goal of IPE and collaboration is a non-hierarchical, collaborative workplace, which holds great promise for many health professionals who have felt less than equal to their hospital counterparts. At the individual level, people are willing to make a commitment when they feel safe, valued, and believe the commitment will somehow enrich their lives either personally or professionally. As described in participants’ stories, the interprofessional structure and content of the sessions had a positive effect on them both personally and professionally. The successful ‘‘flattening’’ of the staff hierarchy, e.g. ‘‘they made us feel equal’’ that is central to the values and principles of IPE/C, was linked to increased confidence, feeling valued, and a sense of ‘‘safety’’. Participants acknowledged the importance of support at the administrative level. In the organizational change literature, Parish, Cadwallader, & Busch (2008) identify ‘‘affective’’ commitment to change (ACTC) as having the greatest positive impact. Antecedents for ACTC that warrant administrative attention include fit with vision, job motivation, role autonomy, and importantly, the quality of employee–management relationships (Parish et al., 2008). In helping organizations address these ‘‘hard elements’’ of transformative change, Sirkin, Keenan, and Jackson (2005) warn against placing too high a workload burden on employees (or risk project failure), thus the importance of ‘‘dedicated’’ time. According to Mazmanian and Mazmanian (1999) continuing education in health care is increasingly tied to the organizational goals of cost reduction, improved quality of care, and performance data with CTCs often playing an assessment role. If the current interprofessional movement is to become more than (as one participant warned) organizational ‘‘flavor of the day’’, it will require continued commitment on the part of governments, professional bodies, health organizations, health professionals, and academic institutions. The results from this study should be considered in the context that this was a small sample of the program participants and due to the nature of self-reporting, recall biases are in play. As there was a significant amount of time that lapsed between the program
Commitment to change and IPE faculty development
275
and the date of the interviews, the changes identified by the participants cannot be solely attributed to their participation in the program. It is difficult to control for external factors such as other continuing education or local unit initiatives that may have influenced the participants follow through on their CTC statements. In summary, this paper explored the effectiveness of an IPE faculty development program at a community teaching hospital. The study highlights some of the issues surrounding implementation of collaborative actions linked to participants’ ability to follow through on commitment to change statements made during their IPE program.
Acknowledgements We would like to acknowledge the co-developers of the Interprofessional Faculty Development Program: Susan Woollard, Tammy Muskat, and Mohini Pershad.
Declaration of interest The authors report that they have no declaration of interest. The authors are responsible for the writing and contents of this paper.
References Dolcourt, J. (2000). Commitment to change: A strategy for promoting educational effectiveness. The Journal of Continuing Education in the Health Professions, 20, 156–163. Dolcourt, J., & Zuckerman, G. (2003). Unanticipated learning outcomes associated with commitment to change in continuing medical education. The Journal of Continuing Education in the Health Professions, V23, 173–181. Glaser, B., & Straus, A. (1967). The discovery of grounded theory: Strategies for qualitative research. New Jersey: Transaction Publishers. Lockyer, J., Fidler, H., Ward, R., Basson, R., Elliott, S., & Toews, J. (2001). Commitment to change statements: A way of understanding how participants use information and skills taught in an educational session. The Journal of Continuing Education in the Health Professions, 21, 82–89. Lowe, M., Rappolt, S., Jaglal, S., & Macdonald, G. (2007). The role of reflection in implementing learning from continuing education into practice. The Journal of Continuing Education in the Health Professions, 23, 143–148. Mazmanian, P.E., & Mazmanian, P.M. (1999). Commitment to change: Theoretical foundations, methods and outcomes. The Journal of Continuing Education in the Health Professions, 19, 200–207. Overton, G., & MacVicar, R. (2008). Requesting a commitment to change: Conditions that produce behavioural or attitudinal commitment. Journal of Continuing Education in the Health Professions, 28, 60–66. Parish, J.T., Cadwallader, S., & Busch, P. (2008). We want to, need to, ought to: Employee commitment to organizational change. Journal of Organizational Change Management, V23, 32–52. Sirkin, H.L., Keenan, P., & Jackson, A. (2005). The hard side of change management. Harvard Business Review, October, 33–47. White, M., Grzybowski, S., & Broudo, M. (2004). Commitment to change instrument enhances program planning, implementation and evaluation. The Journal of Continuing Education in the Health Professions, 24, 153–162.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
SHORT REPORT
Outcomes of commitment to change statements after an interprofessional faculty development program Voula Christofilos1, Dale DeMatteo1, and Rick Penciner1,2 1
North York General Hospital, Centre for Education, Toronto, Ontario, Canada and 2Division of Emergency, Department of Family & Community Medicine, University of Toronto, Toronto, Canada Abstract
Keywords
Commitment to change (CTC) statements have been shown to have a useful role as an instrument of change. We explored the experiences of six health professionals at a large community teaching hospital in making and keeping CTC statements in the context of a foundational interprofessional education (IPE) faculty development program. As part of program evaluation, a qualitative study, applying a grounded theory approach, was conducted to gain a deeper understanding of using CTC statements in the context of a paradigmatic organizational change project. This paper explores the effectiveness of an IPE faculty development program at a community teaching hospital. Participants identified personal/ professional and interpersonal/interprofessional changes related to CTC statements. The study highlighted a range of issues surrounding implementation of collaborative actions connected to participants’ ability to follow through on commitment to change statements made during the program.
Commitment to change, faculty development, grounded theory, interprofessional education, interviews, reflection
Introduction To begin the process of organizational change towards interprofessional education (IPE) and practice, a longitudinal faculty development program was developed at a large community teaching hospital in Toronto, Canada. The program consisting of four 90-minute workshops over four consecutive months was open to all professional staff interested in expanding their knowledge and skills to be effective teachers and leaders in an interprofessional education (IPE) setting. The program, developed and facilitated by an interprofessional team of educators from the hospital, consisted of topics on principles of IPE and reflective practice; collaboration and teamwork; facilitation in IPE; and conflict resolution and feedback. Incorporated into the program, was the change strategy of commitment to change (CTC) as a method of measuring and enhancing learning by reinforcing the teaching points having the greatest impact on the individual learner (Dolcourt, 2000). Commitment to change tools have been used in continuing health professional education in order to assess course effectiveness (Lockyer et al., 2001); document unintended changes (White, Grzybowski, & Broudo, 2004); provide feedback (White et al., 2004); identify/reinforce behavioral change (White et al., 2004); develop committed leaders (Overton & MacVicar, 2008) and facilitate reflective practice (Lowe, Rappolt, Jaglal, & Macdonald, 2007; White et al., 2004). This paper describes findings from a qualitative study that was part of the evaluation of the program. The question guiding the
Correspondence: Ms Voula Christofilos BASc, MEd, RD, North York General Hospital, Centre for Education, 4001 Leslie St, Toronto, Ontario, Canada M2K 1E1. E-mail: [email protected]
History Received 20 May 2013 Revised 26 May 2014 Accepted 29 July 2014 Published online 26 August 2014
research was did participants apply the knowledge that they gained during the program and follow through on their CTC statements?
Methods The study employed a grounded approach (Glaser & Strauss, 1967) to understand issues related with the implementation of IPE and collaboration commitment to change statements from an IPE faculty development course. Data collection and analysis At the end of each IPE session, participants were asked to individually write down at least one action (CTC statement) that they were willing to incorporate into their practice as a result of their learning. Six months after the program, semi-structured interviews with consenting participants were used to explore experiences in acting upon their CTC statement(s). During individual interviews each participant was asked: if they addressed each CTC statement; if something helped to facilitate the change; if they experienced barriers to change and whether there had been unexpected changes related to follow through (or not) to the committed action. We asked for their thoughts about making written CTC statements and whether they felt it was a useful tool for IPE programs. The interviews were taped, transcribed, and analyzed in an inductive manner. This involved a line-by-line review of each transcript using a multi-step process going from open to focused coding, applying the constant comparative approach (Glaser & Strauss, 1967) until no new codes were identified. Codes were grouped into discrete categories or themes and relationships among the different themes were further explored using axial coding.
274
V. Christofilos et al.
Ethical considerations Ethical approval for all phases of the evaluation research was obtained from the hospital’s research ethics board.
Results Twenty-four health professionals from nine different professions attended the four workshops. Six participants representing five different professions (social work, nursing, physiotherapy, medicine, and medical radiation technology) agreed to be interviewed. Participants ranged in age from 35 to 63 years with 15 to 40 years of experience in their respective professions. Four participants held leadership positions and four also provided front-line service. Among the six individuals interviewed, a total of 22 CTC statements were identified with 15 of these being implemented in their professional practice. The statements were related to change at personal, interpersonal, and social levels. They reflected both IPE content and structure (such as flattened professional hierarchy) and identified both professional and student-related issues. Individual changes Personal changes reported by the participants included: the use of reflection and journaling; increased awareness and appreciation of other professions; viewing situations from others’ perspectives; and behavioural changes to reflect interprofessional values and goals. Interpersonal changes were most often related to incorporating management or leadership techniques and tools to further interprofessional collaboration such as conflict resolution, facilitation methods, non-directive teaching/
J Interprof Care, 2015; 29(3): 273–275
leadership, preparing students interprofessionally, and building/ supporting inclusivity (Table I). Factors facilitating change Participants identified supporting factors at different levels which helped to facilitate their CTC statements. The first of these was environmental factors (e.g. hospital moving in the direction of interprofessional learning/care; administrative permission to take time for interprofessional interaction with students, staff; working/learning in a ‘‘safe’’ environment; seeking the help of others due to increased workload). The second was personal factors (e.g. use of reflection, increase in confidence, application of new/enhanced IPE skills, and heightened level of sensitivity/empathy). The third was social factors (e.g. high level of cooperation/engagement; new/enriched relationships, greater openness towards others, being part of an experienced team). The final were educational factors (e.g. parallel course reinforcing and building on IPE; reading; having good facilitators/mentors). Participants noted special challenges for successful implementation of IPE and interprofessional collaboration (IPC). These challenges included the stressed and fast-paced hospital work environment, the importance of introducing IPE/IPC in a non-threatening manner to physicians, and the need to build a ‘‘strong foundation’’ for IPE/IPC to grow and flourish (Table I). Barriers to change Participants described some type of barrier for approximately half of their 22 CTC statements. Frequently, these barriers were linked to lack of time and/or workload. Other barriers identified included
Table I. Data quotes. Individual changes
Profession
‘‘not making assumptions about people; it’s the basis of negotiations and a whole bunch of other things. I listen more. I do try to put myself in their shoes . . . .looking through their eyes at the scenario . . . .my perspective too.’’ ‘‘what I did find, I started taking up more leadership roles’’ ‘‘I think people are appreciating the knowledge and skill of other disciplines and people are starting to reflect on other disciplines’ contributions to the department and patients. ‘‘I have been more self aware . . . I try and think of how another person may perceive my expression or my body language . . . I’ve passed it on to staff. I think I’ve become a better manager or leader because I’ve been able to sort of step back and look at the situation . . . from different sides.’’
Medicine Social work Nursing Medical radiation technology
Factors facilitating change The biggest thing through the course is having permission to do it (taking the extra time to interact and communicate with others). It’s actually a requirement as opposed to a frill.’’ ‘‘I think part of the confidence is (people) meet you and say oh, this is what you do and you sort of feel valued, and that increases your confidence.’’ ‘‘We are getting a cohort of students who learn differently . . . the intensity . . . the feedback . . . . the constancy of it. They require feedback! They demand a voice, an equal voice, which is not the way most of us learned.’’ ‘‘There needs to be external support from people in the organization who help you grow but you also need opportunities to be who you are and to grow. It’s not only the people we work with but management helping support you through change.’’ ‘‘it has something to do with everybody being together and being able to hear from everybody and everybody’s voice being heard.’’ ‘‘when you get together on more of an almost social basis it just makes things more . . . it helps people work together.’’
Medicine Medical radiation technology Medicine Social work Nursing Medical radiation technology
Barriers to change ‘‘I only have so much authority . . . it’s the manager who sets the tone on the unit and what the expectations are.’’ ‘‘You hear it over and over again. People are stressed. They’re jobs are hugely busy . . . they just have to carve more time out of the day which is just impossible. It’s a shame, you know, there’s huge potential for personal growth and improvement.’’ ‘‘There are some mindsets and I have to say the physicians . . . they are independent. You have to not overcome, but emphasize to them that it’s (IPE) not a threat.’’ ‘‘I am nervous about conflict between disciplines because it’s risky. The benefits could be huge but it’s risky.’’
Physiotherapy Medicine Medicine Nursing
DOI: 10.3109/13561820.2014.950725
lack of confidence or skill; not having the opportunity to apply new knowledge; limited authority to make needed change; the unwillingness of others to respond/open up. One person said she did not think in terms of barriers, viewing CTC facilitation as a ‘‘process’’ (Table I).
Discussion As noted above, participants were positive about the use of CTC statements in this program. CTC statements have been identified as a way to ensure both educators and learners have a stake in educational goals and outcome (Dolcourt, 2000; Dolcourt & Zuckerman, 2003). A connection was made between the use of CTC and the fact that IPE is all about change – in how health professionals think, behave, relate to others, and practice their profession. There was indication that the CTC statement is not simply an individual act, but one that occurs within a context that must be acknowledged and understood. Although unstated, the goal of IPE and collaboration is a non-hierarchical, collaborative workplace, which holds great promise for many health professionals who have felt less than equal to their hospital counterparts. At the individual level, people are willing to make a commitment when they feel safe, valued, and believe the commitment will somehow enrich their lives either personally or professionally. As described in participants’ stories, the interprofessional structure and content of the sessions had a positive effect on them both personally and professionally. The successful ‘‘flattening’’ of the staff hierarchy, e.g. ‘‘they made us feel equal’’ that is central to the values and principles of IPE/C, was linked to increased confidence, feeling valued, and a sense of ‘‘safety’’. Participants acknowledged the importance of support at the administrative level. In the organizational change literature, Parish, Cadwallader, & Busch (2008) identify ‘‘affective’’ commitment to change (ACTC) as having the greatest positive impact. Antecedents for ACTC that warrant administrative attention include fit with vision, job motivation, role autonomy, and importantly, the quality of employee–management relationships (Parish et al., 2008). In helping organizations address these ‘‘hard elements’’ of transformative change, Sirkin, Keenan, and Jackson (2005) warn against placing too high a workload burden on employees (or risk project failure), thus the importance of ‘‘dedicated’’ time. According to Mazmanian and Mazmanian (1999) continuing education in health care is increasingly tied to the organizational goals of cost reduction, improved quality of care, and performance data with CTCs often playing an assessment role. If the current interprofessional movement is to become more than (as one participant warned) organizational ‘‘flavor of the day’’, it will require continued commitment on the part of governments, professional bodies, health organizations, health professionals, and academic institutions. The results from this study should be considered in the context that this was a small sample of the program participants and due to the nature of self-reporting, recall biases are in play. As there was a significant amount of time that lapsed between the program
Commitment to change and IPE faculty development
275
and the date of the interviews, the changes identified by the participants cannot be solely attributed to their participation in the program. It is difficult to control for external factors such as other continuing education or local unit initiatives that may have influenced the participants follow through on their CTC statements. In summary, this paper explored the effectiveness of an IPE faculty development program at a community teaching hospital. The study highlights some of the issues surrounding implementation of collaborative actions linked to participants’ ability to follow through on commitment to change statements made during their IPE program.
Acknowledgements We would like to acknowledge the co-developers of the Interprofessional Faculty Development Program: Susan Woollard, Tammy Muskat, and Mohini Pershad.
Declaration of interest The authors report that they have no declaration of interest. The authors are responsible for the writing and contents of this paper.
References Dolcourt, J. (2000). Commitment to change: A strategy for promoting educational effectiveness. The Journal of Continuing Education in the Health Professions, 20, 156–163. Dolcourt, J., & Zuckerman, G. (2003). Unanticipated learning outcomes associated with commitment to change in continuing medical education. The Journal of Continuing Education in the Health Professions, V23, 173–181. Glaser, B., & Straus, A. (1967). The discovery of grounded theory: Strategies for qualitative research. New Jersey: Transaction Publishers. Lockyer, J., Fidler, H., Ward, R., Basson, R., Elliott, S., & Toews, J. (2001). Commitment to change statements: A way of understanding how participants use information and skills taught in an educational session. The Journal of Continuing Education in the Health Professions, 21, 82–89. Lowe, M., Rappolt, S., Jaglal, S., & Macdonald, G. (2007). The role of reflection in implementing learning from continuing education into practice. The Journal of Continuing Education in the Health Professions, 23, 143–148. Mazmanian, P.E., & Mazmanian, P.M. (1999). Commitment to change: Theoretical foundations, methods and outcomes. The Journal of Continuing Education in the Health Professions, 19, 200–207. Overton, G., & MacVicar, R. (2008). Requesting a commitment to change: Conditions that produce behavioural or attitudinal commitment. Journal of Continuing Education in the Health Professions, 28, 60–66. Parish, J.T., Cadwallader, S., & Busch, P. (2008). We want to, need to, ought to: Employee commitment to organizational change. Journal of Organizational Change Management, V23, 32–52. Sirkin, H.L., Keenan, P., & Jackson, A. (2005). The hard side of change management. Harvard Business Review, October, 33–47. White, M., Grzybowski, S., & Broudo, M. (2004). Commitment to change instrument enhances program planning, implementation and evaluation. The Journal of Continuing Education in the Health Professions, 24, 153–162.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
