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​​ IHI Psychology of Change FrameworkThis white paper is a guide for all leaders interested in understanding the underlying psychology of change and leveraging its power to impact quality improvement efforts: to achieve breakthrough results, sustainably, at scale.

Improvement science has given health care improvers a theoretical framework and the applied technical skills to understand variation, study systems, build learning, and determine the best evidence-based interventions (“what”) and implementation strategies (“how”) to achieve the desired outcomes.

Yet, health care improvers worldwide still struggle with the adaptive side of change, which relates to unleashing the power of people (“who”) and their motivations (“why”) to advance and sustain improvement — two commonly cited reasons for the failure of improvement initiatives.

The paper presents a framework and set of methods for the psychology of change — five interrelated domains of practice that organizations can use to advance and sustain improvement:

  • Unleash Intrinsic Motivation
  • Co-Design People-Driven Change
  • Co-Produce in Authentic Relationship
  • Distribute Power
  • Adapt in Action

Building on the legacies of W. Edwards Deming, Everett Rogers, and many others, a renewed focus on the human side of change increases the likelihood that efforts to improve health and health care will succeed in the short term and be scaled and sustained over time.

[em português y en español: Portuguese and Spanish translations also available. See below.]

How to Cite This Paper: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. (Available at​

​Download Documents

Fill in the form below for access to the following documents:

  • IHI Psychology of Change Framework to Advance and Sustain Improvement
  • SLIDES: IHI Psychology of Change Framework
  • Framework da Psicologia da Mudança do IHI (em português)
  • Marco de la Psicología del Cambio de IHI (en español)​