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White Papers

IHI Psychology of Change Framework

This 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.


  • Define psychology of change: The science and art of human behavior as it relates to transformation
  • Leverage the human side of change — the people engaged in improvement work and their motivations — to overcome resistance to change and positively impact improvement efforts
  • IHI Psychology of Change Framework: Five interrelated domains of practice that organizations can use to increase the success and sustainability of improvement projects
  • Guidance on a measurement system for the psychology of change focused on the effect of the framework on achieving the goals of the specific improvement activity

Note: Portuguese and Spanish translations also available for download.

​​​​​​​​​​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.

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

How Do You Make Change Happen?

IHI White Paper co-author Kate Hilton provides an overview of the IHI Psychology of Change Framework.



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