Transformational Leadership and Followers' Innovative Behavior: Roles of Commitment to Change and Organizational Support for Creativity.

This study aims to investigate the relationships among transformational leadership, followers' innovative behavior, commitment to change, and organizational support for creativity. First, we examine the mediating role of commitment to change in the relationship between transformational leadership and followers' innovative behavior, using both objective and subjective measures. Our results reveal that commitment to change indeed mediates this relationship. Second, we analyze whether the link between commitment to change and followers' innovative behavior is moderated by organizational support for creativity. We find that this relationship is stronger for individuals with high organizational support for creativity compared to those with low support. Empirical analysis was conducted using data collected from 535 managers in 11 subsidiaries of a financial institution in South Korea. This study contributes to the management discipline by resolving mixed outcomes between transformational leadership and followers' innovation and highlighting the influence of commitment to change and perceived organizational support for creativity on innovative behavior.

Adaptation and Validation of Indonesian Version of the Commitment to Change Scale.

Purpose: The study aims to adapt and validate the Indonesian version of the commitment to change scale that was initially developed by Herscovitch and Meyer. Methods: Data were collected using an online application among faculty members of several universities who have experienced policy changes from the Indonesian government regarding research-related issues. A total of 204 responses were obtained. The data was validated using the Content Validity Index (CVI), the Confirmatory Factor Analysis (CFA), the Convergent and Discriminant correlations as well as the Cronbach's alpha. Results: The results demonstrated that commitment to change could be represented by three dimensions of affective, continuance and normative commitment to change, although there is one item that must be adjusted. The results of the Scale-Content Validity Index (S-CVI) show that the commitment to change scale has excellent content validity (S-CVI/Ave = 0.97). CFA results show a good fit, Cronbach's alpha obtains good results with ACTC (α = 0.71); CCTC (α = 0.83); NCTC (α = 0.77) and Construct Reliability (CR) values obtained are also quite good with ACTC = 0.85; CCTC = 0.86; NCTC = 0.86. From the results of the convergent and discriminant validity tests, it was found that the affective commitment to change positively correlates with job satisfaction and negatively correlates with job stress. However, both continuance and normative commitment to change scale does not correlate with the two variables. Conclusion: The Indonesian version of the commitment to change scale shows good psychometric properties and has proven valid to provide the measurement of commitment to change, especially for the faculty members in Indonesia.

Organizational culture and affective commitment to e-learning' changes during COVID-19 pandemic: The underlying effects of readiness for change.

Higher education institutions (HEIs) have been embracing digital transformation for years, but the disruptive influence of the global COVID-19 pandemic has accelerated it. Despite the importance of organizational culture (OC) for the successful delivery of e-learning, empirical studies looking at its impact on academics' readiness and affective commitment to e-learning-induced changes are scant. This study unveils the underlying impacts of multiple employee readiness for change (ERFC) dimensions in the OC-employee affective commitment to change (EACC) relationship. Survey data were obtained from 1,200 Jordanian public HEIs' academics. Structural equation modelling was used to analyze the data, testing the study's six hypotheses. The findings offer a novel contribution by showing that OC types influence different dimensions of ERFC, each having a distinctive impact on EACC. It further shows that two ERFC dimensions, namely self-efficacy and personal valence, function as full mediators in the relationships between group culture/adhocracy culture and EACC.

Net Promoter Score (NPS): What Does Net Promoter Score Offer in the Evaluation of Continuing Medical Education?

Net promoter Score (NPS) has been used in many fields, such as software, clinical care, and websites, as a measure of customer satisfaction since 2003. With a single question, NPS methodology is thought to determine brand loyalty and intent to act based on experiences with the brand or product. In the current study, accredited continuing medical education or continuing education (CME/CE) was the product. Providers of CME have utilised NPS rating (the individual score on a scale of 0 to 10) to collect data about the value of the experience a clinician has with CME activities, but there has been no research to examine what it actually is associated with. This study looked to understand - relative to other self-reported and assessment outcomes in CME, what does NPS at the activity level indicate? From 155 online CME programmes (29,696 target audience learners with complete data), potential outcomes of CME, including whether knowledge or competence improved via assessment score, mean post-confidence rating, and whether one intended practices changes and was committed to those changes, were examined as predictors of NPS. NPS is unique in that it cannot be calculated at the individual level; individual scores must be aggregated, and then the percentage who selected ratings of 0 to 5 is subtracted from the percentage who selected 9 or 10. Results showed that percentage of learners who are committed to change predicts 70% of the variance in NPS, which suggests NPS is a valid indicator of intention to act. These results have implications for how we might, as a field, incorporate the utilisation of a single standardised question to examine the potential impact of online CME and call for additional research on whether NPS predicts change in clinical practice.

Do learners implement what they learn? Commitment-to-change following an interprofessional palliative care course.

BACKGROUND: Palliative care educators should incorporate strategies that enhance application into practice by learners. Commitment-to-change is an approach to reinforce learning and encourage application into practice; immediately post-course learners commit to making changes in their practices as a result of participating in the course ("statements") and then several weeks or months later are prompted to reflect on their commitments ("reflections"). AIM: Explore if and how learners implemented into practice what they learned in a palliative care course, using commitment-to-change reflections. DESIGN: Secondary analysis of post-course commitment statements and 4-months post-course commitment reflections submitted online by learners who participated in Pallium Canada's interprofessional, 2-day, Learning Essential Approaches to Palliative Care (LEAP) Core courses. SETTING/PARTICIPANTS: Primary care providers from across Canada and different profession who attended LEAP Core courses from 1 April 2015 to 31 March 2017. RESULTS: About 1063 of 4636 learners (22.9%) who participated in the 244 courses delivered during the study period submitted a total of 4250 reflections 4 months post-course. Of these commitments, 3081 (72.5%) were implemented. The most common implemented commitments related to initiating palliative care early across diseases, pain and symptom management, use of clinical instruments, advance care planning, and interprofessional collaboration. Impact extended to patients, services, and colleagues. Barriers to implementation into practice included lack of time, and system-level factors such as lack of support by managers and untrained colleagues. CONCLUSIONS: Examples of benefits to patients, families, services, colleagues, and themselves were described as a result of participating in the courses.

Is Gaining Affective Commitment the Missing Strategy for Successful Change Management in Healthcare?

Despite the requirement for continual change and development, change failure is omnipresent in health care, ranging from small technical errors within new systems, processes or technologies, through to breakdowns and large-scale disaster. Despite decades of research investment, consultancy and initiatives, creating a healthcare context that promotes clinician engagement with change remains elusive, with limited demonstrated progress. Affective commitment to change refers to commitment that is driven by a desire to support change based on its perceived benefits or value, as opposed to commitment that is based on a sense of obligation or the minimization of costs. Recent evidence from health-care contexts indicates that affective commitment to change drives change readiness more so than the individual's self-efficacy for dealing with the change. Considering evidence regarding the effect of affective commitment to change on individual and collective change readiness among health-care staff, we may need to reorient our current strategies for managing change. We explore the opportunities to enhance affective commitment to change and, in turn, change readiness through adopting values-based approaches to designing and executing change proposals with clinicians and service users.

The Relationship Between Public Service Motivation and Affective Commitment in the Public Sector Change: A Moderated Mediation Model.

How can public organizations promote change recipients' affective commitment to public sector change? Based on socially desirable responding theory, this study explores the theoretical mechanism and boundary effect of the relationship between public service motivation and affective commitment to change. By conducting a survey of 465 front-line public employees in an eastern Chinese city undergoing public sector change, this study found that voice behavior partially mediates the relationship between public service motivation and affective commitment to change. Superficial harmony also negatively moderates the relationship between public service motivation and affective commitment to change through the mediation of voice behavior. This study mainly contributes to our understanding of the theoretical mechanism and the conditional effect of change recipients' affective commitment during public sector change.

What Do Reinforcement and Confidence Have to Do with It? A Systematic Pathway Analysis of Knowledge, Competence, Confidence, and Intention to Change.

The outcomes model most applied in continuing education for the health professions evaluation is Moore and colleagues' conceptual framework. Examination of how the levels interact and the role of confidence and intention to change can help outcomes professionals understand better how to impact clinician practice and conductand report outcomes studies. The current study examined the relationships among knowledge and competence change, confidence change, and intention to change across 57 online oncology certified education programmes published from 2018 to 2020 on Medscape.org. Findings indicate that not only improvement in knowledge and competence but also reinforcement of knowledge and competence are significant predictors of changes in confidence. They also indicate that knowledge and competence influence intention to change through confidence.

Effect of Pause Procedures on Participant Reflection and Commitment-to-Change in Continuing Medical Education.

Problem: Conferences are the most common form of continuing medical education (CME), but their effect on clinician practice is inconsistent. Reflection is a critical step in the process of practice change among clinicians and may lead to improved outcomes following conference-based CME. However, reflection requires time to process newly-learned material. Adequate time for reflection may be noticeably absent during many conference presentations. Intervention: The pause procedure is a 90-second 'pause' during a 30-minute presentation so learners can review and discuss content. The goal of the pause procedure is to stimulate learners' active engagement with newly learned material which will, in turn, promote learner reflection. Context: Fifty-six presentations at two hospital medicine CME conferences were assigned to the pause procedure or control. Study outcomes provided by conference participants were validated reflection scores and commitment-to-change (CTC) statements for each presentation. A post-hoc survey of the intervention group was conducted to assess presenters' experiences with the pause procedure. Impact: A total of 527 conference participants completed presentation evaluations (response rate 72.7%). Presentations incorporating the pause procedure failed to lead higher participant reflection scores (percentage 'top box' score; intervention: 39.2% vs. control: 41.7%, p = 0.40) or participant CTC rates (median [IQR]; intervention: 4.64 [3.04, 10.57] vs. control: 8.16 [5.28, 17.12], p = 0.13) than control presentations. However, the majority of presenters (16 out of 17 survey respondents) had never before used the intervention and little active engagement among learners was noted during the pause procedure. Lessons Learned: Adding the pause procedure to CME presentations did not lead to greater reflection or CTC among clinician learners. However, presenters had limited experience with the intervention, which may have reduced their fidelity to the educational principles of the pause procedure. Faculty development may be necessary when planning a new educational intervention that is to be implemented by conference presenters.

Moderating role of cynicism about organizational change between authentic leadership and commitment to change in Pakistani public sector hospitals.

PURPOSE: This study aims to explore the moderating role of cynicism about change in the positive relationship between authentic leadership and employee commitment to change. DESIGN/METHODOLOGY/APPROACH: This study used an exploratory research design with deductive approach to invite responses of doctors, nurses and para medical staff of public sector district hospitals, set to be privatized, on structured close-ended questionnaires. Data gathered from four hospitals chosen because they were undergoing restructuring that facilitated the testing of our propositions were analyzed through structural equation modeling using AMOS. A total of 271 usable responses (response rate of 65 per cent) were analyzed. Interaction and simple slope tests were applied to test moderating effects. FINDINGS: Results indicate that authentic leadership is positively related to commitment to change. Cynicism about change moderated this positive relationship such that a high level of authentic leadership has a stronger impact on commitment to change when cynicism is low rather than when cynicism is high. PRACTICAL IMPLICATIONS: Results show that in Pakistani hospitals undergoing restructuring, leaders who use authentic leadership will have followers who are more committed to enacting the planned changes, but this effect is magnified if followers are not cynical about the change. Thus, regulators of public sector hospitals may benefit from this study by developing authenticity in hospital leaders to mitigate cynicism about and enhance their commitment to change. ORIGINALITY/VALUE: This study is the first which has explored relationships among cynicism about change, authentic leadership and commitment to change in a privatization context of Pakistan. Findings should be tested in other cultural contexts to determine generalizability.

Mitigating the Harmful Effect of Perceived Organizational Compliance on Trust in Top Management: Buffering Roles of Employees' Personal Resources.

This study considers how employees' POC-defined as their beliefs that the organizational climate stifles change and values compliance with the status quo-reduce their trust in top management, as well as how this negative relationship might be buffered by access to two personal resources that support organizational change: openness to experience and affective commitment to change. Data from a sample of Pakistan-based organizations reveal that POC reduce trust in top management, but this effect is weaker at higher levels of openness to experience and affective commitment to change. These findings are significant in that they indicate that employees who operate in organizational climates marked by "yea-saying" can counter the difficulty of improving their job situation by drawing from adequate personal resources.

Peer-assisted debriefing of multisource feedback: an exploratory qualitative study.

BACKGROUND: The Manitoba Physician Achievement Review (MPAR) is a 360-degree feedback assessment that physicians undergo every 7 years to retain licensure. Deliberate reflection on feedback has been demonstrated to encourage practice change. The MPAR Reflection Exercise (RE), a peer-assisted debriefing tool, was developed whereby the physician selects a peer with whom to review and reflect on feedback, committing to change. This qualitative study explores how physicians who had undergone the MPAR used the RE, what areas of change are identified and committed to, and what they perceived as the role of reflection in the MPAR process. METHODS: The MPAR RE was piloted out to a cohort of MPAR-reviewed physicians. Thematic analysis was conducted on completed exercises (n = 61). Semi-structured interviews were conducted with individuals (n = 6) who completed the MPAR RE until saturation was reached. RESULTS: Physicians reviewed feedback with a range of peers, including colleagues, staff, and spouses. Many physicians were surprised by feedback, both positive and negative, but interviewees found the RE useful in processing feedback. Areas where physicians committed to change were diverse, covering all CanMEDS roles. Most physicians identified themselves as being successful in implementing change, though time, habit, and structures were cited as barriers. CONCLUSIONS: Peer-assisted debriefing can assist reflection of multisource feedback. It is easy to implement, is not resource-intensive, and feedback implies that it is effective at promoting change. Participants, with the aid of peers, identified areas for change, developed approaches for change, and largely thought themselves successful at implementing changes. Areas of change included all seven CanMEDS roles.

Intimacy after prostate cancer: A brief couples' workshop is associated with improvements in relationship satisfaction.

OBJECTIVE: Prostate cancer (PCa) treatments often leave men with erectile dysfunction (ED). Even when ED treatments are effective in restoring men's ability to have an erection sufficient for intercourse, couples continue to struggle sexually. Effective treatments to help couples recover sexually are needed. METHOD: PCa patients and partners (N = 59 couples) attending a one-time couples' intimacy workshop, participated in an evaluation. The workshop, offered eight times over a 2-year period, emphasized a couples-based approach to treatment that enhances direct communication about sexuality and implementation of sexual recovery strategies that are consistent with the couple's values. Couples completed pre and post questionnaires (at baseline and 2 months later) assessing the primary outcome of relationship adjustment (Revised Dyadic Adjustment Scale) and secondary outcome of sexual function (Sexual Function Questionnaire). T-tests were employed to examine pre-post changes in scores. A small qualitative sub-study was conducted on the use of a Commitment to Change goal-setting exercise, completed during the workshop. RESULTS: Results provide insight into the specific nature of improvements. Patients and partners showed improvements in relationship satisfaction. Improvements with small-to-medium effect sizes were observed for patients and partners sexual function; however, after adjusting for multiple comparisons, these changes were no longer statistically significant. The specific goals set by couples, and their achievement status, are presented. CONCLUSIONS: The workshop offers a comprehensive, one-session intervention to help couples implement a treatment plan to promote sexual recovery after PCa treatment. Given the observed improvements, progression to a randomized control trial is warranted. Copyright © 2016 John Wiley & Sons, Ltd.

Is the Cognitive Complexity of Commitment-to-Change Statements Associated With Change in Clinical Practice? An Application of Bloom's Taxonomy.

INTRODUCTION: This study categorizes 4 practice change options, including commitment-to-change (CTC) statements using Bloom's taxonomy to explore the relationship between a hierarchy of CTC statements and implementation of changes in practice. Our hypothesis was that deeper learning would be positively associated with implementation of planned practice changes. METHODS: Thirty-five family physicians were recruited from existing practice-based small learning groups. They were asked to use their usual small-group process while exploring an educational module on peripheral neuropathy. Part of this process included the completion of a practice reflection tool (PRT) that incorporates CTC statements containing a broader set of practice change options-considering change, confirmation of practice, and not convinced a change is needed ("enhanced" CTC). The statements were categorized using Bloom's taxonomy and then compared to reported practice implementation after 3 months. RESULTS: Nearly all participants made a CTC statement and successful practice implementation at 3 months. By using the "enhanced" CTC options, additional components that contribute to practice change were captured. Unanticipated changes accounted for one-third of all successful changes. Categorizing statements on the PRT using Bloom's taxonomy highlighted the progression from knowledge/comprehension to application/analysis to synthesis/evaluation. All PRT statements were classified in the upper 2 levels of the taxonomy, and these higher-level (deep learning) statements were related to higher levels of practice implementation. CONCLUSION: The "enhanced" CTC options captured changes that would not otherwise be identified and may be worthy of further exploration in other CME activities. Using Bloom's taxonomy to code the PRT statements proved useful in highlighting the progression through increasing levels of cognitive complexity-reflecting deep learning.

Organizational Change, Leadership, and the Transformation of Continuing Professional Development: Lessons Learned From the American College of Cardiology.

There is a need for a transformational change in clinical education. In postgraduate medical education we have traditionally had a faculty-centric model. That is, faculty knew what needed to be taught and who were the best teachers to teach it. They built the agenda, and worked with staff to follow Accreditation Council for Continuing Medical Education (ACCME) accreditation criteria and manage logistics. Changes in the health care marketplace now demand a learner-centric model-one that embraces needs assessments, identification of practice gaps relative to competency, development of learning objectives, contemporary adult learning theory, novel delivery systems, and measurable outcomes. This article provides a case study of one medical specialty society's efforts to respond to this demand.

Encouraging Reflection and Change in Clinical Practice: Evolution of a Tool.

This article describes the systematic development and gradual transformation of a tool to guide participants in a continuing medical education program to reflect on their current practices and to make commitments to change. The continuous improvement of this tool was influenced by evolving needs of the program, reviews of relevant educational literature, feedback from periodic program surveys, interviews with group facilitators, and results from educational research studies. As an integral component of the educational process used in the Practice Based Small Group Learning Program, the current tool is designed to help family physicians think about what has been learned during each educational session and examine issues related to the implementation of evidence-based changes into their clinical practice. Lessons learned will be highlighted. Both the developmental processes employed and the practice reflection tool itself have applicability to other educational environments that focus on continuing professional development.

Relationship among knowledge acquisition, motivation to change, and self-efficacy in CME participants.

INTRODUCTION: The relationship among an individual's sense of self-efficacy, motivation to change, barriers to change, and the implementation of improvement programs has been reported. This research reports the relationship among self-efficacy, motivation to change, and the acquisition of knowledge in a continuing medical education (CME) activity. METHODS: The measure of individual sense of self-efficacy was a 4-item scale. The measure of motivation was a 6-item scale following on the work of Prochaska and colleagues. The knowledge acquisition was measured in a simple post measure. The participants were enrolled in a CME activity focused on HIV.  RESULTS: The CME activities had a significant effect on knowledge. Preliminary analysis demonstrates a relationship among the self-efficacy measure, the motivation to change measure, and global intent to change. Specifically, as reported earlier, the sense of efficacy in effecting change in the practice environment is predictive of a high level of motivation to change that, in turn, is predictive of formation of intent to change practice patterns. Interestingly, there were also relationships among the self-efficacy measure, the motivation to change measure, and knowledge acquisition. Finally, as expected, there was a significant relationship between knowledge and intent to change practice.  DISCUSSION: Further inspection of the motivation to change construct suggests that it mediates the self-efficacy constructs' effect on intent as well as its effect on knowledge acquisition. This new finding suggests that the proximal construct motivation completely masks an important underlying causal relationship that appears to contribute to practice change as well as learning following CME-self-efficacy.

Outcomes of commitment to change statements after an interprofessional faculty development program.

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 and assessment of confidence: tools to inform the design and evaluation of interprofessional education.

INTRODUCTION: This study examines use of the commitment-to-change model (CTC) and explores the role of confidence in evaluating change associated with participation in an interprofessional education (IPE) symposium. Participants included students, faculty, and practitioners in the health professions. METHODS: Satisfaction with the symposium and levels of commitment and confidence in implementing a change were assessed with a post-questionnaire and a follow-up questionnaire distributed 60 days later. Participants who reported changed behavior were compared with those who did not make a change. Independent sample t-tests determined whether there were differences between groups in their average level of commitment and/or confidence immediately following the symposium and at follow-up. RESULTS: At post-symposium, attendees were satisfied with content and format. Sixty-eight percent said they would make a change in profession related activities. At 60 days, 53% indicated they had implemented a change. In comparison to those who reported no change, those who made a change reported higher levels of commitment and higher levels of confidence. Logistic regression suggested that the combination of commitment and confidence did not predict implementation in this sample; however, confidence had a higher odds ratio for predicting success than did commitment. DISCUSSION: Confidence should be studied further in relation to commitment as a predictor of behavioral change associated with participation in an IPE symposium. Evaluators and instructional designers should consider use of follow-up support activities to improve learners' confidence and likelihood of successful behavior change in the workplace.