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UBC Theses and Dissertations

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UBC Theses and Dissertations

Implementing performance change among health-care professionals Scott, Anne


The purpose of this study was to aid in understanding the process of change in occupational settings by examining factors that influence an employee to change his performance of a task. Five factors thought to be critical to the change process were selected and their relationships to both immediate and long-term changes in employee performance levels were examined. The factors selected were: an individual's knowledge about the task, his motivation to change, and his perceptions of the resources available to do the task, the standards required for correct performance and the reinforcers associated with his performance. The specific task used to observe changes in performance levels was a new method of keeping records in a hospital department, called Problem Oriented Recording (POR). The hypothesized relationships were as follows: initial changes in performance would be more closely linked to motivation to change, increase in knowledge and the perceived presence of performance standards than to the perceived availability of resources and reinforcers for correct performance; and subsequent changes in performance would be more closely linked to the individual's perceptions of the presence of performance standards and availability of resources and reinforcers than to his motivation to change and loss of knowledge. Four specially constructed instruments were developed to measure the dependent and independent variables. Record-keeping behaviour was measured on a check-list which indicated the presence or absence of required items in randomly selected patient-care records. A paper and pencil recall test measured the participants' knowledge of recording policies, procedures and format, and two attitudinal surveys measured their motivation to change and their perceptions of performance standards, resources and reinforcers. An inservice education program provided the participants, 62 physical and occupational therapists, with an opportunity to learn about Problem Oriented Recording. The program consisted of seven 1-hour sessions; five sessions were held on consecutive days and the remaining two were held one month later and after a further interval of three months. With the exception of motivation to change, which was measured once at the beginning of the study, data collection on all variables coincided with the delivery of the inservice program. Thus, variables were measured before the introduction of POR, one month after its introduction and again three months later. Changes in each variable were calculated from the differences between scores at baseline and one month, and one month and four months. The data showed that recording behaviour significantly increased during the first month and significantly decreased during the next three months. Knowledge also significantly increased during the first month but it remained at that new level. A similar pattern was observed for therapists' perceptions of standards for proper performance. Data collected at the beginning of the implementation of POR indicated that therapists were motivated to change their record-keeping practices. Stepwise multiple regression equations showed that the selected variables accounted for 33% of observed variance in acquisition of recording behaviour and 34% in the subsequent decline of recording behaviour. General hierarchical tests confirmed that motivation to change, knowledge and performance standards accounted for significantly more variance in the initial change of performance than resources and reinforcers; and performance standards, resources and reinforcers accounted for significantly more variance in the loss of performance. Therefore, the hypothesized relationships were confirmed. The findings imply that inservice education programs help employees to reach new levels of performance but additional activities are necessary to help them maintain the newly acquired level. Several recommendations for ensuring maintenance are discussed including the need for collaboration between supervisors and educators, the advantages of a situational assessment and the need to establish how much knowledge has been retained before a decision is made to remedy performance deficits through more inservice education programs.

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