Positive psychology for culture change

Posted on October 2, 2011

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Culture change is possible through positive psychology.  This model may work for initiatives that usually illicit  resistance from staff. This is especially suited for safety culture projects such as progress toward a Just Culture. A psychology trained consultant can help with such a project.

Culture has been described as the thing that determines what people pay attention to and what they ignore (Rosinski & Abbott, 2006). Positive psychology highlights the benefits of shifting attention to the strengths and visions of the organization rather than on the issues that cause pain (Kauffman, 2006). This is a shift for many consultants who focus on a deficit-conflict model for helping clients (Kauffman, 2006). Positive psychology argues that negative impulses can be transformed into hope, wisdom, creativity, responsibility and perseverance (Seligman & Csikszentmihalyi, 2000). In terms of group values positive psychology is about civility, responsibility, and work ethic (Seligman & Csikszentmihalyi, 2000).

Positive psychology is about how positive emotions work. Negative emotions are theorized to narrow behaviors to those that benefit humans in threatening situations while positive emotions are thought to function in the opposite. The broaden and build theory states that positive emotions widen the thoughts and behavior available to individuals in order to grow and flourish (Fredrickson & Losada, 2005). Flourishing is defined as living in an optimal state characterized by generativity and resilience (Fredrickson & Losada, 2005). A positive emotion like interest or curiosity has been shown to correlate with motivation to learn (Fredrickson & Losada, 2005). Positive psychology can have a direct link with patient safety as illustrated by a study in which positive emotions mediated by giving a piece of candy actually influenced internists’ ability to accurately and quickly diagnose liver disease (Kauffman, 2006).

Frederickson conducted studies that show positive emotions are fleeting however their effect can be seen weeks later as evidence by reports of well being (Fredrickson & Losada, 2005). When Losada studied flourishing teams in organizations, the optimal ratio of positive to negative experiences was determined to be 2.9:1 (Fredrickson & Losada, 2005). This is known as the Losada line and predicts flourishing teams from languishing teams (Fredrickson & Losada, 2005). This is a dynamic process though, with ratios of positivity greater than 11.6:1 showing the beginnings of disintegration of flourishing as it seems some form of negative emotions are needed for continued transformation (Fredrickson & Losada, 2005).

Another concept of positive psychology is known as flow commonly described as “being in the zone” (Kauffman, 2006, loc. 227). Kauffman (2006) described several coaching strategies to help clients attain this state and these include: timely feedback, reducing self consciousness, merging action and awareness, controlling focus, finding intrinsic rewards, balancing skills and challenge, and time transformation in which time seems to speed up and perception is heightened. One way to help attain the flow is to coach clients via having them describe times when they felt in the flow and try to identify personal stimulators to this state (Kauffman, 2006).

Foster and Lloyd (2007) reported using positive psychology principles in consulting work in such a way to help clients get through negative work experiences. Once a negative situation was identified, workers were taught to replace this with a positive word or two which then allows thinking to broaden and an action plan to be made (Foster & Lloyd, 2007). Another technique to increase positivity ratios is to take a negative thought such as “I am a bad manager” and find at least one piece of evidence that refutes that assumption (Kauffman, 2006).

Resilience has been shown to correlate with positive psychology. Resilience is defined as “the ability to persist in the face of challenges and to bounce back from adversity” (Reivich, Seligman, & McBride, 2011, p. 25). Resilience is a topic important to patient safety in terms of hospital staff being able to recover incidences and prevent or limit patient harm. Reivich, et al. (2011) described the Army’s Master Resilience Training course as one which uses positive psychology principles to build resiliency in soldiers. Some of the positive training that is part of this program includes soldiers’ utilization of the following phrases: “I will always place the mission first; I will never accept defeat and I will never leave a fallen comrade” (Reivich, et al., 2011). There is also a section where soldiers review negative thought patterns that lead to poor outcomes and replace these with positive affirmations and actions (Reivich, et al., 2011). They spend time identifying character strengths and building team  relationships (Reivich, et al., 2011). While the program is too recent to measure the long term outcomes, post training evaluations contain comments from soldiers that indicate this program has been life changing for them (Reivich, et al., 2011). Other hospital systems have been adapted from military procedures and this program would be an interesting one to use with doctors and nurses to increase resiliency.

One workplace approach for consultation derived from positive psychology is Appreciative Inquiry. The role of positive inquiry was introduced by the Cooperrider and Srivastva in 1987 (Sorensen & Yeager, 2002). Appreciative Inquiry is based on several principles: reality is socially constructed, inquiry changes the nature of what is being studied, an organization’s vision of the future can guide its behavior and the Positive Principle which theorizes that “the more positive the question, the longer-lasting and more successful the change effort will be” (Sorensen & Yeager, 2002, loc. 8267).

Moody, Horton-Deutsch, & Pesut (2007) utilized Appreciative Inquiry to improve the functioning of a leadership council that was comprised of three merged departments in nursing at the University of Indiana. Outcomes reported include increased trust, less conflict, more taking of responsibility and open communication (Moody, et al., 2007). Peele (2006) compared Appreciative Inquiry with creative problem solving used by new formed cross-functional teams and found Appreciative Inquiry to be more effective for producing group identification and group confidence. These provide evidence that Appreciative Inquiry should be effective in this case study for infusing Just Culture in the cross-functional leadership group in a hospital setting.

One limitation of positive psychology may relate to culture. Emotions may be classified as positive or negative differently in racial cultures. For example happiness is not viewed as a positive emotion in Japanese culture (Leu & Koo, 2011). Lei and Koo studied Asian cultures and found negative emotions to be consistent but positive emotion labeling to differ. It would be prudent for a consultant to ascertain a group’s classification of positive versus negative elements rather than make a general assumption on these polarities. Also as stated previously there is a limit at which a positive or strengths focus begins to show decline. The correlation between increasing positivity and strength and productivity stops at a point where it either stays steady or declines (Kaiser & Overfield, 2011). One example is contentiousness. While this is considered a positive strength, studies have shown when one is more than one standard deviation above the mean, task performance decreases (Kaiser & Overfield, 2011). Theoretically this may occur because the conscientious person may get consumed in the details, strive for perfection or become stalled in decisions for fear of making a mistake (Kaiser & Overfield, 2011). A leader too may focus so much on strengths that other important areas are neglected (Kaiser & Overfield, 2011). In light of the interdependence noted in systems theory, the consultant can help the leadership find balance so that focus on the safety program is balanced with other vital leadership tasks.

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