Agency: maintaining a sense of control


Throughout researching the issue of change, the importance of agency has come up repeatedly. People like to have a sense of control during processes. Part of this is need for control is due to the natural human tendency to resist persuasion. Medical diagnosis approaches that include the patient as an active participant lead to a stronger understanding and commitment to a patient’s treatment. Similarly, academic health centers recognize the difficulty in transitioning ideas to action so they encourage avoiding a hands-off approach to introducing innovation. This understanding is reinforced by the increased enthusiasm seen when employees are given more control over there jobs in many other industries.

As Academic Health Centers introduce innovation, it is important to engage individuals as active participants in their own stories. Tim Brown introduces this in Change by Design . He recognizes each individuals experience with a new process will be unique as everyone has different needs to be met. Allowing participants to take an active role enables their experience to become a unique story that can be referenced later.

This approach is just as vital when addressing personal change. Wellness coaches are professionals who help people work through personal change. Their approach employs a technique known as motivational interviewing. This is similar to a psychologist’s technique of guiding instead of directing. Motivational interviewing recognizes the human tendency to resist change. As such, wellness coaches do not dictate what a patient needs to do, rather the patient receives guidance through inquiry. This reinforces the value of agency by allowing the patient to make their own discoveries. A successful example of this can be seen in the Design Council’s Red Health Report: The Diabetes Agenda case study.

In many cases, diabetes is onset or exacerbated by a lack of exercise, maintaining a healthy diet, and managing prescribed medication. This type of regulation is personal and treatment plans vary with each individual. Instead of adhering to the traditional, directing approach, patients were empowered to describe their unique needs, act on this knowledge which would improve their quality of life. Within this project, a team of designers examined a number of patients daily routines and struggles. They developed a set of cards that captured the types of difficulties patients who live with diabetes regularly face. These cards became a boundary object to enable patients to share their personal situations with their physicians. Ultimately, dimensions of the patients’ lives were shared with their physicians that would not have been discovered otherwise. This type of engagement, allowing patients to self-diagnose their unique struggles with diabetes, led to stronger understandings not only between patients and their doctors, but also between patients and their loved ones.

Source: Design Council

Just as there has been success leveraging agency when seeking personal change, it is equally as important when employing organizational change. Developing High-Impact Innovation Centers, a white paper compiled from research performed at 10 Academic Health Centers, reinforces this theory by promoting a hands-on approach. While many health centers invite employees to attend workshops and bootcamps to learn about innovative thinking, the scaffolding to support the transition to implementation is missing. In order to execute an effective transition to implementation, including agency allows employees to have control and ownership over their learning.

The Power of Habit shares an anecdote of successful culture change seen at a manufacturing plant in Ohio. Employees were given the freedom to design their uniforms as well as more control over there shifts. Without changing pay scales or production proceses, productivity at the plant increased 20%. Fewer errors occurred during production and workers took fewer breaks. Charles Duhigg attributes the success to giving the employees a sense of agency, improving the amount of “self-discipline” brought to work.

NOTE: I originally identified autonomy as a theme. After further research, I have changed this term to agency. Autonomy aludes to singular control. The type of control I am focusing on can be something that is shared or exists in a collaborative environment.


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