Studying the dynamics of social movements such as recycling and the anti-smoking lobby could be the key to improving the quality and safety of healthcare in the NHS. Jo Bibby explains

Household waste recycling in theUKhas increased from 1.5 million tonnes in 1995-96 to 8 million tonnes in 2006-07. A survey published this year found that 81 per cent of people now consider it a duty to recycle.

Imagine if we could see a similar shift in action and attitude around quality improvement in healthcare. Yet securing sustained improvements in the quality and safety of care continues to evade many NHS organisations.

Why is this? It cannot be the lack of knowledge about what constitutes high-quality, safer care. Neither can it be said that we lack the understanding of how to put evidence into practice. Perhaps the answer lies in public management expert Steven Kelman's observation that 'unless large numbers of individuals on the front lines end up altering attitudes and behaviour, change can be proclaimed but it will not be performed'.

The NHS Institute for Innovation and Improvement is leading research on this issue. Drawing on the knowledge base that explains phenomena such as the rise in waste recycling, the anti-smoking lobby and the civil rights movement, they have identified some key things we need to do if we are to get the same energy and momentum around healthcare quality improvement that we see in other areas of social change.

People power

First, we must frame our quality goals in a way that taps into the sentiments of people and teams in the NHS. If recycling can be felt to be a duty, why not hand hygiene or on-time medication?

Healthcare is an intrinsically emotional business but too often humanity appears to be left at the quality improvement door as people are forsaken for processes. As a result, we lose one of the most powerful levers we have.

We also need to generate energy around the cause. Years of top-down targets create their own sort of energy - keeping people awake at night rather than making them want to get up in the morning.

We need to create a buzz around our quality goals that captures people's attention and mobilises them in the direction of meaningful action.

Critical to this idea of energising and mobilising is the need to organise differently. Programmes and projects are great for pulling on the levers we can control, but when the goal requires widespread behavioural change, we need to find different ways to allocate roles and responsibilities that ensures people with the passion and activism to make care better for patients - wherever they sit in the organisations - can make a contribution.

Finally, we need to build momentum to keep the movement growing under its own steam.

There is still some way to go before we will know if it is possible to create such dynamics in organisations, but there can be no doubt that new theories of change are needed if our quality goals are going to be more than fodder for the office recycler.