Page 4 - JRCERT Update Articles
P. 4
JRCERT Update
well as the organizational culture, is necessary to create change such as cessation of smoking. In the maintenance
successful organizational change. stage, the individual is working to prevent relapse but
does not need to apply change processes as often as those
Transtheoretical Model in the action stage. The final stage, termination, is one in
The transtheoretical model of change was first which individuals have no temptation and are confident
proposed by Prochaska and DiClemente in 1983 as a that their behavior will remain no matter what obstacles
biopsychosocial model of understanding behavioral they may face. This behavior is now automatic and rou-
change. To date, this has been used most robustly in tine. Although termination is the goal of change, most
6
addressing addictive behaviors such as smoking, with people spend the majority of their time after a behavioral
much success in the health care space. More recently, change in the maintenance stage. 9,10
this model of change has been used to improve mam- Often overlooked in the transtheoretical model
mography screening rates and follow-up. This model of change is decision-making and decisional balance,
7
stands on the premise that behavioral change progress- which were conceptualized by Janis and Mann in 1977
es through 6 stages : as a balance sheet of cost and benefits that included
6
precontemplation 8 decision-making constructs :
10
contemplation approval from others
preparation approval from self
action disapproval from others
maintenance disapproval from self
termination instrumental benefits to others
In addition, there are dependent variables, including instrumental benefits to self
decisional balance, self-efficacy, and temptation, as instrumental cost to others
well as independent variables characterized as processes instrumental cost to self
of change. A key feature of the transtheoretical model Although this model has been directed largely at health
8
is that the steps must be completed in sequence behaviors in patients, the basic construct of how people,
without skipping. and therefore organizations, manage change at a behav-
A person in the precontemplation stage is character- ioral level is likely not much different. Understanding
ized as currently not engaging in the target behavior and where people in an organization fit in the stages of change
having no intention to do so. Typically, these individuals can allow for a more targeted approach to addressing
are not fully informed of the consequences of a behavior needed change. For example, using structured and
or lack of a behavior. In organizations, these people often standardized reporting has been shown to decrease
are labeled as resistant or unmotivated to implement ambiguity in interpretating reports that can lead to con-
change. The contemplation stage is characterized by fusion and medical errors and also promote adherence
a person who is intending to act in the next 6 months. to guidelines. This has been best represented by the
11
In this stage, there is an awareness of the advantages to implementation of the Breast Imaging Reporting and
making a change, however the disadvantages of making Data System.
a change still have substantial weight. The preparation Transitioning practices into standardized templates
stage is one in which people are ready to act in the near is a prime case for assessing the stages of the trans-
future, usually in the next month. With this stage comes theoretical model of change. There are clear reasons to
a plan of action. In the behavioral health care space standardize templates for reporting purposes in radiol-
this has typically included action items such as joining ogy, in addition to those stated above, such as improving
a gym, joining a group, or implementing a self-change the search of reports for research purposes, improving
approach. In the action stage, a person is performing spe- patient care through standardized language, and allow-
cific tasks or modifications to implement the behavioral ing for review of diagnostic accuracy and outcomes.
12
change they are seeking. This stage includes observable However, the barriers can be high for radiologists who
RADIOLOGIC TECHNOLOGY, January/February 2024, Volume 95, Number 3 229
Reprinted with permission from the American Society of Radiologic Technologists for educational purposes. ©2023. All rights reserved.
