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Chapter 14
Tools to help you plan and
support self care
Tool 1
Force-field analysis
This technique gives you:
- a way of diagnosing a situation
- a means of planning for change
- a way of implementing a change strategy and programme.
With this approach, there will be one set of influences and pressures pushing for a change and a different set pushing to keep things as they are.
- Driving forces are factors that indicate instability and an openness towards change.
They are therefore positive forces for change.
- Restraining forces are those that promote stability and maintain the status quo: indicating, therefore, resistance to change.
In effect any situation is really a state of ‘dynamic equilibrium’ between these two sets of forces. Change will occur when the interplay of various forces and influences at play in a particular situation alters. When you change the net effect of the influences involved, the situation will realign itself into a new ‘dynamic equilibrium’. Rather than trying to force others to change their views, you should try to reduce some of their reasons for resisting change, so re-balancing the situation, enabling change to occur. Just pushing harder and harder for what you want to happen, may just make people dig their heels in and resist.
With a force-field analysis approach the interconnections between different influences and forces are more easily seen, and can help you decide which influences to work on first.
Draw up a force-field analysis of the culture of self care in your PCT or practice
Why you should use this
To help people identify and focus down on the positive and negative forces in the developmentofaself care cultureandgainanoverview of theweighting of these factors.
When to use this
In a PCT or practice planning day or team meeting – as an individual or preferably working in a group.
What to do
Draw a horizontal or vertical line in the middle of a sheet of paper. Label one side ‘positive’ and the other side ‘negative’. Draw arrows to represent individual positive
drivers that motivate you and the PCT/practice team on one side of the line, and negative factors that demotivate you on the other side of the line. The chunkiness and length of the arrows should represent the extent of the influence; so, a short, narrow arrow will indicate that the positive or negative factor has a minor influence, and a long, wide arrow indicates a major effect.
Take an overview of the force-field and consider if you are content with things as they are, or can think of ways to boost the positive side and minimise the negative factors. You can do this part of the exercise on your own, with a peer or a small group, or with a mentor, or trainer from the PCT.
How it works (insight)
You realise whether a known influence in your life is a positive or negative factor. For instance you may realise upon reflection that you had assumed that reducing your workload was the main positive motivator. But really, the wish to empower patients to lead healthier lives through self care is your main motivator, giving added benefit of improving your job satisfaction.
Whom to engage
The exercise is suitable for anyone and everyone in the PCT/practice team who has contact with patients or has a public health or health promotion or public involvement role. Include local community pharmacists too to gain a wider perspective and collaboration.
How much time you should allow
Up to an hour with ensuing discussion. Longer for subsequent action planning.
What a facilitator should do
Urge participants to subsequent action.
What to do next
Make a personal or organisational action plan to boost the positive factors in establishing a self care culture and minimise arrows on the negative side.
What makes it work better
Get someone who knows the context well to review the force-field analysis and comment on any blind spots and whether positive and negative influences are in proportion. This might be someone from another general practice who is already promoting and supporting self care there.
What can go wrong
People perpetuate their own misconceptions – and use the force-field analysis diagram to reinforce their negative or resistant behaviour in a pseudo-scientific way.
An example of a force-field analysis is shown in Box T1.1.
Box T1.1: Example of force-field analysis diagram. Achieving a culture that promotes and supports patients’ self care in a general practice
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