Investigation of factors influencing the adoption of safety-related changes during the early stages of implementation : an exploratory study.

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Investigation of Factors Influencing the Adoption of Safety-Related Changes during the Early Stages of Implementation: An Exploratory Study

Dissertation

Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University

By

Radin Zaid Radin Umar, B.S., M.S.

Graduate Program in Industrial and Systems Engineering

The Ohio State University 2015

Dissertation Committee: Dr. Carolyn M. Sommerich, Advisor

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Copyright by Radin Zaid Radin Umar

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ii Abstract

Musculoskeletal disorders (MSDs) have been recognized as one of the leading causes of workplace injuries. The economic burden of MSDs is estimated to cost up to $54 billion annually. Previous studies have shown that the development of workplace ergonomics interventions could reduce workers’ exposure to physical stress and strain,

consequently reducing workers’ risk of developing work-related MSDs. Even with promising results demonstrating efficacy in laboratory-based studies, theoretically sound ‘changes’ may be resisted or rejected by end users. The long term objective of this

research is to improve adoption rates of theoretically sound safety-related changes in the workplace. The underlying hypothesis in this three phase study is that employing structured contemplating activities may result in better acceptance compared to traditional implementation processes.

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checking) and validate findings related to Aims 1, 2, and 3 with industrial practitioners, and 5) Investigate how the presented findings and ideas for introduction-training program components might influence the industrial practitioners to possibly reconsider their strategies to introduce workplace safety-related changes in the future.

Semi-structured interviews with managers responsible for implementing changes and employees who had experienced receiving changes were used to achieve the first aim. The second aim was achieved through a laboratory-based study that employed group activities, surveys, worksheets, and discussions to explore the effects of contemplative activities that potentially influence intentions and attitudes to adopt an introduced change. The participants’ designs of their ‘ideal’ introduction-training program were explored using generative method activities (Aim 3). The fourth and fifth aims were addressed through employment of semi-structured interviews with industrial practitioners, in order to share information and validate the outcomes from the previous phases of the study.

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implementation process. The second phase of the study documented advantages, disadvantages and improvement suggestions for each of the explored introduction-training approaches. The data also revealed that a single introduction-introduction-training approach might not be as effective as the integration of two or three types of approaches, in terms of positively influencing a worker’s intention and attitude towards adoption of an introduced change. The inclusion of the three explored approaches in the Phase 2 participants’ ideal programs verified the initial theoretical assumptions that the

contemplative activities explored in this study may have potential to shape a worker’s thought processes during the implementation of a workplace change. An integrated introduction-training framework, representing the study participants’ collective designs, was proposed as multi-element base structure that could be used to organize specific activities as part of the process of introducing workplace changes to employees in practice. In the third phase of the study, the findings from the previous phases of the study, including the integrated introduction-training framework, were shared with and reviewed by experienced safety practitioners. Generally, these experienced practitioners, from a diverse range of industries, and who were located in the US or in Malaysia were in agreement with the findings from phases 1 and 2 of study, which provides a degree of validation of the results. In addition to reviewing results from the first two phases, data gathered from phase 3 participants yielded a compilation of themes and factors that contribute to failure of a change effort, as well as a list of optional activities to be considered in an introduction-training program.

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Acknowledgments

I wish to thank my mentor and main advisor, Dr. Carolyn Sommerich who guided and supported me unconditionally throughout my academic journey. I also wish to extend my appreciation to Dr. Steven Lavender for his great insights and creative mind, Dr. Kevin Evans for his continuous positivity and encouragements, and Dr. Elizabeth Sanders for challenging me to think differently and pushing me out of my comfort zone. It has been a wonderful learning experience working with all of them. Special thanks to lab colleagues Jing Li, Mohini Dutt, Shasank Nagaparavu, and Alex Pires for being there whenever I needed them.

I would like to extend my gratitude to the Government of Malaysia, through Universiti Teknikal Malaysia Melaka and The Ministry of Education for providing scholarship opportunity to support my graduate studies. I also owe thanks to peoples behind the scenes in Bahagian Cuti Belajar and Bahagian Biasiswa, who have always provided me efficient technical support.

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vii Vita

2003 – 2007 ...B.S. Mechanical Engineering,

University of Wisconsin – Madison, WI 2007 – 2009 ...Tutor, Universiti Teknikal Malaysia Melaka 2009 – 2010 ...M.S. Integrated Systems Engineering, The Ohio State University

2009 to present ...Research Associate, Department of Integrated Systems Engineering, The Ohio State University

Publications

Sommerich, C. M., Lavender, S. A., Radin Umar, R. Z., Li, J., Park, S., & Dutt, M. (2015). A

biomechanical and subjective comparison of two powered ambulance cots. Ergonomics,

(In-print), 1-12.

Lavender, S.A., Sommerich, C.M., Patterson, E.S., Sanders, B.-N., Evans, K.D., Park, S.,

Radin Umar, R.Z., Li, J. (2015). Hospital Patient Room Design: The Issues Facing 23

Occupational Groups Who Work in Medical/Surgical Patient Rooms. Health Environment

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Patterson, E. S., Murray, J., Park, S., Sanders, E. B-N., Li, J., Radin Umar, R. Z, Sommerich,

C., Evans, K., & Lavender, S. A. (2014). Barriers to Infection Control due to Hospital Patient

Room Factors A Secondary Analysis of Focus Group and Interview Transcripts. In

Proceedings of the Human Factors and Ergonomics Society Annual Meeting (Vol. 58, No. 1,

pp. 1266-1270). SAGE Publications.

Sommerich, C. M., Lavender, S. A., Radin Umar, R. Z., Park, S., Li, J., & Dutt, M. (2013).

Powered Ambulance Cots: Effects of design differences on muscle activity and subjective

perceptions of operators. In Proceedings of the Human Factors and Ergonomics Society

Annual Meeting, (Vol. 57, No. 1, pp. 972-975). SAGE Publications.

Le, P., Dufour, J., Monat, H., Rose, J., Huber, Z., Alder, E., Radin Umar, R. Z., Hennessey,

B., Dutt, M. & Marras, W. S. (2012). Association between spinal loads and the

psychophysical determination of maximum acceptable force during pushing tasks.

Ergonomics, 55(9), 1104-1114.

Sommerich, C. M., Lavender, S. A., Radin Umar, R. Z., Le, P., Mehta, J., Ko, P. L., Farfan, R.,

Dutt, M., & Park, S. (2012). A biomechanical and subjective assessment and comparison of

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Radin Umar, R.Z, Sommerich, C., Evans, K., Lavender, et. al. (2011) Ergonomic

Interventional Design of an Articulating Arm for Echocardiography Application: Front-End

Design and Pilot Study, In Proceedings of the Human Factors and Ergonomics Society

Annual Meeting, (Vol. 55, No. 1, pp. 980-983). SAGE Publications.

Sommerich, C., Lavender, S., Sanders, E., Lamar, S., Joines, S., Yen, W.T., Radin Umar, R.Z.,

(2011) Participatory Ergonomics Applied to Sonographers’ Work. In Proceedings of the

Human Factors and Ergonomics Society Annual Meeting, (Vol. 55, No. 1, pp. 1067-1070).

SAGE Publications.

Lavender SA, Sommerich CM, Johnson MR, Radin Z. (2010). Developing Ergonomic

Interventions to Reduce Musculoskeletal Disorders in Grocery Distribution Centers. In

Proceedings of the Human Factors and Ergonomics Society Annual Meeting, (Vol. 54, No. 15,

pp. 1229-1233). SAGE Publications.

Radin Umar R.Z & Halim I. (2008) An Anthropometric Evaluation of Workstation Design: A

Case Study in an Automotive Industry, In Proceedings of National Conference on Design and

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x Fields of Study

Major Field: Industrial and Systems Engineering Minor Field 1: Design

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Table of Contents

Abstract ... ii

Acknowledgments... vi

Vita ... vii

List of Tables ... xv

List of Figures ... xix

Chapter 1: Introduction ... 1

1.1 Musculoskeletal Disorders ... 1

1.2 Complexity of Ergonomics Intervention Adoption ... 5

1.3 The Scope of Study ... 12

Chapter 2: Background and Literature Review ... 15

2.1 Introduction ... 15

2.2 Existing Adoption and Behavioral Frameworks ... 18

2.3 Knowledge Gaps and Theoretical Perspective ... 33

2.4 Conceptual Framework ... 44

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2.6 Research Approach Overview ... 54

Chapter 3: Phase 1 – A Study of Prior Experiences of Workplace Intervention Implementation ... 58

3.2 Objectives ... 59

3.3 Subjects ... 61

3.4 Methodology ... 64

3.5 Data Processing and Analysis ... 68

3.6 Results and Discussion ... 76

3.7 Study Limitations ... 130

3.8 Conclusions ... 132

Chapter 4: Phase 2 – A Study of ‘Slow Thinking’ Approaches to Introducing A Workplace Safety-Related Change ... 135

4.2 Theoretical Constructs... 139

4.4 Subjects ... 161

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Chapter 5: Phase 3: Validation Study ... 251

5.3 Subjects ... 255

5.5 Data Processing and Analysis ... 277

Chapter 6: Conclusions & Future Works ... 357

6.1 Research Summary ... 357

6.2 Potential Impacts ... 366

6.3 Future Works ... 371

References ... 375

Appendix A: Consent Document for Phase 1 of Study ... 388

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Appendix C: Keywords and Pictures to Trigger or Evoke Participants’ Concern Worksheets. These Worksheets Were Provided To the Participants As They Were

Completing Their Scratch-Pad Worksheet in Phase 2 of Study ... 396 Appendix D: Consent Document for Phase 2 of Study ... 400 Appendix E: Baseline Survey Given To the Participants at the Beginning of the First Session in Phase 2 of Study ... 406 Appendix F: End of Session Worksheets Given To the Participants at the End of Each Approach in Phase 2 of Study ... 408 Appendix G: End of Session Surveys Given To the Participants at the End of Each Approach in Phase 2 of Study ... 412 Appendix H: Kolb Learning Style Inventory Given To the Participants between Sessions in Phase 2 of Study ... 416 Appendix I: Fourth Session Worksheet Given To the Participants at the Beginning of the Second Session in Phase 2 of Study ... 418 Appendix J: Keywords and Pictures to Trigger or Evoke Participants’ Thoughts and Feelings Worksheets. These Worksheets Were Provided to the Participants as They Were Collectively Designing Their Ideal Introduction Training Program During In Phase 2 of Study ... 420 Appendix K: A Checklist Given To the Participants as a Structure to Guide Their Design Activity in Phase 2 of Study. This Checklist Summarizes Five Components to Be

Considered When Designing an Ideal Introduction-Training Program ... 426 Appendix L: An Animated PowerPoint Presentation Used as a Visual Aid to set up the Stage and Design Context to the Participants in Phase 2 of Study ... 428 Appendix M: Participants’ Collective Designs of Ideal Introduction-Training Program in Phase 2 of Study... 433 Appendix N: Consent Document for Phase 3 of Study ... 440 Appendix O: A List of Statements on Key Facilitator to Influence Employees’

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xv List of Tables

Table 3.1: Phase 1 participant demographics ... 63

Table 3.2: Summary of interview components and the analysis of Phase 1 data. ... 70

Table 3.3: Summary of milestones components shared by the subjects. ... 77

Table 3.4: Summary of case studies shared by participants in Phase 1 ... 88

Table 3.5: Factors that influence adoption, extracted from the case studies in the first coding cycle of data from Phase 1interview transcripts. ... 94

Table 3.6: Factors that influence adoption, re-sorted in a timeline format. ... 96

Table 3.7: Factors that influence adoption organized by themes... 103

Table 3.8: Lessons learned, extracted in the first coding cycle of these data from the transcripts ... 108

Table 3.9: Lessons learned data and their corresponding theme groupings. ... 110

Table 3.10: The managers’ rating of their own management implementation style: let it happen (0), help it happen (3.5), make it happen (7) ... 120

Table 3.11: The employees’ rating of the management implementation style of their manager: let it happen (0), help it happen (3.5), make it happen (7). ... 120

Table 3.12: Manager-participants’ comments related to the management implementation style scale pictured in Figures 3.2 and 3.14. ... 124

Table 3.13: Employee-participants’ comments related to the management implementation style scale pictured in Figures 3.2 and 3.14 ... 126

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Table 4.1: Order and activities in the scratch-pad approach. ... 148

Table 4.2: Order and activities in the evidence based approach ... 153

Table 4.3: Order and activities in the scenario-based approach. ... 158

Table 4.4: Demographic of participants in phase 2 of the study. ... 163

Table 4.5: Summary of Phase 2 data components and their analysis ... 177

Table 4.6: Summary of advantages, disadvantages and improvement suggestions of the scratch-pad approach. ... 185

Table 4.7: Summary of advantages, disadvantages and improvement suggestion of the evidence-based approach. ... 189

Table 4.8: Summary of advantages, disadvantages and improvement suggestion of the scenario-based approach ... 191

Table 4.9: Participants’ average ratings of the initial and modified survey assessment, as well as the differences between the averaged initial and final assessments. The assessment is on a 10 point scale (where 10 = full agreement, 0 = full disagreement). . 195

Table 4.10: Question 2 analysis using Nonparametric Comparisons For All Pairs Using Dunn Method For Joint Ranking. ... 199

Table 4.11: Question 3 analysis using Nonparametric Comparisons For All Pairs Using Dunn Method For Joint Ranking ... 200

Table 4.14: Subjects’ assessment of most persuasive introduction-training approach ... 217

Table 4.15: Average ranking of characteristics between the three introduction-training approaches (Lower average value represents better evaluation). ... 220

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Table 4.17: Characteristic 2 analysis using Nonparametric Comparisons For All Pairs

Using Dunn Method For Joint Ranking ... 224

Table 4.18: Characteristic 3 analysis using Nonparametric Comparisons For All Pairs Using Dunn Method For Joint Ranking. ... 225

Table 4.19: Characteristic 5 analysis using Nonparametric Comparisons For All Pairs Using Dunn Method For Joint Ranking. ... 227

Table 4.20: Analysis of overall assessment using Nonparametric Comparisons For All Pairs Using Dunn Method For Joint Ranking ... 228

Table 4.21: Frequency analysis of the components involved in the design of participants’ “ideal” introduction-training program. ... 232

Table 4.22: Clustering analysis to determine component activities to be included in the integrated design of an introduction training program. ... 234

Table 4.23: Distribution of learning style in each group ... 244

Table 5.1: Participants’ demographic in Phase 3. ... 257

Table 5.2: Summary of interview components and the analysis. ... 279

Table 5.3: Summary of participants’ average scale ratings on each of the statement on employees’ acceptance to safety-related changes introduced in the workplaces. ... 287

Table 5.4: Summary of the themes and factors leading to failure of a change effort identified from the first and second cycle of data coding processes. ... 296

Table 5.5: Summary of participants’ average ratings of all “overall” and “could do” introduction-training programs ... 306

Table 5.6: A summary of additional components proposed by Group 1’s participants in the analysis of added components... 316

Table 5.7: A summary of additional components proposed by Group 3’s participants in the analysis of added components... 327

Table 5.8: A summary of original components from the integrated program being removed by participants in their ideal introduction-training program ... 328

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xix List of Figures

Figure 1.1: Conceptual model of the development of work-related musculoskeletal

disorders (Karsh et. al, 2001). ... 6 Figure 1.2: Ergonomics and sociotechnical system (Moray, 2000)... 7 Figure 1.3: A new conceptual adoption model. This model is based upon the original “model of the development of work-related musculoskeletal disorders” (Karsh et al, 2001) previously shown in Figure 1.1 ... 9 Figure 1.4: Possible factors influencing intervention adoption. ... 10 Figure 2.1: NORA Intervention Effectiveness Research Team’s Intervention research framework (Goldenhar et al, 2001) ... 16 Figure 2.2: Stages in the Precaution Adoption Process Model (Weinstein & Sandman, 2002) ... 21 Figure 2.3: Transtheoretical model (adapted from Prochaska & Velicer, 1997). ... 23 Figure 2.4: A Model of Five Stages in the Innovation-Decision Process (Rogers, 2003) ... 24 Figure 2.5: Technological Acceptance Model (Davis et al. 1989) ... 26 Figure 2.6: The industrial adoption model (adapted from Ozanne & Churchill, 1971). .. 29 Figure 2.7: Stages of the symbolic adoption process model, adapted from Hermann et al. (1971 ... 30

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Figure 2.9: A proposed simplified conceptual logic of the end user’s adoption decision processes integrated with the new conceptual adoption model (Figure 1.3) developed in

the previous Chapter 1. ... 35

Figure 2.10: The Ladder of Inference, adapted from Senge et al. (1994) ... 41

Figure 2.11: Wheel of Learning, adapted from Senge et al. (1994) ... 42

Figure 2.12: A model of learning process (Kolb et al. 1995). ... 44

Figure 2.13: A new conceptual model describing the thought cycles in the adoption process proposed in this study. This model integrates the components in Ross’s Wheel of Learning model with Argyris’s Ladder of Inference model ... 46

Figure 2.14: A revised conceptual adoption model proposed in this study. This revised model extended the initial new conceptual adoption model (Figure 1.3) by integrating components in the previous model describing the ‘thought cycles in the adoption process’ (Figure 2.13) ... 49

Figure 2.15: A new conceptual model of intervention adoption processes that summarizes the possible pathways of adoption or non-adoption process. ... 51

Figure 3.1: This visual aid, an ‘introduction of change timeline’, was presented to the study participants in order to facilitate discussion with them about major milestones in change processes in which they had participated ... 66

Figure 3.2: The scale used as an assistive tool for participants to describe the management’s implementation style during the change process. This scale is based upon the “Theoretical Basesfor the Spread of Innovation Model” by Greenhalgh et al. (2004) ... 67

Figure 3.3: A timeline summary of the identified major milestones involved in a change process... 79

Figure 3.4: A timeline summarizing the beginning of full participatory, partial participatory, and traditional implementation approaches in a change process. This timeline is an extension of the previous ‘timeline summary of the identified major milestones involved in a change process’ (Figure 3.3) ... 82

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Figure 3.6: The scope of this study highlighted within the implementation stage of the change process. This figure is based upon the previously described ‘timeline summary of the identified major milestones involved in a change process’ (Figure 3.3) ... 86 Figure 3.7: The ‘factors that influence adoption’ identified from the coding process mapped in a timeline format. Each of the numbers (see Table 3.5) represents an

identified factor that influences adoption. ... 101 Figure 3.8: A framework to summarize the identified themes that influence adoption from the coding process (mapped in a timeline format). ... 106 Figure 3.9: A summary of ‘lessons learned’ themes identified from the coding process mapped in a timeline format ... 114 Figure 3.10: Continuum of leadership behavior (Tannenbaum & Schmidt, 1973) ... 115 Figure 3.11: Leader-follower dynamic relationship framework (adapted from Smith, 1994). ... 116 Figure 3.12: A summary of ‘lessons learned’ data mapped to the leader-follower

relationship framework originated by Smith (1994 ... 118 Figures 3.13: The tabulation of participants’ ratings of managers’ implementation styles. Most manager-participants rated their implementation style as ‘help the change happen’ while several employee-participants rated their manager’s implementation style closer to or as ‘make it happen’ ... 121 Figure 3.14: The summary of participants’ average ratings of the management

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Figure 4.5: A conceptual model summarizing the traditional MakeToolsTM application used in the development stage vs. the new proposed application of the MakeToolsTM method to be used in the implementation stage. ... 145 Figure 4.6: Participants completing their scratch pad worksheet. The two iPods were being used to audio-record the session ... 149 Figure 4.7: The worksheet used by the participants to document their thought process in the scratch pad approach ... 151 Figure 4.8: Muscle activity captured and later analyzed by the participants. The blue circle indicates the location of the electrodes on the study participant wearing green. The first column of muscle activity data was collected while using the current transfer method and the second column of data was collected while using the new transfer method. ... 155 Figure 4.9: Postural images of patient transfer using normal method (left) vs using

HoverMatt (right) captured and later analyzed by the participants ... 156 Figure 4.10: Research participants simulating patient transfer with multiple IV lines attached to the ‘patient’ in the scenario-based approach. The IV pole and lines attached to the ‘patient’ are surrounded by the blue rectangle ... 160 Figure 4.11: Participants completing individual worksheet and survey at the end of one of the three introduction-approach sessions. ... 167 Figure 4.12: Participants collectively designing their ‘ideal introduction-training program (left). A participant presenting the group’s finished design (right) ... 172 Figure 4.13: An example of one group’s ‘ideal’ introduction-training program ... 176 Figure 4.14: Participants’ average rating of the approaches on Question 1 (This

“approach” encouraged me to think deeply about the alternative work-method). ... 197 Figure 4.15: Participants’ average rating of the approaches on Question 2 (I think it would be very good to use this particular “approach” rather than other approaches to which I’ve been exposed in the past work situation when I’m being introduced to a new work-method) ... 198 Figure 4.16: Participants’ average rating of the approaches on Question 3 (In the future, when I am introduced to a new work-method, I’d like to be introduced using this

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Figure 4.17: Participants’ average rating of the approaches on Question 4 (I think other health care providers that I know would prefer to be introduced to a new work-method using this “approach”)... 201 Figure 4.18: Participants’ average rating of the approaches on Question 5 (The

“approach” would persuade me to consider using the new work-method in my job, when applicable) ... 202 Figure 4.19: Participants’ average ranking of the approaches on Characteristic 1 (Easy to follow structure / organization) ... 222 Figure 4.20: Participants’ average ranking of the approaches on Characteristic 2

(Potential practicality in a real work setting). ... 223 Figure 4.21: Participants’ average ranking of the approaches on Characteristic 3 (Good level of engagement with participants) ... 224 Figure 4.22: Participants’ average ranking of the approaches on Characteristic 4

(Encourages deep contemplation) ... 226 Figure 4.23: Participants’ average ranking of the approaches on Characteristic 5

(Addresses potential issues and concerns). ... 227 Figure 4.24: Participants’ average ranking of the overall assessment between the three approaches... 228 Figure 4.25: Components involved in the integrated design of participants’ ideal

introduction-training program ... 240 Figure 4.26: Distribution of participants’ learning style, adapted from Kolb’s Learning Style Type Grid (Kolb et al.1995). The red marks represent the relative score of each participant participated in this study. ... 243 Figure 5.1: A visual aid presented to the participants as an assistive material to

summarize the different phases of study ... 263 Figure 5.2: Timeline mapping of the major themes grouping the identified thirty

facilitators reviewed by the participants. This timeline mapping was adapted from the previous framework of “Themes to influence adoption mapped in a timeline format” (Figure 3.8) ... 267 Figure 5.3: The scale rating shown to the Phase 3 participant for providing an

“importance rating” evaluation on each of the thirty statements about the change