Locus of Control and Health Innovations

The concept of locus of control is a powerful psychological construct that significantly influences an individual's attitudes and behaviors, including their propensity for innovative thinking and innovative behaviors. In the context of healthcare, understanding that locus of control is crucial for fostering a culture of innovation, can facilitate the overcoming of resistance to change. The social learning theory introduces locus of control as the degree to which individuals believe that they have control over the events that affect their lives. It exists on a continuum, with two primary orientations.

Internal locus of control (ILOC) is attributed to individuals who believe that they are primarily responsible for their own outcomes. They attribute successes and failures to their own efforts, abilities, and decisions. They tend to be proactive, take initiative, and believe their actions can influence their environment. In contrast, external Locus of control (ELOC) is attributed to individuals who believe that external forces, such as luck, fate, powerful others (e.g., superiors, providers), or uncontrollable circumstances, are primarily responsible for what happens to them. They may feel less empowered to change their situation and might be more passive or resigned.

My research on ILOC and innovative behaviors sheds light on the critical link between the two.  My studies demonstrate that ILOC is a strong driver of innovative behaviors. Nurses with a higher ILOC were significantly more likely to exhibit innovative behaviors. This suggests that when healthcare professionals believe that their actions can make a difference, they are more inclined to propose new ideas, seek out better ways of doing things, and champion change. Also, the research revealed associations between ILOC and perceived organizational innovativeness. Individuals who feel they have control over their environment are also more likely to perceive their organization as supportive of innovation, or perhaps their internal drive helps shape a more innovative organizational culture.

An ILOC fosters proactivity. Individuals who believe they can influence outcomes are more likely to take initiative, identify opportunities, and actively seek solutions to problems. In healthcare, this means that nurses and other professionals with ILOC will be more willing to propose new protocols, adopt new technologies, or suggest improvements to patient care processes. Conversely, an ELOC can lead to a lack of motivation and a tendency to avoid responsibility, as individuals may believe their efforts won't significantly impact outcomes.

The concept of EntrepreNursing refers to nurses who exhibit entrepreneurial characteristics within their professional roles, leading to innovations that enhance healthcare quality, accessibility, and cost-effectiveness. Our research suggests that strengthening nurses' ILOC is a crucial step towards fostering EntrepreNursing and unlocking this untapped potential for innovation within healthcare systems. While the relationship can be nuanced, studies generally suggest that individuals with a higher ILOC are more likely to be early adopters of new technologies and approaches. They are more likely to evaluate innovations based on their perceived effectiveness and take personal responsibility for learning and integrating them into their practice. In contrast, those with an ELOC might be more hesitant, wait for external mandates or fear that technology will create more problems than it solves, or that they won't be able to master it.

Given the significant role of ILOC as a driver of innovative behaviors, healthcare organizations can cultivate a stronger ILOC among their staff through several paths. To cultivate ILOC executives are called to grant health professionals greater autonomy and control over their work processes, including involving them in decision-making, allowing them to experiment with new approaches, and providing them with the resources and support to implement their ideas. Managers are also called to invest in professional development that enhances skills, knowledge, and confidence, to reinforce an ILOC. Training on problem-solving, critical thinking, and change management, can also empower individuals to feel more capable of influencing their work environment. Acknowledging and rewarding innovative efforts by executives, regardless of the immediate outcome, can reinforce the idea that the actions of individuals matter. This can include formal recognition programs, opportunities for career advancement, or simply public praise for creativity and initiative.

Leaders need to communicate clearly about organizational goals and how individual contributions align with them to help staff feel more connected to outcomes. Constructive feedback that focuses on learning and improvement, rather than solely on performance, will reinforce the belief that personal efforts can lead to positive change. Further, leaders play a crucial role in shaping the perceived locus of control within an organization. Innovative nursing leadership, for example, has been shown to positively influence the proactivity levels and perceived control of nurses over their practice. Leaders who act as facilitators, provide psychological safety, and encourage experimentation, will foster a more internal locus of control among their teams.

Flatting organizational structures and promoting cross-functional collaboration can break down barriers that might otherwise lead individuals to feel powerless. When employees feel they can directly influence their work and interact with decision-makers, their ILOC is strengthened.  Figure 1 presents the components of fostering ILOC.

Figure 1. The components of fostering ILOC

To sum up, understanding how ILOC among healthcare professionals can strategically influence innovation can help healthcare organizations tap into an immense wellspring of creativity and drive innovative behaviors.  By fostering ILOC among clinicians and staff through empowerment, supportive leadership, and recognition, executives can cultivate innovation. While an ILOC is generally beneficial for innovation, there can be potential downsides. Extreme ILOC can sometimes lead to overconfidence, where individuals might overlook external factors or resist collaboration, believing they alone must handle tasks. Conversely, an ELOC can manifest itself as "victim blaming" or a lack of personal responsibility. Informed by insights from my research, executives can start building a truly dynamic, responsive, and ultimately healthier future for all.  By fostering environments that empower individuals, recognize their contributions, and provide avenues for proactive engagement, healthcare organizations can cultivate a workforce that is not only capable of innovation but also driven by the belief that their efforts can truly transform care.

Additional readings

• Gabay G. Exploring perceived control and self-rated health in re-admissions among younger adults: A retrospective study. Patient education and counseling. 2016 May 1;99(5):800-6.

• Gabay G. Perceived control over health, communication and patient–physician trust. Patient education and counseling. 2015 Dec 1;98(12):1550-7.

• Gabay G, Tikva SS, Kagan I. Exploring EntrepreNursing: The influence of internal locus of control and organizational innovativeness on nurses' innovative behavior-A cross-sectional study. Applied Nursing Research. 2025 Feb 1;81:151900.