I recently read the book “Switch,” which describes some techniques on how to change when change is hard.1 The authors write about a rider, an elephant, and a path. If all three are aligned toward a change, it will most likely succeed; without all three, change will be very difficult or unsuccessful altogether.
The rider is the intellectual portion, which will find the rational, statistical, logical solution to get from point A to point B. But the rider is steering an elephant, which is bulky, unruly, and emotional. The rider has to figure out how to motivate and direct the elephant; the two of them then have to get down a common path, which could be winding, confusing, and full of roadblocks. So to overcome all of these, the book gives innumerable, tangible examples of how to maneuver all three of these to facilitate change. In the case of my husband’s Mass issue, a few things could have facilitated the change for many:
Direct the rider:
- Find the bright spots. Find a success story of how others quickly relearned Mass within weeks and see how they accomplished it.
- Script the critical moves. Be very precise about what needs to be done differently; don’t just tell people to “learn the Mass,” but instead tell them to “repeat three new lines every day in the shower” until they have an error-free Mass.
- Point to the destination. Be very specific about the future goal, such as “You will be cue-card-free by October.”
Motivate the elephant:
- Find the feeling. Find a “heavy” emotion that will motivate the change. Shame, embarrassment, or anger from being stared at by a 10-year-old after missing so many lines should be pretty effective.
- Shrink the change. Make it seem like all the lines are easy to learn, if learned only one at a time.
- Grow the person. Motivate the Catholic to learn it as quickly and seamlessly as they did in fifth grade; if you already did it once, you just have do it again!
Shape the path:
- Tweak the environment. Have cue cards all over the place, laminate them, make them easy to fit in a pocket or purse.
- Build habits. Have the Catholic go to church every week until they have an “error-free” Mass.
- Rally the herd. Have them watch others for cues on behavior; this has worked for me for decades!
You can see that many of these techniques should be easier in healthcare than in other industries, especially motivating the elephant and shaping the path. To facilitate change, hospitalists should find ways to direct the rider, motivate the elephant, and shape the path, and we may find that change is not as daunting and overwhelming as it might at first seem.
And when you finally do make a positive change happen, give yourself a high-five—and send a “Hail Mary” to the Creasters.
Dr. Scheurer is physician editor of The Hospitalist.