Changing thinking changes doing
(By John Atkinson)
Often in our processes of change we focus on what people are doing currently and how we would like them to do it differently. After all, if people don’t change what they are doing, what has actually changed? Logically it seems like the right place to start. New ‘Target Operating Models’ are designed, new visions of the future are created and sold. Yet what we see is the stubborn persistence of culture and activity. People keep finding ways to keep doing the things that seem to them to be right. Perhaps we make some progress but never as much as we’d hoped or thought. The same problems re-appear, maybe in slightly different guise. We spend a fortune on consultants, training, and ‘re-structuring’.
But what if instead, we re-structured our own thought? What if the activity we see currently and so want to change is an emergent outcome of our own thinking?
Let me give an example from the health sector in the UK. Increasingly ‘social prescribing’ is seen to be a good thing. We want our Primary Care Physicians to do more of it. We know, for instance, that the right forms of exercise can delay the onset of dementia. That knowledge comes from ‘clinical evidence’. Studies done on specific groups, under specific conditions, deliver measurable impact in comparison with a control group.
So if it makes people better we should prescribe it. Our mental model of how we improve the health of the population is to determine the interventions that work, often drugs or surgery, and prescribe them.
Yet even a really simple clinical intervention that requires minimal activity like taking a tablet each morning, noon and evening has quite noticeable limits to compliance. Prescribing complex activity like specific exercise regimes will inevitably have even less so.
So we have an interesting cocktail of mental models coming together. We have a mindset that says prescribing is the way we treat people. We have a mindset that says social activity is good. We have a mindset that says the two together must therefore form a good intervention. We also have a mindset that says target the most needy, hardest to reach groups. So why aren’t we getting a population level shift towards more healthy activity amongst people in the early stages of dementia?
What we are really trying to create is a shift in behaviour in a whole group of people. We know that telling people they need to change is low in effectiveness. We know primary care physicians can be wary of non-clinical interventions. And we all know how little we want to exercise when we’re feeling down, out-of-condition and tired.
So what would happen if we changed the way we thought about this. What would happen if we stopped thinking about what we might better prescribe as the route to change? What if we thought of getting our group more active in terms of how we might create an epidemic? An epidemic of activity.
Well clinicians know really rather a lot about epidemics and how they spread. For instance, we’d want to begin by infecting the weak not the resistant. We’d want to infect those susceptible to the infection, people who are in some way predisposed to exercise, maybe because they had been active in the past, because their relatives are active now, maybe because they are already exercising in some form already.
Then we’d build pockets of infection where the strain grew. We might do this through clubs, gym memberships, but not by giving people the membership or telling them they should buy one. We’d want to make it attractive to people like them, places that nurtured the growing germ of exercise in a safe and comfortable environment. Then, where the commitment levels grew (and it wouldn’t be everywhere, science is not exact), they’d begin to infect others in their networks. And then the bug would spread rapidly. We’d get a more active population but maybe not in the way we imagined.
This is an example of working with emergence. In changing the ‘rules’ that govern our thought we allow a new and novel form to emerge. The nature of emergence is you cannot control what that form will be. But are we really controlling drug prescribing? Are people really compliant with their tablets? Do they always take all the course? Aren’t we constantly being warned about the dangers arising because we are not compliant with the use of antibiotics.
So maybe it is time for health systems to stop fighting every epidemic and to start growing a few.
And in any organisation, time taken to understand how our thoughts are shaping action is at the heart of the art of growing a more meaningful form of change.