There is really only one way for people to change. Marshall Goldsmith calls this ‘natural law’. We all know it (that’s why it’s natural), but we often don’t like to talk about it. I think the reason is that it feels a little self centered. Marshall puts it this way: “people will do something, including changing [his or her] behavior, only if it can be demonstrated that to do so is in their own best interests, as defined by their values. ”
For those of us that like catchy phrases this is also known as “what’s in it for me?” or WIIFM. It’s not possible to ‘make’ anyone do anything except for brief periods of time and under coercion. Outside of that, people do have an opportunity to choose to change. The factors that influence our choices are what interest me. Every choice, big or small, is a risk-reward decision where the bottom line is “what’s in it for me?”
So that’s why we don’t like to talk about it. Is pure self interest the only thing that motivates people? That’s where the nuance comes in.
Goldsmith points out that defining something more consistent with our value system can mean different things to different people at different stages of their lives and careers. People who have already achieved power, money, status, and popularity may be more concerned with leaving a legacy than achieving another business deal.
How do people change?
The key to getting people to change is to have them see something through a lens that matches their values. That’s probably why successful people later in their careers decide to volunteer as board members of nonprofits; it is in their best interest at that time of their life to leave a legacy.
For those of us in organizational leadership, this is an interesting concept. How do we effectively make a case to someone that choosing to change is in his or her best interest which, thereby, makes a new organizational future more likely? Or put another way, who in our organization shares the future vision and who may not choose to come along, and what kinds of values might we need to find in new people to join us in our journey?
These concepts assume we need to know where we are going, and to know what values are needed to allow people to choose to change or join us. My readers know that I craft most of this leadership and change theory in the realm of health care because that’s where I work. You can, however, apply this thinking to any choice you face.
Change in health care
In health care I believe change has to be specific and local. We serve others. Providers cannot bring their training and beliefs to any population and ‘just do it’. Well, they can, but they won’t be successful unless they learn to meet the needs of those they serve. This is the core of what is meant by population health.
To improve the health of a population we have to know who they are and what they need. And the only way to know is to ask. This is the core of process improvement: the ‘value stream’ is the ‘values’ or needs of the people we seek to have as our customers. It’s true in any business. For example, our health system measures the health needs of the community using surveys. Focus groups can supplement surveys. We need to offer both health care services for those who are sick and preventive services to those who are not.
The population Cooley Dickinson serves
Our population is well educated but bimodal in socioeconomic status. University faculty and their families likely need a different kind of shared decision making than homeless people. We are quite diverse and have a growing population of Asian and Hispanic neighbors. We serve a relatively large proportion of gay, lesbian, bisexual, and transgender people. Knowing who we serve and what they need frames our vision for improving health.
So a vision for the future of a health system is proposed by leaders to include a picture of a healthy community and the values required by those who work in the system to get there. In our health system, that vision includes building on the ‘local hero’ concept to have even better health prevention through access to and consumption of better food, more exercise on our delightful walking paths, and local opportunities to learn how to prepare foods and take up exercise that match the cultural values of our diverse populations. For care delivery, we need to better understand what people need: almost every population wants easy access, caregivers who clearly are curious and serious about the needs of the person in front of them, and a quality care product. What else? Some populations make decisions using extensive family support. How do we make sure that happens? What are the implications for our ‘spaces’?
The values that will allow an organization to achieve this kind of success must include self interest that is aligned with these needs. Some call these our ‘buttons.’ As Goldsmith observes, it’s usually quite easy to find the buttons in successful people (like health care workers). Just ask what the motivations behind people’s self interest are. They will usually tell you. This is why behavioral interviewing is so useful. We have to find people whose ‘buttons’ are pushed by accomplishing the goals of the community.
I believe we can have the healthiest communities possible by deploying our resources to the needs of our community according to the communities self-described needs and by people whose values match the achievement of those needs.
Cooley Dickinson Hospital • 30 Locust St. (Route 9), Northampton, Mass. • (413) 582-2000
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