Managing change… Switch: How to Change Things When Change is Hard

By Anne Sexton - Last update

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Managing change is always difficult. But Chip and Dan Heath’s Switch: How to Change Things When Change is Hard is an incredibly useful book.

The authors, brothers, and co-authors of Made to Stick: Why Some Ideas Survive and Others Die, begin  by explaining why making changes can be so difficult. They use real life case studies and colourful anecdotes which are backed up by theoretical research to explain how implementing changes can be made easier.

The elephant and the rider

The authors borrow an analogy created by Jonathan Haidt in his book The Happiness Hypothesis and describe our emotional side as an elephant. Our rational side is the rider sitting atop the elephant and holding the reins. Although the rider seems to be steering the elephant, the reality is it’s a precarious control. Anytime the elephant and the rider disagree about the direction to go in, the elephant by dint of its sheer size, wins.

Similarly, most of us are familiar with situations where our elephant overpowers our rider. For example, you make a resolution to go the gym, get fit or lose weight. But after the initial flurry of activity, you fall off the bandwagon. The weakness of the elephant, our emotional side, is obvious – we want the quick win over the long term pay off.

Change efforts often fail because short term sacrifices are needed for long term payoffs. The rider, our rational/logical side, can’t keep the elephant on the road long enough to achieve the goal.

On the flip side, the elephant’s strengths are its energy and drive. What’s more, when it takes action, it comes from having an emotional attachment to achieving a particular goal. The rider’s weakness can be a tendency to overanalyze and overthink.

Therefore, effective change interventions must appeal to our emotional and logical/rational side. Or, in the authors’ words they must:

1.  Direct the rider

2.  Motivate the elephant

3.  Shape the path

Case studies: putting theory into practice

There were a number of very compelling case studies in this book. The following one illustrates the change framework.

Donald Berwick, a doctor and CEO of the Institute for Healthcare Improvement (IHI), mobilised hospitals to save 100,000 lives.

In 2004, IHI conducted research on patient care. They used analytical tools normally reserved to assess cars coming off a production line. They uncovered a shocking statistic – the ‘defect’ rate in health care was as high as 1 in 10. As a result, 10 percent of patients did not receive their antibiotics within the required timeframe.

Berwick realised that meant that tens of thousands of patients unnecessarily died every year. He believed that hospitals could use the rigorous process improvements that worked in other industries. For example, why couldn’t a transplant be as consistent and flawless as a production line?

Although Berwick’s ideas were very well supported by research he had no power to force any changes on the industry. IHI was a small organisation with only 75 employees. How did he achieve his goal?

On December 14, 2004, Berwick gave a speech to a room full of hospital administrators at a large industry convention. He stated: “Here is what I think we should do. I think we should save 100,000 lives. And I think we should do that by June 14, 2006 – 18 months from today. Some is not a number; soon is not a time. Here’s the number: 100,000. Here’s the time: June 14, 2006, 9 am.”

From idea to action

Berwick and his team set out to achieve this daunting goal. IHI began by proposing six very specific interventions to save lives. This involved asking hospitals to adopt proven procedures to manage patients with particular illnesses. In addition, a major obstacle was to engage the hospitals in reducing their defect rate. This, in effect meant admitting that patients were dying needless deaths. IHI made joining the campaign easy: it required only a one-page form signed by a hospital CEO.

Two months after Berwick’s speech, over a thousand hospitals had enrolled. Once a hospital enrolled, the IHI team helped the hospital embrace the new interventions. They provided research, step-by-step instruction guides, and training. They also arranged conference calls for hospital leaders to share their victories and struggles with one another. And, crucially, they encouraged hospitals with early successes to become ‘mentors’ to hospitals just joining the campaign.

The adopting hospitals saw dramatic results. As a result, more hospitals joined the campaign. Eighteen months later, at the exact moment he’d promised to return – June 14, 2006, at 9 am – Berwick took the stage again to announce the results.

“Hospitals enrolled in the 100,000 Lives Campaign have collectively prevented an estimated 122,300 avoidable deaths and, as importantly, have begun to institutionalize new standards of care that will continue to save lives and improve health outcomes into the future,” he announced.

Breaking down the process

Berwick managed to achieve what had seemed impossible at the outset.  Breaking down the process he used we see the following steps.

Firstly, he directed his audience’s Riders. Their destination was crystal clear: 100,000 lives saved by June 14, 2006. He also made it as easy as possible for hospitals. He introduced very specific interventions that were known to save lives.

Secondly he motivated his audience’s Elephants. He made them feel the need for change. At his initial speech he brought them face to face with the mother of a girl who died due to medical error. And he made the change very specific–  to save 100, 000 lives.

Finally, he shaped the Path. He made it easier for the hospitals to manage the change. There was a simple one-page enrolment form, step-by-step instructions, training, support groups, and mentors.

He designed an environment that made it more likely for hospital administrators to change their behaviour. He matched up people who were struggling to implement the changes with people who had mastered them. Perhaps the change or switch you’re looking for is in your work, your family, your organisation. You’ll achieve it by making three things happen: Directing the Rider, motivating the Elephant and shaping the Path.

Isobel Tynan is a senior Learning & Talent Development Professional and AC accredited coach. She has 15 years experience within the Professional Services and engineering sectors in the UK, France and Ireland. As an accredited coach with the Association for Coaching, Isobel coaches individuals transitioning into new roles and taking up leadership positions. Isobel has a particular interest on the career advancement of females in the professional and financial services. She has also guest lectured in DCU on this topic.

Anne Sexton

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