We're Creating A Herd of Unhappy Elephants

The Institute for Healthcare Improvement (IHI) produces some interesting webinars on some “non-traditional” topics that can be applied to health care. You can listen to their programs by going to www.ihi.org and then going to the WIHI section on the site. Look in the Archive section for past programs.

Yesterday, IHI had Chip Heath, the Stanford professor who, along with his brother Dan, a Harvard MBA, produced the bestselling business book “Made to Stick.” Made to Stick discusses why some ideas seem to create lives of their own, and others die a quick death in both business and in our lives.

Their new book, “Switch- How to Change When Change Is Hard” discusses why it is so hard for us to change even when we know that change is the right thing to do.

Everything in our lives is changing right now whether we like it or not. The fundamental way we interact as a society is changing as technology, globalization, and the foundation of how our economy operates sets the stage for continued change in the future.

Our health care system is changing and is going to change even more when whatever comes out of Congress starts to become reality. While these external forces may dictate the changes we will need to make we don’t always go along willingly even though we know change is necessary.

In Switch, the Health brothers use the metaphor of The Rider, The Elephant, and the Path to visually describe why change is hard and why many good ideas fall to the wayside because we didn’t understand that we need to address both the intellectual and emotional aspects of making changes when they need to occur.

“The Rider” is our intellectual side. The Rider is our rational thoughts and all of the statistics, research, PowerPoint presentations, academics, etc. that knows changing the way our health care system operates is the right thing to do. We all know the way our health care is financed and delivered today is unsustainable for the future. In all of the research we’ve seen 75%-80% of Americans believe we need to reform the system.

“The Elephant” is our emotional side, and, as you visualize the metaphor, the more powerful of the two. The Elephant is more comfortable just plodding along in its comfort-zone but can be motivated and directed by The Rider if handled appropriately. The Elephant in health care can be seen with the reactions in the Town Hall meetings last summer, the Tea Party movement, and the response to what is taking place in Congress today. The Elephant in health care is being directed by the whip instead of following the direction of The Rider by the light tug of the reigns.

“The Path” recognizes the need to create the right environment to create lasting change. Here, the Health boys utilize the ideas of Stanford professor Lee Ross stating “people have a tendency to ignore the situational forces that shape other people”. You need to clear The Path to create real change. The Path for change in health care is being cleared by Congress since the free-market has not been able to get it done. It’s not a pretty path and certainly has many potholes, but it’s the path we have today.

As we look at our healthcare system The Elephant is reluctantly traveling down a bumpy path. The Rider is furiously using the whip to make The Elephant obey. When Congress passes the reform legislation that is on the table we don’t know if more obstacles will be thrown on the path or if obstacles will be cleared. We don’t know if The Elephant will finally follow the direction of The Rider or will rear on its hind legs, throw The Rider off and run back into the jungle.

But, we do know that lasting change using the approaches in place today will be difficult and ugly. Using the whip as the way to implement health care reform is going to create a herd of unhappy Elephants.