- Serenity or Courage?
- Power to Change
- Best Practice
- Eradicate Disease
- People are Flawed
- Will You Influence Them?
- Talk is Cheap
- They Must Feel It
- The Six Sources of Influence
- Can’t or Don’t Want to?
- Are They Motivated?
- Are They Able?
Do you effectively influence others? If you are like me, you spend a good part of your day trying to influence or persuade. I do so with variable success.
I set few goals. Then I find I’m unable to change behaviors (mine or others’). Without behavioral changes, I fail to meet my goal. Frustration leads to fewer goals or lower targets. It is a vicious cycle.
Given my lack of success at achieving goals, I turn to serenity. I try to accept things as they are. This can be difficult for Type-A, OCD physicians!
I would like to be a positive force for change in the world. Choosing acceptance is the best choice when you cannot affect a change. But some of us give up instead.
Serenity or Courage?
“God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.”
Serenity Prayer by Reinhold Niebuhr
How would you like the power to change anything?
- Influential people can pick an impossible goal and then do it. Here’s an example. Take hardened criminals like drug-addicted felons and make them helpful. Imagine getting them an education, job, and positive/productive habits. See Delancey Street.
- Influencers have eliminated HIV/AIDS transmission in some parts of the world. See the work of Dr. Wiwat.
- They have all but eliminated Guinea worm disease. See the Carter Center.
- Others have targeted drowning rates in YMCA pools.
- Or infection rates and medical error rates in hospital systems. See Dr. Berwick’s work at IHI.
Power to Change
These examples have saved millions of lives and reduced worldwide suffering. I recently read the book, “Influencer; The Power to Change Anything.” The authors explain the factors involved in changing human behavior.
The book’s message is encouraging. Anything is possible with the right people and the right positive influence.
The change-agents in this book have done incredible things. By comparison, I have accomplished little in my life. It is discouraging.
But hey, my life isn’t over yet! I can use some of what I learned and make an even greater positive impact on my life. I wish the same for you.
“It is not enough to do your best; you must know what to do, and then do your best.” W Edwards Deming
We must search for the few “vital behaviors” that make the most impact on outcomes and behaviors. A handful of high-leverage behaviors have a massive impact. Those behaviors and factors may not be obvious in the beginning.
Study “best practice.” Someone somewhere likely has accomplished – at least on a small scale – whatever it is you are trying to do.
Don’t try to recreate everything from scratch. Learn which vital behaviors they are influencing and how they do it.
Study “positive deviance.” If you find a problem, look at the likely cause. Then find an area that shares the same likely cause but does not have a devastating effect. This will provide a clue to “positive deviance.”
The Carter Center provided an example when they attacked Guinea worm disease. Some parts of Africa should have had Guinea worm but didn’t. Why? This points to positive deviance.
They observed the local villagers. Would the habit patterns provide a clue about why their disease risk was low? It did.
The researchers noticed something. The women poured their water through their skirts. They did this before bringing the water home to their family.
This vital behavior turned out to be a clue since it was straining the larvae. How could they spread this? Could a simple strainer make all the world of difference?
People are Flawed
Search for “recovery behaviors.” People make mistakes. They will relapse. People are not always rational. How will you handle that? Do you have a plan in place?
Test your results. Test the positive change on a small scale. To improve handwashing in your hospital start with a single department.
Set up your tracking, your vital behaviors, your social influence, your rewards. Check the outcomes and improvements and barriers before rolling it out on a wider scale. Try this at home.
Not always at your house. But use it in a familiar environment. Then you can bring it to an unfamiliar area.
Dr. Bandura helped people overcome phobias. For example, he showed how to desensitize people from irrational fears of snakes.
People choose their behaviors based on what they think will happen to them as a result. Many of those thoughts are incomplete and inaccurate.
Will You Influence Them?
That depends on how well you change vital behaviors.
Will people actually do the “vital behavior?” That depends on two questions that will be on their mind.
Thought One: “Is It Worth It?”
Thought Two: “Can I Do This?”
Talk is Cheap
The most common tool we use to change other people’s expectations is the use of verbal persuasion. This also happens to be the least effective tool.
When it comes to resistant chronic problems, verbal persuasion is rarely effective.
Do you remember the last time you talked an alcoholic out of drinking ever again by simple logic? This is never happened, of course!
They Must Feel It
The great persuader is a personal experience.
The second best is a simulated experience.
How could you create that?
Create a vicarious experience that affects them as a person. This is very different from verbal persuasion.
Use stories to change minds.
Tell Them a Story
If you want to gather the attention of others or persuade them, you must become a master storyteller.
You’ll need to tell the whole story complete with background and all the details. If we cut to the chase and go to the outcome we bypass the story and lose its effectiveness.
A good story provides hope. Stories include experiences and possibilities. A good story can have a plot change or storyline twist that influences our thinking.
“A good story beats PowerPoint bullet points any day.” Wealthy Doc
The Six Sources of Influence
Be aware of the six sources of influence. A master influencer understands and benefits from all six.
Let’s say someone isn’t doing what you expect them to do. Or they aren’t doing what you want them to do. How should we begin to understand this?
Can’t or Don’t Want to?
Ask yourself, “Is this a matter of motivation or ability?”
I asked this with my children often.
My daughter seems unable to get up on time in the morning. Let alone make breakfast, get herself dressed, and out the door within 30 minutes.
Is this because of her lack of focus? ADHD symptoms? Sleep disorder or low muscle tone?
Are They Motivated?
One day she had to get ready for a fun outing and then a sleepover at a friend’s house. She got ready within 20 minutes with no difficulty or prompting.
This makes me think it’s more of a motivational issue than an ability issue.
What about your staff?
Are They Able?
At work, I asked my medical assistant to help with something. I checked back the next day and it still was not done. She seemed willing and yet did not do it.
Was she being passive aggressive? Do I need to threaten or reward? No. Under further review, I realize she needed some coaching on how to use the technology.
It was a matter of ability, not a matter of motivation. Making this distinction helps me better understand behaviors.
Here is an example of how to use these principles to create change:
Our doctors should help teach students and residents. They do not.
Each physician needs to take part in helping to teach.
How can we change physician behaviors?
How could we use the Six Sources of Influence?
Source 1. Personal Motivation
Teaching the next generation of physicians is part of the Hippocratic Oath. We can remind them.
Those who teach learn the most. Those who give of themselves are happier in their own lives. How can we link in personal values to life choices?
Source 2. Personal Ability
Could we host workshops on how to teach? Could we run training in PowerPoint and other useful tools?
How can we exploit Up-to-Date, Anki, and other technology tools?
Source 3. Social Motivation
Medical directors have administrative authority. Their physician peers respect them. Medical Directors can set an example by carving out time to teach. That message signals what is important.
Source 4. Social Ability
Set up informal gatherings. Give clinicians an opportunity to share and discuss. What is working well with regards to teaching? How can we build on that?
Source 5. Structural Motivation
Could we offer a stipend?
Could teaching be part of the bonus structure? My employer went this route.
Doctors notice and appreciate a few thousand extra dollars.
Source 6. Structural Ability
Could we carve out 20% of each physician’s work schedule to allow more time to prepare lectures and to teach?
Adding teaching onto an already busy schedule would be difficult or undesirable. Having carved out time would make this possible.
What do you think? Could you better apply the Six Sources of Influence when implementing a change you want?
Have you used these techniques to influence others when negotiating?
I gave examples from my family and my work. I’m sure you have examples in your life. When did you want someone to do something different? How will you use these ideas to improve your social leverage?
What has worked well for you or not worked? The masters of influence routinely combine the 4-6 source of influence to affect change. We could all learn from them. What tips can you share on applying these concepts?
Your example of your daughter is absolutely spot on with my own daughter’s behavior. It is amazing when there is something beneficial like visiting a friend that motivates her to get ready in half the time it takes for her to go to school. Same with eating. If she doesn’t like it it can last for over an hour versus something she enjoys it can be almost instantaneous.
The most successful influence methods engage both sides and have some sort of motivation or reward that makes them want to be invested in the task at hand
Xrayvsn recently posted…When You Play The Game And They Change The Rules
I sometimes struggle with the motivation vs ability difference. When someone isn’t doing something it can be tough to know which is paramount. It is worth even just asking this question though and seeing where things go.
The book was helpful but a little intimidating. The projects highlighted were on a huge scale. The masters used 5-6 sources of influence routinely. They were saving 100,000 lives at a time as starter projects. I’m just trying to get through my day!
I aim much smaller, but am grateful for the changes I effect. Close friend is working at a big fund to end neglected diseases, doing incredible work, even met the queen of England. She also travels non-stop and spends a lot of time away from home. I’m grateful for my small sphere of influence because I’ve seen the costs up close and don’t particularly wish to incur them, no disrespect to her.
Still, I like this framework for thinking about change and incentives
Thanks Wealthy Doc for a thoughtful exploration.
I hear you. It takes heroic effort and huge personal sacrifice to achieve the biggest humanitarian objectives.
I’m so glad that people like your friend are out there working and grinding. We all serve in our own way. Mine too is on a much smaller scale.
I still find it useful to apply some of the lessons they have learned to affect changes. Even if my biggest goal is to get my son to clean up the yogurt he spilled.