Our hospital CEO recently chose the book “Switch” by Chip and Dan Heath for our leadership reading club. This book seems very appropriate for the health care reform that is looming in our future. The authors explain “how to change things when change is hard” and that we all have two different systems – the rational mind (Rider) and emotional mind (Elephant). Both minds unite to achieve changes that improve outcomes when goals seem out of reach. The authors go on to explain that leaders need to do three things when making changes:

1. Change the person’s situation or tweak the environment
2. Appeal to the emotional side (Elephant)
3. Appeal to the rational side (Rider) What appears to be a people problem is often a situation problem. If the person’s situation is changed then one has to influence his heart and mind. Often the heart and mind are at odds.

The Elephant

The Elephant is our emotional side and our rational side is its Rider . We have all experienced our Elephant overpowering our Rider when we procrastinate, skip exercising, get angry and say something we regret or refuse to speak in a meeting because we are scared. Changes can fail because the Rider fails to keep the Elephant under control long enough to reach the desired outcome. The Elephant isn’t always the bad guy, and he has enormous strengths. When contemplating change the Elephant is the one that gets things done.

The Rider

The Rider provides the planning and direction. The Rider thinks long term and beyond the moment but the Rider can overanalyze and spin his wheels. You may know someone with Rider problems; indecisive, brainstorm for hours but does not make a decision. For things to change the Rider must provide the planning and direction and the Elephant provides the energy. If you appeal to the Riders on a team you will have understanding without motivation unless you appeal to the Elephants. The Elephants will have the passion without direction. But when Elephants and Riders are in sync then change can come effortlessly.

Finding Bright Spots

The authors present many examples of extraordinary people that overcame obstacles to make positive changes. Jerry Sternin working for Save the Children was invited to open an office in Vietnam in 1990 to fight malnutrition. Sternin’s approach was to find “the bright spots” or “poor children that were well nourished” and discover what these mothers were doing differently. If some children were healthy despite their disadvantages then those successes were worth emulating. Observations in these homes revealed some insights. The bright spot mothers were feeding the children the same amount of food but instead of the traditional two meals per day it was divided into four meals per day. The children’s malnourished stomachs could not process too much food at one time. Another difference was more active feeding – hand-fed by parent. An important difference was that the bright spot mothers were collecting tiny shrimp and crabs from rice paddies and mixing it into the rice with sweet-potato greens. These differences were providing the protein and vitamins to the diet. Sternin organized cooking groups and the mothers were to bring shrimp, crabs and greens and cook together. The most important aspect of this strategy was that it was their change, using the local wisdom of the village mothers. This was a native change solution. NAACLS is in the process of Standards revisions focused on student outcomes. There are many approved and accredited NAACLS programs that have unique and diverse processes – “bright spots” – to achieve great outcomes. NAACLS intent is to foster innovation and uniqueness so that graduates are prepared to enter the workforce with competencies that meet patient’s needs in our ever changing and challenging healthcare environment. I have written several self studies and believe that program directors will embrace outcomes focused standards because there will be less emphasis on inputs for self studies such as arduous documentation of resources and more emphasis on student expectations and graduate accomplishments. For things to change, somebody somewhere (NAACLS) has to start acting differently. NAACLS is pursuing its vision by scripting new critical moves for programs and providing direction for Program Director’s Riders to shape a new path. I hope your Elephant will be motivated by the excitement shared by the NAACLS board, staff, committees and standards revision task force. Share your “bright spots” and determine what will you Switch?

Reference: Heath, Chip & Dan., Switch, Broadway Books, NY, 2010.

by By Peggy Simpson, MS, MT(ASCP)
President, Board of Directors