Remember your last New Year’s resolution? Many people fail to keep their resolutions or make long-lasting modifications in how they live or do business because they don’t lay the foundation for successful change. Adopting or transitioning between electronic medical records systems (EMRs) or transforming to a new care delivery model are major changes that are fraught with potential pitfalls.
I recently had a conversation about this with someone who specializes in change management consulting, and she pointed out some lessons she had learned from BJ Fogg, a behavior design expert at Stanford. Fogg states that any significant behavioral change is only sustainable if at least one of three factors takes place:
(A) The sought-after change is accompanied by an epiphany
(B) The sought after change is accompanied by a change in the setting and environment around you
(C) The sought-after change is implemented in a series of mini-changes.
Fogg notes that while it is possible to be successful under all circumstances, some who try to change too much too fast without the proper supports found in A and B find they never complete the transformation.
Let’s look at approach C in more depth. You can think of this as a series of micro-behavioral changes. According to Fogg, getting people to take action requires three simultaneous conditions:
(1) Person is motivated to take action
(2) Person is capable of taking action
(3) Person perceives a trigger to initiate action.
Missing any one of these will greatly reduce the chances that the behavior will occur, and proactively incorporating each of these conditions into your plan for change will increase your chances of success. Setting the conditions to prompt behavior are important and can help drive #1, but, as my consulting colleague was quick to point out, studies have shown that positive and negative consequences that take place after the action are four times more effective at influencing future behavior.  Designing a plan that ensures each next action is achievable given the person’s current capabilities has a strong influence on whether someone will even try. And there needs to be some stimulus to initiate the action. How often have you gotten home from work only to realize you forgot to pick something up from the grocery store?
When you apply this line of thinking to the big initiatives taking place in the healthcare industry, such as Meaningful Use, it is wise for CMS and other organizations to propose such sweeping change in stages. And for EMR implementation teams, it can be beneficial to consider these lessons when developing a project plan. Including significant training to build capabilities, setting milestone goals that are aggressive but achievable and incremental in nature, molding the workflows of the EMR software to match the needs of each clinician to make it easier to transition to the new system, building in point-of-action reminders to encourage daily behavior changes, and designing positive feedback both for the daily wins and for meeting milestone goals are just a few ways to design a more effective project plan.
In my next blog, I’ll look at how these principles can apply to patient engagement and self-management.
Special thanks to Whitney Chiu for introducing me to BJ Fogg. His work reminds me just how important planning is to successful change.
 Braksick, Leslie. Unlock Behavior. Unleash Profits, 1999, and Litre, Patrick, Bain & Company, Inc. Changing Behaviors to Deliver Business Results, 2011.
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