!tags:: #lit✍/🎓course #status🚦/🔴red
!links:: Change Management Leadership Project Management
!parent::
!ref:: These notes are from a talk that Rose went to at CHOP
!author::

=this.file.name

Reference

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Summary

Notes

• Be sure to take the "experience of change" into account
  • Understand the kinds of feelings and emotions people might experience as a result of the change and develop a plan that addresses how individual contributors, managers, leaders, etc will be supported throughout the change.
• Much of the content below is based on the book Switch: How to Change Things When Change Is Hard by Chip Heath
• Successful Change = Clear Direction x Ample Motivation x Supportive Environment

Elephant Metaphor for Driving Change

• Elephant metaphor: the rider is the rational mind, the elephant is the emotional mind, the path is the environmental factors.
  • 

The Rider

• Creativity, control, persistence
• Self-control vs habit
• We offload a lot on the rider (rational mind), so they rely a lot on habit because of the low processing required.
• A lot of change resistance is "rider overload" - rational mind is so busy, overloaded, exhausted
• On intention - fundamental attribution error. Attributing their behavior not to environment or circumstances, but to characteristics about them as a person

Direct the rider

Examples

• Jam sampling in the grocery store - table with 6 jams to try v.s. 24
  • The 24 might get more people to approach the table, sure, but the table with 6 will sell more.
• Hip surgery - "We've tried all medications, time to decide if we're getting surgery.
  • If you say, "Oh wait, jk, we found one more pharmaceutical you can try" - 47% will try one more med, rest will go for surgery
  • OR
  • "Oh wait, jk we found two more pharmaceuticals we can try" - ~22% will try another med, rest go for surgery

Strategies

1. Script the critical moves - e.g. checklist manifesto; checklists in airplane cockpits, operating rooms
2. Find the Bright Spots - are there folks currently doing this well? What are they doing well? How are they doing it?
   • Example 1
     • Vietnam war, rural Vietnam, lots of child malnutrition
     • Small non-profit did root cause analysis: lack of access to clean water, lack of infrastructure, widespread poverty.
     • While this is true, it was useless info ("what are we, as a small non-profit, going to be able to do about that?")
     • Then realized this is true for 80% of families, but not true for 20%.
     • Decided to look at the 20% and talk to them and see what was going on/what their strategies were.
     • Got those families to go around and talk to other families about what they do
     • Over time, child malnutrition dropped for the whole population
   • Example 2
     • Teach for America - new teacher found that many of her incoming students didn't know their numbers, couldn't hold a pencil, etc. Teacher knows that students always look up to slightly older kids -- tells kids "at the end of this year, you're not going to be 2nd graders, you're going to be 3rd graders" (this is somewhat of a hybrid strategy - this part speaks a bit to emotions) -- but this leads to "how are we going to do that? How do we get there?"
3. Point to the Destination - compelling destination moves people past whether or not they want to do this to how are they going to do this, problem solving mode

Motivate the Elephant

Examples

• Locations all over the country, but no centralized purchasing.
• New purchasing director realizes there's a lot of waste, "we could be using our size to negotiate better purchasing"
• Prepared presentation w charts and figures, presented to executives, not really any movement.
• Finds out that org is purchasing 423 different types of pairs of gloves at prices from $4 - $26.
• Has someone buy one of each kind, attaches price tags, takes it in to exec office and dumps it on the table. "wait why is this one $7 but that one $19? " "how much money are we wasting on this? " etc
• Immediately got buy in, then took the "glove shrine" on tour to show people why centralization is important

Strategies

1. Find the feeling
   • Example
     • Loyalty card - 8 blanks and then free car wash. vs a card with 10 blanks but two already stamped. Rider -- no difference, they're exactly the same. Elephant - 10 with two already stamped more effective at getting people to come back.
   • Makes you feel like you're already started, have some positive momentum
2. Shrink the change - can you make the change feel smaller? (doesn't need to actually BE smaller) Or make it feel like there's more positive momentum already going?
   • Kids going home after time on oncology unit. Very very very important for them to adhere strictly to their medication regiments. Missing 20% of doses increases risk 200%. Tried to implore them to not miss any doses, and yet they do frequently.
   • Video game with 20 levels of playing game as the medication, going through the bloodstream, shooting the cancer cells. At the end of each level, an unskippable video about importance of taking meds. Adherance went up regardless if they played a few levels of all of them.
   • Identity shift, not "sick kid" (who is desperately trying to shed that identity, doesn't want to be reminded about it, wants to be healthy kid again), but I am a super hero, cancer killer, etc
3. Connect to meaning - Am I the kind of person that would do this?
   • Talking to nurses about why they became a nurse reduces attrition, increases sense of connection

Shape the path

Examples

• Most commonly purchased items - milk, eggs, bread -- at the back of the store to make you walk past everything else in order to buy more stuff. Putting other stuff in the way of what you need, to encourage you to buy more.
• ATMs - people would forget their card in the ATM. Banks got annoyed (costs with having more customer service reps to answer calls, identity theft complaints, having to replace cards). took a while to get to what works now, but first tried signs at the ATM, which helped a little, but not much. Then alarms/beeps -- a little helpful, but not much. Threatening letters (you've left your card 3 times, now we're going to charge you $20 each time), also not very helpful.  Now, ATMs don't give you money until you take your card out. Make it impossible (or very difficult) to do the thing you don't want them to do.
• 401k/403b, workplaces can only have if enough people are engaged in it. Rider (partially elephant) strategy -- matching contributions. Helps a little, but still people have to put in effort to do it. Webinars about retirement contributions, tabling, etc. What really worked (and won a Nobel prize apparently? ) make it default choice - opt-out instead of opt-in. Behavioral inertia.

Strategies

1. Tweak the environment

   • Example
     • Control group - after hip surgery, release from hospital w normal discharge instructions -- get up, walk around as soon as you can, every day, etc
     • Test group - release with additional instructions - do this every day "ok cool" alright, when will you do this? "oh hmm... after breakfast every morning"

2. Build Habits - habit chaining

   • Examples
     • Signs in hotels saying "hey we're trying to be good to the environment, consider reusing your towels" sorta effective. Changed these signs to then say "hey, most of our guests prefer to reuse their towels" 26% increase.
     • UK not paying taxes on time -- send people letters "your neighbors pay your taxes on time"

3. Rally the herd - peer pressure works, people want to fit in

Putting it all together

Situation

• Company moving from paper based tracking of hours worked to electronic tracking. They've already announced in advance, reminder a few weeks before implementation, then they implement. After implementation, 20% using, 80% still on paper. Then they send out communication, "use of Bronos is mandatory" -- up to 50%.
• Company should withhold their pay?
  • Eh, this is kind of a fundamental attribution error -- they're not avoiding because they're stubborn and in need of exertion of more power (also, this is definitely a department of labor issue)

What to do

• Tweak the environment - make it more easily accessible -- link it on the intranet make it easier to find
• Shrink the change - have it already filled out and they just have to confirm the accuracy/approve. or maybe even just make it auto-confirmed, they only have to open it if they have an abnormal schedule this week.
• Point to the destination -- tell them why it matters. What's being saved as a result of the change? Time? Paper? Money? -- more efficient as an organization, we can pay you a day sooner, save money for other things.
• Identify bright spots
  • Go talk to the people who are doing it.
  • "Yeah it's quick and easy." they show them by opening and doing it.
  • Then they talk to people who aren't doing it "it's stupid. " Oh why, can you show me? - they open, there's a tutorial/wizard that shows them through doing everything the first time, takes a while, can't close out of it.
  • "I don't have time for this, I have work to do, I'll just do it on paper" -- they make the change so that you can actually just close out of the demo, they told people they did this -- next pay period, up to 80%
• You can (and probably should) use multiple strategies. Lecturer suggests using shrink the change basically every time, as there's almost always a way to do that.