Doctor’s Orders: What Compliance in Medicine Can Teach Us About Leadership

Categories: Behavior change, Conference, Leadership, One on One Coaching, Reinforcement, TrainingTags: , , , , , Author:

This blog post is a summary of a talk that I gave at our last BMT for Leaders conference titled, “Doctor’s Orders”. Watch the edited video here.

Why should we as business leaders be talking about compliance in medicine? A lot of research has been done in the medical field on adherence and compliance, and there are a lot of parallels between compliance in medicine and compliance in business and safety that we could learn from.
What is compliance? Compliance means taking medications in the way they were prescribed, complying with diet and lifestyle advice, and being honest with your doctor. In business, we can think of it as completing tasks on time and in the manner they were meant to be done, behaving in appropriate ways in the workplace (professionally, safely, etc), and being honest with supervisors and leaders.

5 factors that impact compliance:
The more complex a demand is, the less chance of compliance. A patient is much less likely to take a pill 5 times a day correctly than a pill once a day.
Compliance is better in medicine when the patient is experiencing some discomfort that is made better by complying with advice. It’s harder when the disease isn’t as obvious (hypertension), and especially when the impact of the drug or advice is hard to feel/perceive/measure. You have to provide other reinforcers in order to maintain behavior when the performer doesn’t perceive any consequences.
Side Effects
When a patient experiences negative side effects because of a medication, compliance rates drop dramatically. It’s important to minimize the impact of side effects as much as possible.
Having an understanding of why you’re being asked to comply with medical advice dramatically increases the chances that you’ll do it.
Surprisingly or not, the relationship between the patient and the practitioner has a large impact on compliance. The more you like your doctor, the more likely you are to comply with their advice/requests. In fact, the more a doctor interrupts a patient in the exam room the less likely it is that the patient will comply with the doctor’s advice.

In medicine, compliance starts with the doctors in the exam room. In business, it has to start with leaders. Keeping things simple, explaining why, and focusing on relationships are the first steps to creating the conditions where people comply with your requests because they want to, not because they have to.

Do we LIKE being stressed?

Categories: Conference, Events, Leadership, Reinforcement, Stress, WorkshopsAuthor:

I recently gave a talk on stress at the BMT for Leaders Conference in Manchester, England and was asked, “Why do we choose to put ourselves into stressful situations?”  This is a great question, given the many impacts that stress has on your physical, mental, and social well being (risk of stroke and heart attack, increased blood pressure, strained interactions, depression, and having a hard time remembering things just to name a few).

Behaviorally speaking, when we continually choose to put ourselves in stressful situations there is some source of reinforcement for our behavior.

In some situations, it’s a matter of lots of R-: we choose to do a behavior to avoid missing out on something, to avoid a bad consequence, etc. This can be as simple as wanting to avoid disappointing your boss, wanting to avoid letting your colleagues down, or even wanting to avoid people thinking that you’re lazy. Remember, the threat we’re avoiding can be real or imagined – as long as the person perceives it as a threat, it’s enough to cause a stress response, and possibly motivate us to put ourselves into that situation.

The other reason we may continually choose to put ourselves in a stressful situation is for R+. I can think of many things I love to do that always involve a bit of stress and R-, but ultimately a lot of R+. Take for example, speaking at conferences. I love it, I enjoy it, but there’s lots of stress and R- on the front end of preparing a talk, practicing it over and over, making sure I won’t make a fool of myself in front of everyone. I even have a stress response before walking on stage, every time. But the R+ of delivering a talk well, the nods of agreement while I’m talking, the applause at the end, getting feedback from my peers and the audience – that’s what motivates me to continually want to speak at conferences. The dose of R+ is big enough that it easily outweighs the stress and R- that happens beforehand.

I can also think of many people who look at “being stressed out” as a bit of a badge of honor – similar to the “too busy badge”. The sympathy, help, or conversations we have around being stressed out could be a kind of R+ for putting ourselves in stressful situations – we get attention that we like for doing it. There’s also the case that being stressed out helps us to avoid more responsibilities or tasks, which would be an example of R-.

It’s also important to remember that stress responses that are short and temporary aren’t bad for us – in fact they can be really helpful in improving our performance and motivation.  It’s the long-term, chronic stress that we should be concerned about and trying to avoid.

So, do we LIKE being stressed? The answer is: it depends. There are a lot of reasons we may put ourselves in stressful situations, whether we like it or not.

BBS and BMT … What’s the Difference?

Categories: Behavior change, BMT Courses, Employee Engagement, Leadership, Safety, TrainingAuthor:


By Nicole Gravina and Lisa Kazbour

Both Behavior Based Safety (BBS) and Behavior Management Techniques (BMT) are based in the science of behavior.  Behaviors provide a leading measure of safety and measuring them creates the opportunity to provide feedback and deliver reinforcement on a more regular basis, which can have a positive impact on safety.

BBS is a set of techniques developed by behavioral psychologists that are applied similarly in organizations.  Although applications of BBS may vary slightly, they all use a checklist to observe behaviors (and sometimes conditions) and provide feedback either at the individual level, the group level, or both.  The fact that BBS is a set of techniques makes implementation fairly straightforward and doesn’t require people within the organization to have a deep understanding of behavioral science.

The downside of not needing to have a deep understanding of behavioral science to implement BBS techniques is that it is easy for these techniques to be misapplied just slightly, resulting in the process not having the intended impact or even making things worse.  Unfortunately, this happens so often that many labor unions and other groups strongly oppose the use of BBS, calling it a “Blame the Worker” system.

In contrast, BMT is a more comprehensive and flexible approach that teaches people behavior science blended with project management.  By teaching behavioral science, BMT provides a skill set and knowledge base to apply the science to any of a number of problems in business and safety.

Behavioral science tells us that the current environment influences our behavior.  Shifts in the current environment can help create new behaviors, including safer ones.  If BBS, or any safety initiative, is applied without an understanding of how the environment is currently impacting behavior, we cannot be sure that the new initiative will be a positive influence, regardless of the intended impact.  For example, if we ask people to observe each other’s behaviors in an environment that is low on trust and with poor relationships, the observation process will feel punishing and people will avoid it.  If we give behavioral data to leaders who aren’t well versed in how to use that knowledge to have a positive impact, the data is likely to be used in a way that inadvertently demoralizes the workforce.  If there is low engagement, people will probably not conduct observations without a significant amount of coercion.  Having to coerce people to engage with safety (by using either a “do this or else” approach OR with incentives) does not advance the safety culture.  These situations occur all too often but can easily be addressed with an understanding of behavioral science.

Because people trained in BMT gain a deep understanding of behavioral science, they are able to apply the many tools, including observation and feedback, in a way that fits each unique situation in their business and has a positive impact.  BMT empowers people, improves relationships, and develops great leaders.  Understanding the current environment, and the way shifts in the environment impact behavior, dramatically increases the likelihood that any initiative, BBS or otherwise, will succeed.

The success of your various initiatives depends on a deep understanding of behavior and fluent application of behavioral science techniques by leaders throughout the organization.

Download a pdf of this article here:  BBS and BMT … What’s the Difference?