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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:
Complexity
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.
Reinforcement
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.
Understanding
Having an understanding of why you’re being asked to comply with medical advice dramatically increases the chances that you’ll do it.
Relationships
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.

BBS and BMT … What’s the Difference?

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

bbsandbmt

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?

Why Initiatives Fail

Categories: Behavior change, BMT Courses, Feedback, Leadership, TrainingAuthor:

I gave a presentation on this topic at the BMT Fed Leadership Conference in Manchester in May 2013.  Here is a short excerpt from that talk.

Click to view the 8-min video:  Why Initiatives Fail – John Austin

Most change initiatives fail. 

That’s the simple truth.  In fact, most experts suggest that upwards of 70% of them fail.  You can check my stats here by Googling “Why initiatives fail.”  If you’ve spent any amount of time in just about any job, at just about any level in the organization, you will have seen lots of change efforts come and go.

I suppose this all depends on how you define ‘failure’, but the fact that so many people have written about it suggests there is something going on here. As I was looking through what has been written on the topic – there is so much that I could not read it all – I was struck by the fact that most explanations of how to avoid failure quickly turn aspirational.

“Plan your effort better”

“Realize people are your most valuable asset”

“Communicate the change effectively”

…and so on.

It’s not that these are not reasonable things to consider, but rather that they are not the most important factors. Of all of the articles written about how make change efforts succeed, I have yet to find one that offers a behaviorally sound explanation; an explanation based on behavioral science. The purpose of this blog is to give a quick overview of what the science would suggest is a leading cause of failure among initiatives.

The logic.

Most initiatives are started because results are lacking in some way.  Results are lacking because of the behavior of people – that is, what people are saying and doing. The behavior of people is driven by their local environments – what they see and hear around them from moment to moment.  Therefore, the only way to get the behavior you want out of people is to create an environment in which this will occur.  Most change initiatives are created without ever considering the local environment of the people who will put the initiative into action on a daily basis.  This is a fatal flaw.

Problems with most initiatives.

The local environment is the whole ball game.  That’s what drives the behavior you see.  Here’s a simple example: put your favorite guilty snack on the counter (mine is potato chips) and you’re more likely to eat it.  Throw it away and replace it with fruit and your behavior changes again.

This is the basis of behavioral science and there are countless ways to influence behavior by changing the local environment.  This is the bit of knowledge that successful initiatives manage to get right.

Three problems with most initiatives include:

1)    They are conceived in isolation (without clear knowledge of the local environments in which they will be deployed)

2)    They are constructed from the writer’s perspective, not from the receiver’s perspective.

3)    They do not consider the consequences to the performer for behaving in line with the stated goals of the initiative.

If you want to get yours right, be sure to avoid these predictable mistakes.