Change or Die

All leadership comes down to this: changing people's behavior. Why is that so damn hard? Science offers some surprising new answers — and ways to do better.

What if you were given that choice? For real. What if it weren't just the hyperbolic rhetoric that conflates corporate performance with life and death? Not the overblown exhortations of a rabid boss, or a slick motivational speaker, or a self-dramatizing CEO. We're talking actual life or death now. Your own life or death. What if a well-informed, trusted authority figure said you had to make difficult and enduring changes in the way you think and act? If you didn't, your time would end soon — a lot sooner than it had to. Could you change when change really mattered? When it mattered most?

Yes, you say?

Try again.

Yes?

You're probably deluding yourself.

You wouldn't change.

Don't believe it? You want odds? Here are the odds, the scientifically studied odds: nine to one. That's nine to one against you. How do you like those odds?

This revelation unnerved many people in the audience last November at IBM's "Global Innovation Outlook" conference. The company's top executives had invited the most farsighted thinkers they knew from around the world to come together in New York and propose solutions to some really big problems. They started with the crisis in health care, an industry that consumes an astonishing $1.8 trillion a year in the United States alone, or 15% of gross domestic product. A dream team of experts took the stage, and you might have expected them to proclaim that breathtaking advances in science and technology — mapping the human genome and all that — held the long-awaited answers. That's not what they said. They said that the root cause of the health crisis hasn't changed for decades, and the medical establishment still couldn't figure out what to do about it.

Dr. Raphael "Ray" Levey, founder of the Global Medical Forum, an annual summit meeting of leaders from every constituency in the health system, told the audience, "A relatively small percentage of the population consumes the vast majority of the health-care budget for diseases that are very well known and by and large behavioral." That is, they're sick because of how they choose to live their lives, not because of environmental or genetic factors beyond their control. Continued Levey: "Even as far back as when I was in medical school" — he enrolled at Harvard in 1955 — "many articles demonstrated that 80% of the health-care budget was consumed by five behavioral issues." Levey didn't bother to name them, but you don't need an MD to guess what he was talking about: too much smoking, drinking, eating, and stress, and not enough exercise.

Then the knockout blow was delivered by Dr. Edward Miller, the dean of the medical school and CEO of the hospital at Johns Hopkins University. He turned the discussion to patients whose heart disease is so severe that they undergo bypass surgery, a traumatic and expensive procedure that can cost more than $100,000 if complications arise. About 600,000 people have bypasses every year in the United States, and 1.3 million heart patients have angioplasties — all at a total cost of around $30 billion. The procedures temporarily relieve chest pains but rarely prevent heart attacks or prolong lives. Around half of the time, the bypass grafts clog up in a few years; the angioplasties, in a few months. The causes of this so-called restenosis are complex. It's sometimes a reaction to the trauma of the surgery itself. But many patients could avoid the return of pain and the need to repeat the surgery — not to mention arrest the course of their disease before it kills them — by switching to healthier lifestyles. Yet very few do. "If you look at people after coronary-artery bypass grafting two years later, 90% of them have not changed their lifestyle," Miller said. "And that's been studied over and over and over again. And so we're missing some link in there. Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason, they can't."

Changing the behavior of people isn't just the biggest challenge in health care. It's the most important challenge for businesses trying to compete in a turbulent world, says John Kotter, a Harvard Business School professor who has studied dozens of organizations in the midst of upheaval: "The central issue is never strategy, structure, culture, or systems. The core of the matter is always about changing the behavior of people." Those people may be called upon to respond to profound upheavals in marketplace dynamics — the rise of a new global competitor, say, or a shift from a regulated to a deregulated environment — or to a corporate reorganization, merger, or entry into a new business. And as individuals, we may want to change our own styles of work — how we mentor subordinates, for example, or how we react to criticism. Yet more often than not, we can't.

CEOs are supposedly the prime change agents for their companies, but they're often as resistant to change as anyone — and as prone to backsliding. The most notorious recent example is Michael Eisner. After he nearly died from heart problems, Eisner finally heeded his wife's plea and brought in a high-profile number-two exec, Michael Ovitz, to alleviate the stress of running Disney. But Eisner proved incapable of seeing through the idea, essentially refusing to share any real power with Ovitz from the start.

The conventional wisdom says that crisis is a powerful motivator for change. But severe heart disease is among the most serious of personal crises, and it doesn't motivate — at least not nearly enough. Nor does giving people accurate analyses and factual information about their situations. What works? Why, in general, is change so incredibly difficult for people? What is it about how our brains are wired that resists change so tenaciously? Why do we fight even what we know to be in our own vital interests?

Kotter has hit on a crucial insight. "Behavior change happens mostly by speaking to people's feelings," he says. "This is true even in organizations that are very focused on analysis and quantitative measurement, even among people who think of themselves as smart in an MBA sense. In highly successful change efforts, people find ways to help others see the problems or solutions in ways that influence emotions, not just thought."

Unfortunately, that kind of emotional persuasion isn't taught in business schools, and it doesn't come naturally to the technocrats who run things — the engineers, scientists, lawyers, doctors, accountants, and managers who pride themselves on disciplined, analytical thinking. There's compelling science behind the psychology of change — it draws on discoveries from emerging fields such as cognitive science, linguistics, and neuroscience — but its insights and techniques often seem paradoxical or irrational.

Look again at the case of heart patients. The best minds at Johns Hopkins and the Global Medical Forum might not know how to get them to change, but someone does: Dr. Dean Ornish, a professor of medicine at the University of California at San Francisco and founder of the Preventative Medicine Research Institute, in Sausalito, California. Ornish, like Kotter, realizes the importance of going beyond the facts. "Providing health information is important but not always sufficient," he says. "We also need to bring in the psychological, emotional, and spiritual dimensions that are so often ignored." Ornish published studies in leading peer-reviewed scientific journals, showing that his holistic program, focused around a vegetarian diet with less than 10% of the calories from fat, can actually reverse heart disease without surgery or drugs. Still, the medical establishment remained skeptical that people could sustain the lifestyle changes. In 1993, Ornish persuaded Mutual of Omaha to pay for a trial. Researchers took 333 patients with severely clogged arteries. They helped them quit smoking and go on Ornish's diet. The patients attended twice-weekly group support sessions led by a psychologist and took instruction in meditation, relaxation, yoga, and aerobic exercise. The program lasted for only a year. But after three years, the study found, 77% of the patients had stuck with their lifestyle changes — and safely avoided the bypass or angioplasty surgeries that they were eligible for under their insurance coverage. And Mutual of Omaha saved around $30,000 per patient.

Framing Change

Why does the Ornish program succeed while the conventional approach has failed? For starters, Ornish recasts the reasons for change. Doctors had been trying to motivate patients mainly with the fear of death, he says, and that simply wasn't working. For a few weeks after a heart attack, patients were scared enough to do whatever their doctors said. But death was just too frightening to think about, so their denial would return, and they'd go back to their old ways.

The patients lived the way they did as a day-to-day strategy for coping with their emotional troubles. "Telling people who are lonely and depressed that they're going to live longer if they quit smoking or change their diet and lifestyle is not that motivating," Ornish says. "Who wants to live longer when you're in chronic emotional pain?"

So instead of trying to motivate them with the "fear of dying," Ornish reframes the issue. He inspires a new vision of the "joy of living" — convincing them they can feel better, not just live longer. That means enjoying the things that make daily life pleasurable, like making love or even taking long walks without the pain caused by their disease. "Joy is a more powerful motivator than fear," he says.

Pioneering research in cognitive science and linguistics has pointed to the paramount importance of framing. George Lakoff, a professor of those two disciplines at the University of California at Berkeley, defines frames as the "mental structures that shape the way we see the world." Lakoff says that frames are part of the "cognitive unconscious," but the way we know what our frames are, or evoke new ones, springs from language. For example, we typically think of a company as being like an army — everyone has a rank and a codified role in a hierarchical chain of command with orders coming down from high to low. Of course, that's only one way of organizing a group effort. If we had the frame of the company as a family or a commune, people would know very different ways of working together.

The big challenge in trying to change how people think is that their minds rely on frames, not facts. "Neuroscience tells us that each of the concepts we have — the long-term concepts that structure how we think — is instantiated in the synapses of the brain," Lakoff says. "Concepts are not things that can be changed just by someone telling us a fact. We may be presented with facts, but for us to make sense of them, they have to fit what is already in the synapses of the brain. Otherwise, facts go in and then they go right back out. They are not heard, or they are not accepted as facts, or they mystify us: Why would anyone have said that? Then we label the fact as irrational, crazy, or stupid." Lakoff says that's one reason why political conservatives and liberals each think that the other side is nuts. They don't understand each other because their brains are working within different frames.

The frame that dominates our thinking about how work should be organized — the military chain-of-command model — is extremely hard to break. When new employees start at W.L. Gore & Associates, the maker of Gore-Tex fabrics, they often refuse to believe that the company doesn't have a hierarchy with job titles and bosses. It just doesn't fit their frame. They can't accept it. It usually takes at least several months for new hires to begin to understand Gore's reframed notion of the workplace, which relies on self-directed employees making their own choices about joining one another in egalitarian small teams.

Getting people to exchange one frame for another is tough even when you're working one-on-one, but it's especially hard to do for large groups of people. Howard Gardner, a cognitive scientist, MacArthur Fellow "genius" award winner, and professor at Harvard's Graduate School of Education, has looked at what works most effectively for heads of state and corporate CEOs. "When one is addressing a diverse or heterogeneous audience," he says, "the story must be simple, easy to identify with, emotionally resonant, and evocative of positive experiences."

In Louis V. Gerstner Jr.'s successful turnaround of IBM in the 1990s, he learned the surprising importance of this kind of emotional persuasion. When he took over as CEO, Gerstner was fixated on what had worked for him throughout his career as a McKinsey & Co. consultant: coolheaded analysis and strategy. He thought he could revive the company through maneuvers such as selling assets and cutting costs. He quickly found that those tools weren't nearly enough. He needed to transform the entrenched corporate culture, which had become hidebound and overly bureaucratic. That meant changing the attitudes and behaviors of hundreds of thousands of employees. In his memoir, Gerstner writes that he realized he needed to make a powerful emotional appeal to them, to "shake them out of their depressed stupor, remind them of who they were — you're IBM, damn it!" Rather than sitting in a corner office negotiating deals and analyzing spreadsheets, he needed to convey passion through thousands of hours of personal appearances. Gerstner, who's often brittle and imperious in private, nonetheless responded admirably to the challenge. He proved to be an engaging and emotional public speaker when he took his campaign to his huge workforce.

Steve Jobs's turnaround at Apple shows the impact of reframing and telling a new narrative that's simple, positive, and emotional. When he returned to the company after a long exile, he recast its image among employees and customers alike from a marginalized player vanquished in the battle for market share to the home of a small but enviable elite: the creative innovators who dared to "Think different."

When leaders are addressing a small group of people who have a similar mind-set and shared values, the reframed message can be more nuanced and complex, Harvard's Gardner says. But it still needs to be positive, inspiring, and emotionally resonant. A good example is how chairman and publisher Arthur Sulzberger Jr. rescued The New York Times from crisis. Former editor Howell Raines had alienated much of the newsroom's staff, undermining its communal spirit with a new culture of favoritism. Raines fell when a star reporter he had shielded from criticism was exposed for fabricating news stories. The scandal threatened the famed paper's credibility. Gardner says that Sulzberger successfully reframed the narrative this way: We are a great newspaper. We temporarily went astray and risked sacrificing the community spirit that made this an outstanding place to work. We can retain our excellence and regain our sense of community by admitting our errors, making sure that they don't happen again, and being a more transparent and self-reflecting organization. To achieve these goals, Sulzberger replaced Raines with a new top editor, Bill Keller — a respected veteran who reflected the lost communal culture — and he appointed a "public editor" to critique the paper in an unedited column. Now, Gardner says, "the Times is a much happier place and the news coverage and journalistic empire are in reasonable shape."

Radical Change

Reframing alone isn't enough, of course. That's where Dr. Ornish's other astonishing insight comes in. Paradoxically, he found that radical, sweeping, comprehensive changes are often easier for people than small, incremental ones. For example, he says that people who make moderate changes in their diets get the worst of both worlds: They feel deprived and hungry because they aren't eating everything they want, but they aren't making big enough changes to quickly see an improvement in how they feel, or in measurements such as weight, blood pressure, and cholesterol. But the heart patients who went on Ornish's tough, radical program saw quick, dramatic results, reporting a 91% decrease in frequency of chest pain in the first month. "These rapid improvements are a powerful motivator," he says. "When people who have had so much chest pain that they can't work, or make love, or even walk across the street without intense suffering find that they are able to do all of those things without pain in only a few weeks, then they often say, 'These are choices worth making.' "

While it's astonishing that most patients in Ornish's demanding program stick with it, studies show that two-thirds of patients who are prescribed statin drugs (which are highly effective at cutting cholesterol) stop taking them within one year. What could possibly be a smaller or easier lifestyle change than popping a pill every day? But Ornish says patients stop taking the drug because it doesn't actually make them feel any better. It doesn't deal with causes of high cholesterol, such as obesity, that make people feel unhealthy. The paradox holds that big changes are easier than small ones.

Research shows that this idea applies to the business realm as well. Bain & Co., the management consulting firm, studied 21 recent corporate transformations and found that most were "substantially completed" in only two years or less while none took more than three years. The means were drastic: In almost every case, the CEOs fired most of the top management. Almost always, the companies enjoyed quick, tangible results, and their stock prices rose 250% a year on average as they revived.

IBM's turnaround hinged on a radical shift in focus from selling computer hardware to providing "services," which meant helping customers build and run their information-technology operations. This required a momentous cultural switch — IBMers would have to recommend that a client buy from competitors such as Hewlett-Packard and Microsoft when it was in the client's interest. But the radical shift worked: Services have grown into IBM's core business and the key to its success.

Of course, radical change often isn't possible in business situations. Still, it's always important to identify, achieve, and celebrate some quick, positive results for the vital emotional lifts that they provide. Harvard's Kotter believes in the importance of "short-term wins" for companies, meaning "victories that nourish faith in the change effort, emotionally reward the hard workers, keep the critics at bay, and build momentum. Without sufficient wins that are visible, timely, unambiguous, and meaningful to others, change efforts invariably run into serious problems."

Supporting Change

Even when leaders have reframed the issues brilliantly, it's still vital to give people the multifaceted support they need. That's a big reason why 90% of heart patients can't change their lifestyles but 77% of Ornish's patients could — because he buttressed them with weekly support groups with other patients, as well as attention from dieticians, psychologists, nurses, and yoga and meditation instructors.

Xerox's executives learned this lesson well. Four years ago, when the company was in crisis, they came up with a new vision that required salespeople to change the way they had always worked. "Their whole careers, salespeople had done one thing," says James Firestone, president of Xerox North America, who leads a sales force of 5,400. "They would knock on doors, look for copiers, see how old they were, and sell a refresh. They knew how to do that." The salespeople had such predictable routines that they could plan their days, weeks, even years. It was comforting. But it just wasn't succeeding any longer.

Under the new strategy, the salespeople were supposed to really engage with customers so they could understand the complexities of how their offices operated and find opportunities to sell other products, such as scanners and printers. Maybe they would find that the customer actually needed fewer machines that could do more than the old ones had. Learning about the client's needs meant that the sales reps had to take a lot more time and talk to more people about broader issues. It undermined the cozy predictability of their routines. The reps became anxious, Firestone recalls. "They'd say, 'I know how to sell and make a living the old way, but not the new way.' "

Their anxiety was compounded by the fact that Xerox lagged in giving them the support they needed. It often took a couple of months before the salespeople received their scheduled training in the new approach. And it took two years before the company changed its incentive pay system to fit better with the new model, in which the reps had to invest a lot more time and effort before they signed deals. Eventually, though, the change effort, by expanding the sales focus to a larger range of products, helped Xerox avoid bankruptcy and return to profitability. "People need a sense of confidence that the processes will be aligned internally," Firestone says. "For large companies, this is where change usually fails." Even if change starts at the top, it can easily die somewhere in the middle. That's why Xerox now holds "alignment workshops" that ask middle managers — the people who make processes work — to outline the ways its systems could inhibit its agendas for change.

This Is Your Brain on Change

Are most of us like the fearful copier salespeople who dread disruption to their routines? Neuroscience, a field that has exploded with insight, has a lot more to say about changing people's behavior — and its findings are guardedly optimistic. Scientists used to believe that the brain became "hardwired" early in life and couldn't change later on. Now researchers such as Dr. Michael Merzenich, a professor at the University of California at San Francisco, say that the brain's ability to change — its "plasticity" — is lifelong. If we can change, then why don't we? Merzenich has perspective on the issue since he's not only a leading neuroscientist but also an entrepreneur, the founder of two Bay Area startups. Both use PC software to train people to overcome mental disabilities or diseases: Scientific Learning Corp. focuses on children who have trouble learning to read, and Posit Science Corp. is working on ways to prevent, stop, or reverse cognitive decline in older adults.

Merzenich starts by talking about rats. You can train a rat to have a new skill. The rat solves a puzzle, and you give it a food reward. After 100 times, the rat can solve the puzzle flawlessly. After 200 times, it can remember how to solve it for nearly its lifetime. The rat has developed a habit. It can perform the task automatically because its brain has changed. Similarly, a person has thousands of habits — such as how to use a pen — that drive lasting changes in the brain. For highly trained specialists, such as professional musicians, the changes actually show up on MRI scans. Flute players, for instance, have especially large representations in their brains in the areas that control the fingers, tongue, and lips, Merzenich says. "They've distorted their brains."

Businesspeople, like flutists, are highly trained specialists, and they've distorted their brains, too. An older executive "has powers that a young person walking in the door doesn't have," says Merzenich. He has lots of specialized skills and abilities. A specialist is a hard thing to create, and is valuable for a corporation, obviously, but specialization also instills an inherent "rigidity." The cumulative weight of experience makes it harder to change.

How, then, to overcome these factors? Merzenich says the key is keeping up the brain's machinery for learning. "When you're young, almost everything you do is behavior-based learning — it's an incredibly powerful, plastic period," he says. "What happens that becomes stultifying is you stop learning and you stop the machinery, so it starts dying." Unless you work on it, brain fitness often begins declining at around age 30 for men, a bit later for women. "People mistake being active for continuous learning," Merzenich says. "The machinery is only activated by learning. People think they're leading an interesting life when they haven't learned anything in 20 or 30 years. My suggestion is learn Spanish or the oboe."

Meanwhile, the leaders of a company need "a business strategy for continuous mental rejuvenation and new learning," he says. Posit Science has a "fifth-day strategy," meaning that everyone spends one day a week working in a different discipline. Software engineers try their hand at marketing. Designers get involved in business functions. "Everyone needs a new project instead of always being in a bin," Merzenich says. "A fifth-day strategy doesn't sacrifice your core ability but keeps you rejuvenated. In a company, you have to worry about rejuvenation at every level. So ideally you deliberately construct new challenges. For every individual, you need complex new learning. Innovation comes about when people are enabled to use their full brains and intelligence instead of being put in boxes and controlled."

What happens if you don't work at mental rejuvenation? Merzenich says that people who live to 85 have a 50-50 chance of being senile. While the issue for heart patients is "change or die," the issue for everyone is "change or lose your mind." Mastering the ability to change isn't just a crucial strategy for business. It's a necessity for health. And it's possibly the one thing that's most worth learning.

Alan Deutschman is a Fast Company senior writer based in San Francisco.

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59 Comments

  • Betty Dudas

    Change could not only be challenging, but also almost possible, when the brain has conditioned over a period of time.  In order for change to be effective, people have to process it and that could be overtime, based on their beliefs and conditioning.  Also, based on the trauma model, there could be a fright/flight reaction, when faced with trauma, such as deteriorating health, hearth disease etc.  As Kotter, indicated that behavioral change happens mostly by speaking to people's feelings.  This is true, because people need to process the importance of making a change, and why it would be important for him/or her at that stage in their life.  Also people need to process this with others, which I agree with Ornish's belief of the need of others to support change.  Support provides a mutual-aid, which allow one to not feel alone, and also gives one the opportunity of expressing feelings within a supportive environment, which he/or she may not get at home etc.  Overall, change is possible.    

  • Joel K Leflore

    The article “Change or Die” written by Alan Deutschman was an
    interesting read.  Mr. Deutschman
    discusses a too common topic that no one wants to deal with.  Topic is resistance to change and why we have
    such a hard time dealing with it. Mr. Deutschnan states that “leadership comes
    down to changing people’s behavior.”

    People are unique but the one thing that is common is their resistance
    to change.  From my observation of 23
    years in the workforce, civilian and military, I have noticed that people are
    set in their ways.  In their view if system
    is working do not change it.  They feel
    they have been working a particular process or job for 20 years or more and no
    one should change it even if their process is not producing timely and
    productive results. Something extreme would have to occur for them to change their
    thought process or behavior.  Example:  The fear of being fired.

    A good example of resisting change provided by Dr. Raphael “Ray”
    Levy, founder of the Global Medical Forum, was his comment that “people are
    sick because of how they choose to live their lives.”  He states people are smoking too much,
    drinking and eating too much, stressed and not exercising.  All the above issues lead to poor
    health.  But even with this being known
    it only changes behavior for a short time. 
    Even fear of dying does not help because some people feel they are
    already hopeless.  Additional studies have
    proven that explaining the joy of life is what keeps people from excessive drinking,
    eating, smoking and etc. 

    I agree with Dr. John Kotter’s, Harvard Business School
    professor, assertion that the core of the matter is always about changing the
    behavior of people.  Dr. Kotter states
    that “behavior change happens mostly by speaking to people’s feelings.”

    Even though people have a natural resistance to change we,
    as leaders, must continue to enforce rules and policies to the best of our
    abilities.  At the same time leaders need
    to know their subordinates and have a genuine concern for them.  I believe this will allow for a better
    working relationship with less resistance.

    MAJ Joel K. Leflore

    United States Army, Field Artillery

    ILE Class 12-003

    Staff Group Charlie

     

     

    The above comments represent the views and opinions of the
    author only, and should not be interpreted to represent the official position
    of the United States Army or the Department or Defense.

  • MAJ A. Kirby

    Kotter has hit on a crucial insight. "Behavior change happens mostly by speaking to people's feelings," he says. Bottom line, to affect change in your organization, team or group, you must know your people.
     
    Kotter has a valid point…why?...because it is knowing who in your organization. In knowing who each person is and what makes them tick, allows a leader (Commander, CEO, etc.) to reach people regardless of the operational environment. Much like sports coaches, professors and commanders, a leader must know how to motivate each person of a staff or organization as well as how to execute what the US Army terms “discipline initiative” through mission command or unity of effort.
     
    In addressing a problem set in the operational environment, it comes down to framing the problem. By framing, a leader is developing situational understanding…which requires detailed analysis and sound judgment of relevant and pertinent information in an effort to determine relationships that facilitates and drives decision making. For example, “how do I, the leader, implement change in my organization?”
     
    In understanding your people and how each individual ticks (thought process, motivational variables), a leader capitalizes on initiative in a synergistic manner and enhances concerted effort of the organization (team or group) to make decisions and progress in a positive direction, thus unleashing the full capacity of an organization’s potential.
     
    One practical example is through collaboration and dialogue. By encouraging a respectful, candid environment that fosters both positive and negative feedback, without retribution enables an organization to develop a learning environment. A learning environment breeds what many in the business world term “buy-in” from its people, and achieves what Kotter claims as “short-term wins for companies.” When people see tangible results, either incremental or fundamental, it allows for consolidation of gains ultimately generating more change in support of the leader’s vision. Other skills that enhance this effort include building mutual trust and respect within a group dynamic.
     
    Deutschman’s article is interesting and applicable to today’s operational environment. It is not easy to change, be it a bad habit or overhauling an organization’s business practices. Keep in mind, in the end change is more often positive than negative, especially if your people have a vested interest in your vision…and to the overall “health” of your organization, team or group.
     
    MAJ A. Kirby
    US Army, CGSC 12-003
     
    The above comments represent the views and opinions of the author only, and should not be interpreted to represent the official position of the United States Army or the Department of Defense.

  • Robert Perryman

     Change or Die by Alan Deutschman has provided great insight as to why it is difficult for one to change as well as how managers or leaders should approach the aspect of change within an organization.  After reading the article and many of the posts it’s evident that people are resistant to change.  They are even more reluctant to accept change when it is implemented just for the sake of doing so.  Most people want an explanation or reason for change.  Decisions made in a vacuum are more detrimental to an organization than the idea of change itself.  When and where possible leaders should assess the situation, solicit buy-in and ideas from key personnel prior to instituting change.  I would have to agree with Dr. Kotter, small wins fosters acceptance of change because one sees results; actions aren’t in vain.  When implementing change, as leaders we should provide our subordinates with the necessary tools and constant support to accomplish change.  In short, most individuals accept change if it appeals to their ideals, feelings, or if they are intrinsically or extrinsically motivated.  Robert L. Perryman, MAJUnited States Army Finance CorpsILE Class 2012-003Staff Group C The above comments represent the views and opinions of the author only, and should not be interpreted to represent the official position of the United States Army Finance Corps, the United States Army or the Department of Defense.
    Change or Die by Alan Deutschman has provided great insight as to why it is difficult for one to change as well as how managers or leaders should approach the aspect of change within an organization.  After reading the article and many of the posts it’s evident that people are resistant to change.  They are even more reluctant to accept change when it is implemented just for the sake of doing so.  Most people want an explanation or reason for change.  Decisions made in a vacuum are more detrimental to an organization than the idea of change itself.  When and where possible leaders should assess the situation, solicit buy-in and ideas from key personnel prior to instituting change.  I would have to agree with Dr. Kotter, small wins fosters acceptance of change because one sees results; actions aren’t in vain.  When implementing change, as leaders we should provide our subordinates with the necessary tools and constant support to accomplish change.  In short, most individuals accept change if it appeals to their ideals, feelings, or if they are intrinsically or extrinsically motivated. 
    Robert L. Perryman, MAJ
    United States Army Finance Corps
    ILE Class 2012-003
    Staff Group C
     
    The above comments represent the views and opinions of the author only, and should not be interpreted to represent the official position of the United States Army Finance Corps, the United States Army or the Department of Defense.

    The     

  • Noah Steinberg

    A very interesting and insightful article by Alan Deutschman, and almost as disturbing as it was revealing. It began with a discussion of the impact of the rising cost of health care and our inability as a society to effectively control the trend. In fact, for over 50 years the same five behaviors have contributed, either directly or indrectly, to over 80% of the health care budget. Our population's indulgence in smoking, eating, and drinking, too much stress, and a lack of exercise, all lead to poor health that requires expensive treatments. The true culprit: our resistance or inability to change.

    Several studies described by Dr Edward Miller of John Hopkins University, demonstrated that most patients who undergo coronary-artery bypass graphing, do not maintain the necessary lifestyle changes in order to improve their health and quality of life. Instead, approximately 90% of bypass-surgery patients returned to their poor lifestyle choices within two years post-op.

    So why is change so hard for all of us? Deutschman's article states that all leadership essentially deals with changing people's behavior. Several examples, including Kotter's model, are developed during the article. Well worth the read, and the article is even more insightful on subsequent reviews.

    Enjoy.

    MAJ Noah Steinberg, PA-C
    United States Army Medical Specialist Corps
    ILE Class 2012-003
    Staff Group D
     
    The above comments represent the views and opinions of the author only, and should not be interpreted to represent the official position of the United States Army Acquisition Corps, the United States Army or the Department of Defense.

  • Lori Whitney

    Great article, I am going to check out the magazine as well. I am in the military, and the name of the game is change. Sometimes I think we thrive on change. I am also in the medical field, and in that mileau, change is not so welcome. People want to continue doing things "the way we have always done them", and for that reason, changes in practice do not come easy, even when things are looked at from the perspective of evidence-based medicine. Even when you have well-researched "proof", with documented good outcomes, people still reject change.

    I am surprised that Dr. Ornish has had such success with his diet, but going by the "radical change" being more accepted than smaller incremental change, as stated in the article, I guess it makes sense.

    At my work, we recently adopted electronic health records, which was quite a change for everyone. The government is mandating these changes, in addition to being the obvious and immediate future.

    There was a bit of resistence at first, and it was not the smoothest transition; some folks are still resisting it over a year later, charting on paper every chance they get. About a year after we made the change, I studied the very topic in my doctorate program, and again, we learned that you need to get the people to 'buy-in' before the change can be made successfully.

    Looking at the history of the adoption of electronic health records, there have been entire hospitals that have had to close down because the providers revolted against this change. This was when computer literacy was considerably less than it is today, but the main point of tension was that computer charting seemed to pose a threat to physicians' work-flow. The truth of the matter is that it was simply about change, and nothing else, but the point was that in order to bring about a change successfully, you need to try and prepare people for what is to come before you undertake such a change.

    I am glad we had the opportunity to read this article as part of our ILE class this year.

    Lori Whitney, MAJ, Army Nurse Corps
    ILE Class 2012-003
    Staff Group A

    The above comments represent the views and opinions of the author only, and should not be interpreted to represent the United States Army or the Department of Defense in any way.

  • Joseph Marshall

    As a 20 year aviation officer, I have always looked for ways to learn and grow as a leader, husband, father, and son. One thing is for sure, the more I begin to learn the more I understand how little I know.  I won't go into a hubris fueled rant on my military exploits, graduate education, or deployments; however, Iwould like to submit that I had an opportunity to work with Dr. Kotter and leading change in a military organization several years ago. I will omit the specifics, but dive into the nature of change and how I dealt with the challenge as a leader.

    Intially, I was resistant and fealt defensive to a recommended change. Dispite the change being a more streamlining focus of resources and risk/resource pooling, I was tired of change for the sake of change. Noneltheless, I was not a supporter until we had a second meeting with Dr. Kotter. After the second meeting, I began to grasp an understanding of change and how its origin lies within the people of the organization.

    It is not important which task or the timeline must be accomplished and how that will become some accolade displayed on a plaque or some supervisor's wall a decade later.The most important thing is recognizing a change is needed. The organization can move ahead and the power of change is fostered through belief and expertise. It does take hard work, reflection, and honesty to recognize change is possible. Having said that, trust you have the right people on your team and allow them to employ creative and critical thinking. I know it is not that simple and it also takes intellectual courage and strength to lead a traditional organization into a different direction.  It is critical to differentiate that experience does not equal expertise and humble forthright approaches coupled with critical thinking will start the momentum of change.

    One falicy of change is that some expert will come into an organization and give you a MBA assessment and clear step-by-step quantitative analysis of how to successfully implement change in "X" weeks. Sure this will implement change, but it is not long lasting change that will stand the test of time for the long term. It is truly remarkable how an organization will find change within itself when the leadership envokes an environment of empowerment and allows change to manifest through its sound leaders. One concept senior leadership must understand is that change cannot be bridled, but must be a living, breathing entity that takes the shape of its talent, environment, and available resources. Once the momentum builds, each individual will begin to identify opportunities for change within his or her daily routine at the organizational level. It takes time and yes people will lose faith and believers must be resilient, but staying the course will prevail and also help the organization at all levels grow as well.

    As with any challenge, relationships will flourish and so will resourcefullness. In the end, Dr. Kotter never specified what actions to take, but fostered belief in the organization and allowed the change to permeate from the inside. It was a very powerful and long lasting method that would has proven effective in a multitude of corporate or military applications. Maybe this will provide another lens in applying leading change.

    Joseph C. Marshall, MAJ
    United States Army Acquisition Corps
    ILE Class 2012-003
    Staff Group C 

    The above comments represent the views and opinions of the author only, and should not be interpreted to represent the official position of the United States Army Acquisition Corps, the United States Army or the Department of Defense.

  • Armando V. Corral

    I completely agree with Mr. Deutschman’s assessment
    regarding change.  You see I am one out
    of those nine he mentions that have in fact changed and beaten the odds.  For the most part I agree with the below
    comments from MAJ Ricciardi.  Though he gives
    a compelling argument, I would have to respectfully disagree with his one comment
    “Scaring someone straight only works in
    the near term”.

     

    Back in 2006, I was hospitalized for 5 days with a severe
    case of diverticulitis with abscess.  The
    doctor informed me I was lucky to be alive and that I would have to make some
    “lifestyle changes” in order to see my next birthday.  My immediate reaction was that I wanted to
    live and would make the necessary changes by consuming a healthy diet,
    exercising regularly and adding fiber daily to my meals.

     

    What I thought would only be temporary has now amounted to
    almost 6 years and have since not had a single relapse.  My motivating factor in both the short and
    long term was in fact death.

     

    I do realize I may be the exception here but believe change
    is possible.

     

    MAJ Armando V. Corral

    ILE Class 2012-001

    Staff Group A

     

    The above comments
    represent the views of the author only, and should not be interpreted to
    represent the views or official position of the United States Army or the
    Department of Defense.

  • Mike Ricciardi

    Old Habits die-hard.  Lifelong habits, especially lifestyle habits die even harder.  The problem is not healthcare, rather it’s an individual problem that reflects an individual’s laziness, lack of self control and learned bad habits.  The challenge is getting people to change.  As written below, some folks will never change regardless of which approach they take.  Others will only change over time.  Still, I believe the majority that change initially will revert to their old conditioned bad habits over time.  Scaring someone straight only works in the near term.  It is not a long-term solution as the fear will wear off, or the individual will become desensitized to it.  As blunt and morbid as it sounds the dilemma we face is a prime example of natural selection. 
     
    MAJ Michael Ricciardi
    ILE Class 2011-003
    Staff Group B

    The above comments represent the views of the author only, and should not be interpreted to represent the views or official position of the United States Army or the Department of Defense.

  • Phil Lopez

    I agree Mr. Deutschman’s assertion that leadership is ultimately about changing people’s behavior.  I disagree however with an assertion he makes in his closing that individuals want to change, but often times cannot.  While change is undoubtedly difficult, the truth is that individuals and organizations can change but choose not to.  From the organizational perspective, this is usually the result of failed leadership. When I read Mr. Deutschman’s article I was reminded of an insightful lecture I listened to online a few years ago.  As I interpret the lecture, it reinforces Mr. Deutschman’s assertion that leadership is ultimately about changing people’s behavior, but also refutes his assertion that individuals often times want to change their behavior but cannot.  The lecture, titled Values Based Leadership, was presented by the CEO of P&G, Robert McDonald, at the MIT Sloan School of Management in early 2009.He postulates that leaders must provide development opportunities, and recognize that success comes not just from being strong but being adaptable and prepared for change.  He points out that until we are able to tell the future, the best way to be prepared for change is by continuous learning and education.  Consequently, P&G puts their money where there mouth is so to speak.  Also, when things do not go right in the organization or the organization is slow to change, the leader must first look internally and ask himself if he has given the people in the organization the right leadership, strategy, systems and culture to enable success.  P&G’s record substantiates these high level principles.  The company was created over a decade ago and is only one of nine fortune fifty companies in 1955 still there today.  

  • Phil Lopez

    I agree Mr.
    Deutschman’s assertion that leadership is ultimately about changing people’s
    behavior.  I disagree however with an
    assertion he makes in his closing that individuals want to change, but often
    times cannot.  While change is
    undoubtedly difficult, the truth is that individuals and organizations can
    change but choose not to.  From the
    organizational perspective, this is usually the result of failed leadership. 

     

    When I read Mr.
    Deutschman’s article I was reminded of an insightful lecture I listened to
    online a few years ago.  As I interpret
    the lecture, it reinforces Mr. Deutschman’s assertion that leadership is
    ultimately about changing people’s behavior, but also refutes his assertion
    that individuals often times want to change their behavior but cannot.  The lecture, titled Values Based Leadership, was
    presented by the CEO of P&G, Robert McDonald, at the MIT Sloan School of
    Management in early 2009.

     

    He postulates
    that leaders must provide development
    opportunities, and recognize that success comes not just from being strong but
    being adaptable and prepared for change. 
    He points out that until we are able to tell the future, the best way to
    be prepared for change is by continuous learning and education.  Consequently, P&G puts their money where
    there mouth is so to speak.  Also, when
    things do not go right in the organization or the organization is slow to
    change, the leader must
    first look internally and ask himself if he has given the people in the
    organization the right leadership, strategy, systems and culture to enable
    success.  P&G’s record substantiates
    these high level principles.  The company
    was created over a decade ago and is only one of nine fortune fifty companies
    in 1955 still there today.  

  • John

    Thanks for this interesting article: Framing, radical, supporting change and brain on change. People want to be changed their behavior, but it’s very hard as you mentioned. A person is dissatisfied he or she will not blame themselves but think the problem is our work, our location or our husband or wife. We try to change our job. We change the city where we live. We try to change our marriage partner. Only when it does not succeed in giving us a more wonderful life do we realize that something inside us needs to be changed. What is the reality of the world? Whenever you see the social phenomena and mass media report, you can be discouraged by so many incidences of crimes, corruption, and wrongdoing. You never expect ideal peaceful society in this broken world. So many people in the broken society feel it isolated and lonesome. A changing behavior helps or influences other and organization.
    MAJ John Min, ILE Class 2011-003, Staff Group B. The above comments represent the views of the author only and should not be interpreted to represent the official position of the United States Army or the Department of Defense. David Richkowski 19 hours ago

    David Richkowski 19 hours ago

  • David Richkowski

    This article is very interesting.  I agree that it is possible to change the way people think and live and how organizations function.  While difficult, by influencing people in the right way, changes in habits, both professionally and personally, are possible.  Within the article, Dr. Ornish presents two good perspectives in doing this.  First, by telling people, the changes can make their lives or the company better and why.  Second, it is important to make the changes all at once.  As a former company-level commander in the US Army, I have seen this work.  Initially, I had a vision of how I wanted to command the company.  Then I assessed the current state of the company.  I reassessed my vision and developed a plan on what changes I wanted to make, and how I was going to make them.  I explained the changes to the subordinate leaders in the company and why I was going to make them.  Finally, I made all of the changes at one time.  This minimized the confusion and made the transition more effective and efficient. Everyone in the company did not initially agree with the changes that I made, because some individuals were taken out of their comfort zone.  Eventually, those individuals saw the benefit of those changes.  At times, the transition period was challenging, but we became a cohesive and efficient unit.  Therefore, it is possible to change the way people think and operate, especially in an organization.
    Major David Richkowski, ILE Class 2011-003, Staff Group B.  The above comments represent the views of the author only and should not be interpreted to represent the official position of the United States Army or the Department of Defense. 

  • Reginald

    Change, for the most part, can be rewarding, but quite challenging at times.  We as a nation spend a significant amount of our time trying to influence other countries abroad and we do a pretty decent job at doing so.  We ultimately know that influencing a culture’s way of thinking requires skill and experience and is definitely nothing to be taken lightly.  Most of our third world countries have been fighting for years and are still fighting to this very day, but how do we influence them to change?  Do we coerce them with our military force or do we empower them to build their own government structures.  Ultimately, we would like to treat the problem and not just the symptoms.  Sometimes we can step in and provide a temporary solution, but the problem will remain in existence even after providing a possible solution.  However, if we provide the necessary resources to assist a volatile government to set up their own governments, then may be some of those “un-heard voices” can be heard.  Sometimes we can prescribe the wrong prescription to the problem and sometimes the quick fix is not always the solution either.  Common since tells us that a doctor perhaps should not prescribe eye medication to a patient with a serious heart condition unless it has been proven to cure those diseases related to the eye malfunctions.   Ultimately, the challenge for change not only deals with the fact of influencing, but we must turn down the volume and attempt to empower our subjects to channelize their efforts into making matters better than they were in the past.  Sometimes this may only come in the form of a 50% solution that ultimately has the ability of expanding to a 70% or 80% solution. However, one must keep in mind that we do not have the capacity to satisfy every party concerned, but all leaders should perhaps strive to make their subordinates accountable in providing the best options possible that gets to the root of the problem and not just the symptom. 
    Major Reggie Armstrong, ILE Class 2011-003, Staff Group B.  The above comments represent the views of the author only, and should not be interpreted to represent the official position of the United States Army Acquisition Corps or the United States Army or the Department of Defense.

  • Williams, BL

    I agree with Alan Deutschman’s “Change or Die” article.  This article sheds light on some very sobering statics, for example 600,000 people undergo bypass surgery every year.  Sadly enough, of that 600,000 the vast majority do not change their lifestyle after surgery.  I am not a psychiatrist, but I do know that it is very hard to change a person’s attitude.  I believe that the crux of Deutschman’s argument is that the facts and the statistics are public knowledge, now it is completely up to said person to change their lifestyle, or perhaps die.

  • Michelle Iles

    More often than we realize people are least likely to change so this article really drives it home.  People become accustomed to doing things their way and satisfying all of their guilty pleasures. Nothing in our society speaks moderation, everything is supersized and you do not have to wait to have the things that you want. The figures mentioned in this article are not alarming because all you have to do is look around and you see people over indulging in almost every aspect of their life. There are times when these behaviors generate from a traumatic event from their past or present well that is why we have psychiatrist. I hope that I am not coming off as cold hearted or mean but it really is a sad sight when you see someone wearing oxygen and smoking a cigarette. It is far more rewarding if we indulge in healthy pleasures and enjoy a long prosperous life rather than suffer and live a short painful life. This article really highlights key points that could possibly change the course of health care with the correct implementation in the healthcare profession and reception from the public.

  • Jay Owens

    The author’s assertion that change must be both radical and emotional in order to be sustained is enlightening.  As it pertains to human behavior, emotional development occurs over time and the brain makes adjustments based on life experiences.  For this reason, many people would rather do what they are familiar with.  Once change takes place then it must be maintained over time.  Leaders, who understand this fundamental human nature, can utilize appropriate tools to facilitate change by “framing” the approach for those in need of mental and emotional adjustments.  Changes of any kind must be significant and holistic in order to be sustained long term in the interest of the person or organization.  Jay Owens.  Ile Class 2011-003 Staff Group B.  The above comments represent the views of the author only, and should not be interpreted to represent the official position of the United States Army Medical Department, the United States Army or the Department of Defense.

  • Richard Clark

    This was a very interesting article. It highlights the idea that to survive, an individual or organization must be able to “change” or adapt to alternations in their environment and we do not do it very well. The author provides a practical example of the heart patient that is only compliant with healthy lifestyle suggetions immediately after surgical intervention and treatment but fails to make the long-term commitment to change his or her lifestyle and ends up in the operating room, cath lab, or worse 90% of the time. For commitment to triumph over compliance, in the case of the heart patient, the health care provider must evoke measures; emotional, spiritual, or other; that appeal to what is truly important to the person rather than using on fear and facts to force compliance. By enabling, the patient to reframe and relate the lifestyle changes to something positive and important to the patient, the healthcare provide will have a greater chance of instilling more of a long term commitment. However, wouldn’t it be better to be proactive rather than reactive from the start? As a health care professional, I have witnessed the tangible and intangible benefits of preventive health measures that directly influence the lives of various patient populations.  The perceived costliness of preventive health initiatives is dwarfed when compared to the cost of treatment for chronic disease processes and illnesses. This would require the populace to become proactive and responsible for their health and wellbeing rather than waiting for the next new pill or therapy to come along and “fix” the results of poor lifestyle choices. How this can be most effectively accomplished is truly a "Change or Die" question for some people. 
    MAJ Richard L. ClarkILE Class 2011-003Staff Group BThe above comments represent the views of the author only, and should not be interpreted to represent the official position of the United States Army Medical Department, the United States Army or the Department of Defense. 

  • Ryan Pursel

    I would argue that the United States military has, over the years, fallen into the trap of reacting to adversity and a changing environment rather than learning how to be more adaptable.  One area the army has fallen into this reaction is how it has confronted the Army Physical Fitness Test (APFT).  Over the past few decades, the army has maintained the APFT as a three event test to ensure Soldiers are able to meet the demands of the battlefield.  What it has always failed at is testing the Soldiers endurance across these events and their ability to complete these events under less than optimal conditions.  The result of this approach in many ways has let to Soldiers training on areas that would guarantee them the best score when the test finally arrived, rather than building physical readiness to meet the needs of military operations.  The Change or Die article really demonstrates that a key organization such as the United States Army can even become engrained in the status quo.  I am one of the many guilty members who have resisted this change over the past six months because I understood the test as it was and was conditioned over the past 14 years to score very high on it.  The newly redesigned Army Physical Readiness Training has the goal of balancing overall Soldier readiness with the physical needs of serving the nation in battle while reducing the risk of injury, something the previous program did not focus on.  This article helped me remember the importance of learning new ways to do things better is important, but only when we do something about it.