Change or Die

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.