Change or Die

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.