Lean Management in Your Medical Practice: Changing Behaviors

Today in my Lean Management class we discussed change management. There are a number of different theories, guides, and philosophies out there, but the one we focused most on is John Kotter’s eight-step model. I will spare you the details but one key idea resonated loudly for me. It is this - change behavior before changing culture. I’ve handled change management in myself, my family, my profession exactly backwards. 

Personally, I want to exercise regularly and eat right. Many of you probably have the same goal.  The way that I go about this is to come up with the gigantic plan of attack. I’m going to eat eight servings of fruits and vegetables, exercise at 5 a.m. every morning, and swear off fatty carbohydrates. I go about changing my culture first. When I’m just talking about me, I equate culture with attitude. I try to get myself excited about eating healthy or exercising before I take my first bite of spinach or jog my first step. Instead, I should just do what I need to do. It may be little - 10 minutes running up and down the stairs or eating an orange before I decide whether I want dessert. Over time, these behavioral changes will shape my attitude. I think of it as “fake it ’til you make it.”

Isn’t this what motivational interviewing is all about? We don’t ask patients how the feel about exercising or what their environment dictates about physical activity. Instead we ask: What one thing can you do in the next week? Start with behavior, the rest will follow.

In my family, I realize that my erroneous attempts at change management are partly to blame for the Sunday afternoon clean-your-room-now feud I wage weekly with my son. I tell him to clean his room. He goes to his room. He sits on his floor for hours, not cleaning his room. I go into his room and admonish him to clean his room for all those important reasons that have been passed down from generation to generation. You need to clean your room because you’re losing all your toys. You need to pick up your dirty clothes because otherwise they won’t get cleaned and you won’t have anything to wear. I need to vacuum in here, so the floor has to be picked up. I am trying to motivate and encourage him to clean his room by appealing to the culture in which he lives. Instead, I need to make sure he does a certain behavior -  cleaning his room - and not worry about shaping his entire vision of personal responsibility and cleanliness. He’ll get there, if only because when he’s 27 years old, he’ll hear my voice echoing in his head.

At work, I try to foster a culture of work-life balance. I have all kinds of “cultural” tools. I have a sculpture on my desk with the reminder to “Succeed at Home First.” I have pictures of my family all over my desk. I check work obligations against family obligations. All those ideas are great, but the behavior is what matters. My own culture of work-life balance isn’t summed up in a saying or motto. It’s made up of many, many choices and behaviors that over time create a culture.