Lucy Davies and Denise Lim, ANAES ACP Senior Resident Talent Development Award (SRTDA) recipients AY2020/2021 shared about their thought-provoking course on Influencer behaviors.
This year, under the Senior Resident Talent Development Award we have had the privilege of attending the True North Influencer course. So what does it mean to be an influencer? As they asked us point blank in the course “Do you believe, that the most important capacity, that you possess as a human being is your capacity to influence behaviour: that of yourselves and other people?”
l the people whose behaviour you would like to change, to improve either their lives or yours!
The course emphasized that one skill that determines your success or failure in almost every area of your life, is your capacity to influence behaviour, that of yourself at times and frequently, that of other people. And the same is true in healthcare - but first - you have to be clear what you want to achieve, and how you’re going to measure it. Many people will be familiar with “SMART” goals, which are specific, measurable, attainable, relevant and time bound.
In December 2004, Dr Don Berwick, the former CEO of the Institute for Healthcare Improvement, launched a national campaign in the US to save 100K lives. The campaign slogan was this: Some is not a number, soon is not a time. He started by setting a clear and compelling goal. He wanted to save 100,000 lives, and he wanted to do that by June 14th 2006 – by 9am. His goal was to influence the behaviour of hundreds and thousands of healthcare workers in order to save lives from medical mistakes, and the success of this campaign is now in the record books. By galvanising the attention and efforts of thousands of people across the US, Berwick and his team beat the 100,000 lives goal they had set.
Once you set a goal, you have to go about determining, what few behaviours will lead to the greatest amount of change. The influencer model details 6 key sources of influence that we have to consider to actually get people to carry out the vital behaviour that you desire. It is divided into personal motivation and ability, social motivation and ability and structural motivation and ability.
People do things for 2 reasons - Motivation (because they inherently WANT to) and ability (because they physically CAN). When thinking about how to drive change and considering possible influences for specific behaviours, it is important to remember that there is a difference between motivation and ability - we cannot forget that sometimes as much as a person often desires change, they may lack the ability to achieve it. Any attempt to motivate the unable is more likely to create depression rather than change. From a personal, social and structural perspective, we need to help them do what they can’t, provide assistance if necessary and change the physical environment to facilitate a change or vital behaviour.
The Stanford marshmallow experiment was a study on delayed gratification done in 1972. In this study, a child was placed in a room with a marshmallow and offered a choice between eating the marshmallow now or getting 2 marshmallows if they could wait until the investigator returned to the room. A great proportion just ate the marshmallow. Interestingly enough, in repeat studies done, children were taught techniques to delay gratification (distract themselves in order to wait for the second marshmallow) and those who actually practiced it were followed up and found to be likely to do better in life. The skill of willpower can potentially be taught and this is an example of increasing a person’s personal ability - but of course these skills and habits will also require personal motivation for deliberate practice.
From a social standpoint - how does society and our peers provide encouragement and assistance to perform vital behaviours? Long-standing habits and behaviours are almost always influenced by other people. There is a very successful seed-funding campaign in the Philippines which has over 99% repayment – and the secret is this: before being given a loan, women are asked to join a support group. The support group must be willing to support you in your business, and believe in you, to the extent that if you are unable to repay, they will repay for you. How powerful is peer pressure! Additionally, what strong social support and motivation!
For structural motivation, the course illustrated how rewards, incentives and costs can support desired behaviours. Changing the economy means to ensure that positive and negative incentives don’t undermine the influence message we are trying to send. The use of monetary incentives can often lead to undesired consequences. Rewards need to be linked to developing vital behaviours.
Structural ability is changing the environment to make bad behaviours harder and good behaviours easier. An illustration of this is easily seen in our workplace - many of us consciously make an attempt to reduce our carbon footprint in OT, by conserving our use of resources/plastic. However, does our environment make it easier for us to recycle the materials we actually use? How much more likely would you be to recycle, if the bins were readily available?
Being an influencer is so much more important than we may have realised before, and this course has provided a framework and approach – as well as certainly being thought provoking. We would like to thank the ACP for providing the funding support through the SRTDA and encourage all senior residents to apply for the award!