Switch - Chip Heath [76]
HOW DO WE MAKE THE SWITCH?
• Direct the Rider. N/A. The teens know what is expected of them.
• Motivate the Elephant. 1. Find the feeling. Maybe the kids see Millar as an abstract authority figure rather than as a human being. Imagine a one-on-one conversation with each kid in which Millar says, “I feel stressed out because I’m expected to cover so much material in so little time. And that’s how I’m judged. And I know you don’t think it’s a big deal when you’re a few minutes late, but it makes my chances of doing a good job harder and harder. Can you do me a favor and just get here a second or two early?” Depending on the kids’ empathy level, this might work. Or, more likely, fail utterly.
• Shape the Path. 1. Tweak the environment. Lock the door when the bell rings so latecomers are stuck in the hallway. 2. Build habits. Start having a daily quiz with one or two quick questions at the beginning of every class. If Robby and Kent aren’t present to take the quiz, they’ll fail. 3. Rally the herd. Post a class “on-time” record on the wall. Maybe when Robby and Kent see that they’re the only students violating the social norm to be on time, they’ll change their ways. 4. Build habits. Set a policy that the last student in his or her seat every day will be asked to answer the first question. 5. Rally the herd. Find a way to let Robby and Kent know that the other students dislike what they’re doing (as they almost certainly do). Often troublemakers have the illusion that their defiant behavior makes them folk heroes. They can be deflated quickly by frank peer feedback. 6. Tweak the environment. Do what Bart Millar actually did: He bought a used couch and put it right at the front of the classroom. It was immediately obvious that this couch was the cool place to sit—students could slouch and relax instead of sitting at a dorky desk. Suddenly Robby and Kent started getting to class early every day so they could “get a good seat.” They were volunteering to sit at the front of the classroom. Genius.
4.
Becky Richards worked at Kaiser South San Francisco Hospital, where nurses administer about eight hundred medications a day. “Medication administration” is what happens between the time a doctor prescribes a certain medication (such as 100 mg of ibuprofen) and the patient receives it. Nurses take the doctor’s chicken-scratch prescription, transcribe it so it’s legible, then fax the order to the pharmacy. When the medication arrives from the pharmacy, they deliver it in the right dosage by the right method (IV drip, injection, orally) to the right patient at the right time.
Nurses have an impressive accuracy record: On average, they commit approximately 1 error per 1,000 medications administered. Still, given the huge volume of medications delivered at Kaiser South, that error rate led to about 250 errors annually, and a single error can be harmful or even deadly. For instance, if a patient receives too much heparin, a blood thinner, the patient’s blood will no longer clot and the patient could hemorrhage. If a patient gets too little heparin, the patient could develop a blood clot that could lead to a stroke.
Richards, who was director of adult clinical services at Kaiser South, and her nursing staff wanted to drive down medication errors. Richards believed that most errors happened when nurses were distracted. It was easy to become distracted, because in most traditional hospitals, the medication administration areas are right in the middle of the nursing units, which tend to be the noisiest places on the floor. From memory, Richards quoted Tess Pape, a professor at the University of Texas who has studied medication errors, saying, “Today we admire people for multitasking, we celebrate people who can accomplish many things at once. But when you’re giving out medications it is the last time you should be multitasking.”
Put yourself in Richards’s shoes for a moment. Your goal is clear: Change your nurses’ behavior so they can focus better, so