Switch - Chip Heath [9]
This outcome was the fulfillment of the vision Berwick had articulated as he closed his speech eighteen months earlier, about how the world would look when hospitals achieved the 100,000 lives goal:
And, we will celebrate. Starting with pizza, and ending with champagne. We will celebrate the importance of what we have undertaken to do, the courage of honesty, the joy of companionship, the cleverness of a field operation, and the results we will achieve. We will celebrate ourselves, because the patients whose lives we save cannot join us, because their names can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would have been only beds of weeds.
11.
Big changes can happen.
Don Berwick and his team catalyzed a change that saved 100,000 lives, yet Berwick himself wielded no power. He couldn’t change the law. He couldn’t fire hospital leaders who didn’t agree with him. He couldn’t pay bonuses to hospitals that accepted his proposals.
Berwick had the same tools the rest of us have. First, he directed his audience’s Riders. The destination was crystal clear: Some is not a number; soon is not a time. Here’s the number: 100,000. Here’s the time: June 14, 2006—9 a.m. But that wasn’t enough. He had to help hospitals figure out how to get there, and he couldn’t simply say, “Try harder.” (Remember “act healthier” versus “buy 1% milk.”) So he proposed six specific interventions, such as elevating the heads of patients on ventilators, that were known to save lives. By staying laser-focused on these six interventions, Berwick made sure not to exhaust the Riders of his audience with endless behavioral changes.
Second, he motivated his audience’s Elephants. He made them feel the need for change. Many of the people in the audience already knew the facts, but knowing was not enough. (Remember, knowing wasn’t enough for executives at Jon Stegner’s company. It took a stack of gloves to get their Elephants engaged.) Berwick had to get beyond knowing, so he brought his audience face-to-face with the mother of the girl who’d been killed by a medical error: “I know that if this campaign had been in place four or five years ago, that Josie would be fine.” Berwick was also careful to motivate the people who hadn’t been in the room for his presentation. He didn’t challenge people to “overhaul medicine” or “bring TQM to health care.” He challenged them to save 100,000 lives. That speaks to anyone’s Elephant.
Third, he shaped the Path. He made it easier for the hospitals to embrace the change. Think of the one-page enrollment form, the step-by-step instructions, the training, the support groups, the mentors. He was designing an environment that made it more likely for hospital administrators to reform. Berwick also knew that behavior was contagious. He used peer pressure to persuade hospitals to join the campaign. (Your rival hospital across town just signed on to help save 100,000 lives. Do you really want them to have the moral high ground?) He also connected people—he matched up people who were struggling to implement the changes with people who had mastered them, almost like the “mentors” found in Alcoholics Anonymous. Berwick was creating a support group for health care reform.
In this book, you’ll learn about people like Berwick who’ve created sweeping change despite having few resources and little structural authority. You’ll learn about an entrepreneur who saved his small company by turning his skeptical employees into customer-service zealots; a student fresh out of college who saved an endangered species from extinction; a manager who plotted a way to get his colleague