The Rider and the Elephant: Switch Book Details How to Create Change

A remarkable book provides leaders with a practical, simple framework, based on the latest brain research, for turning an organization to a new direction.

If you’d like to read a book on making organizational change happen that’s very practical, organized around an easy-to-understand framework and filled with great examples, I recommend you put “Switch: How to Change Things When Change Is Hard” at the top of your summer reading list. The authors, Chip and Dan Heath, successfully integrate the latest brain research into a simple (not simplistic) model for leading change, and they delight the reader with amazing examples told in a smart, colorful manner.

The model has three parts, all of which are demonstrated in this extraordinary story.

On Dec. 14, 2004, Don Berwick, who was then CEO of the Institute for Healthcare Improvement (IHI), delivered a talk at a hospital administrators’ convention. Berwick had ideas for saving large numbers of lives by significantly reducing the “defect rate” of certain procedures using process-improvement procedures that had been very successful in other industries. His research convinced him that these procedures would make a huge difference, but he couldn’t require physicians to change their practices. So he challenged the hospital administrators in the room to step up.

“Here is what I think we should do. I think we should save 100,000 lives. And I think we should do that by June 14, 2006. ‘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.”

No doubt the administrators’ jaws dropped. But Berwick was just getting started. He then spelled out six specific interventions that had been shown to save lives (such as keeping a pneumonia patient’s head elevated at a certain angle so that oral secretions wouldn’t go into the windpipe). But the administrators needed more than information; they had to be motivated to take on the many barriers to change in their institutions.

Berwick then introduced a mother he’d invited to the convention. The woman’s daughter had died because of a hospital’s medical error. Then a second person spoke, the chair of the North Carolina State Hospital Association, who said that “an awful lot of people for a long time have had their heads in the sand on this issue [of injuries and death caused by hospital errors], and it’s time to do the right thing. It’s as simple as that.”

The campaign save 100,000 lives began. IHI provided participating hospitals with step-by-step instructions on how to implement the new medical procedures, the research base for these procedures and training. IHI also helped the hospitals’ leaders communicate with each other through a weekly conference call (as many as 800 people participated), and arranged for the most-successful hospitals to mentor those that joined the campaign later. Many physicians resented the new procedures, but those procedures soon produced impressive successes, and in the months after Berwick issued his challenge more than 3,000 hospitals joined the campaign.

And on June 14, 2006, precisely at 9 a.m., Berwick announced that the participating hospitals had exceeded their goals: The campaign had prevented approximately 122,300 avoidable deaths. Moreover, hospitals were institutionalizing the new procedures, ensuring that uncounted lives would be saved in the future.

At first glance, this may seem to be an exciting story about an inspiring, risk-taking leader. But there’s far more to it than that. The authors of “Switch” use this and other examples to illustrate their framework for leading difficult changes, one built around current understanding of the human brain. As the Heaths explain, our brains have two key parts that affect our decisions and actions:

• The logical, rational side, which analyzes our options and thinks long-term. It is very good at self-control. The authors call this “the rider.”

• The emotional side (a much larger part of the brain), which feels pleasure, pain, love, empathy, and so on. It’s more short-term-oriented and demands instant gratification. The authors call this “the elephant.”

Our rider tells us we need to change our diet and use the gym regularly if we really want to shed 30 pounds; our elephant won’t let us walk past the Ben and Jerry’s without trying the latest flavor. If you visualize a rider sitting atop an elephant, you understand the dilemma: The elephant is far larger and stronger than that lonely rider.

On the other hand, the wise and rational rider doesn’t provide energy for change; indeed, the rider is often at risk of “paralysis by analysis,” getting lost in the facts and options. That’s why our elephant is so critical: We don’t make difficult changes without feeling highly motivated. So we need both rider and elephant pulling in the same direction to successfully change.

Let’s take another look at the campaign to save 100,000 lives through the lens of the “Switch” framework. Berwick appealed to the hospital administrators’ rider through his documentation of the problem. He gave the rider a clear destination (save 100,000 lives by June 14, 2006) and explicit directions (six interventions that were known to save lives). Berwick also hooked his audience’s emotions — their elephants — through the two people he introduced at the conference.

There’s a third part of the “Switch” framework, called “shaping the path” by making the change easier. In Berwick’s campaign, the path to change was simplified through the use of step-by-step instructions and support groups. The weekly conference call enabled real-time communications among hospital leaders. And the campaign helped those hospitals that weren’t making progress by connecting their leaders to colleagues who had started earlier and were experiencing success.

The Heath brothers have given us a path to leading change that will appeal to your rider as well as your elephant. It’s a delightful read, and a very important book.


The Perils of Tunnel-Vision Leadership

The leadership fight at the University of Virginia is a powerful example of why so many change efforts fail.

Pop quiz. What do the following have in common?

• The new director of a large state agency initiated a visioning process two months after taking over. She told her staff, “I’ve had very good success using this in my previous management roles and am excited to use it to help this agency move forward.” Six months later, after strong employee pushback, she asked her deputy why there was so little enthusiasm for the visioning initiative. His response: “This is the third visioning exercise we’ve had in two years; the other two didn’t go anywhere, and nobody expects this one to either.”

• A federal agency dealt with a budget shortfall by doing a cost-benefit analysis of its regional offices. Its Alaska office proved to be the least efficient, and the agency announced it would close that office. The agency’s leaders hadn’t bothered to communicate with Ted Stevens, one of Alaska’s senators at the time who happened to be chairman of the powerful Senate Appropriations Committee, or with Alaska’s House member, Don Young. Twenty-four hours after announcing the decision, the agency was forced to reverse course and maintain the Alaska office.

• After winning election, a new governor named four senior members of his campaign team to lead important state agencies. They worked hard to implement the governor’s agenda for change. Like the governor, they had little confidence that their civil servants were up to the job, and they brought in numerous consultants and new staff to lead change initiatives. After two frustrating years, all four agency leaders had left state government, convinced that they were torpedoed by careerists determined to “wait ’em out.”

If your answer is that each of these involved failed attempts at change, you’re correct. But why did they fail? I believe a lack of “situational awareness” is to blame. This term, often used by the military and homeland-security professionals, refers to a person’s ability to integrate input from a variety of sources in order to form a clear understanding of the environment and plan future actions.

Why does situational awareness matter? In short, leaders who lack situational awareness usually fall far short of their goals. And when one of your goals is to lead a major change effort, poor situational awareness can be fatal. Here’s a classic recent example:

On June 10, 2012, the University of Virginia’s Board of Visitors announced that UVA President Teresa Sullivan had resigned. The primary reason initially offered: “philosophical differences.”

University faculty and alumni were stunned. Sullivan was well regarded by most faculty and numerous alumni. The university wasn’t in any sort of a crisis. So, why was Sullivan, UVA’s first female president, forced to resign after less than two years on the job? Helen Dragas, rector (chair) of the board, soon offered additional explanations–a need for bold change, for “strategic dynamism,” the importance of getting into online education. None of it was convincing.

Then came some leaked emails and off-the-record comments from university insiders, all of it damning. Sullivan had received only one informal performance review prior to her firing (which included the comment that she was a “good, not great president”). The board had never given her any warning of major discontent. And it turned out that the board had never met as a body to make the firing decision; Dragas had garnered the votes in one-on-one talks with individual board members.

All of this led to a firestorm of protest from faculty, alumni, wealthy donors and elected officials. On June 26, the board reversed itself and reinstated Sullivan.

Some people thought the matter was settled. But, this past December, UVA was put on warning by an accrediting panel that said the board may have violated governance rules in attempting to force Sullivan out. And UVA found itself back in the headlines last month, when a Washington Post article documented continuing tensions between Dragas and Sullivan, including the fact that the rector had given Sullivan a list of 65 goals to accomplish by the end of this school year!

Why do intelligent, accomplished people make colossal mistakes, such as firing a respected leader without a meeting of the board, without first giving the leader a clear message that she was in trouble, without providing stakeholders and the public with a credible rationale? Why would an experienced leader like Helen Dragas attempt to micromanage the president of an institution that continues to be one of the jewels of public higher education?

There are many theories floating around to explain these mysteries, but I believe the UVA fiasco was primarily about a leader who has no understanding of situational awareness. Dragas may well see herself as engaging in a righteous fight to save UVA’s excellence. Let’s assume the best of intentions. The way she and her board supporters have acted on their concerns, however, reflects extraordinary tunnel vision. Like the three examples in our pop quiz, Dragas and some leaders on the board paid no attention to the organization’s culture. They didn’t learn how change works at their institution, nor did they check in with key organizational stakeholders to share their change plans and get reactions. They all lacked situational awareness.

Every leader can develop situational awareness. It’s not a sophisticated skill set. Rather, it requires an openness to a variety of perspectives from internal and external stakeholders, an understanding of the organization’s culture and recent history, and a willingness to change plans based on these insights. Maintaining good situational awareness is critical to effective leadership.