Sunday, 12 February 2012

Homeostasis: The principle behind resistance to change. Doctors know all about it.

Homeostasis: The principle behind resistance to change. Doctors know all about it.

A software demo

In a session with a very enthusiastic innovator/early adopter group of people passionate about improvement; my own relationship with the group is they trust me but also find me intriguing; I offered the participants a particular software; the features of the software are as follows:

1) it was from a different producer and hence at a user level it was different (but not greatly different) from what they essentially use every day
2) it was at least 4 times quicker to switch on (pressing the button to start working with it) - this was proven to the group right in front of their eyes. It was also much quicker to shut down.
3) it does everything that their existing software does and it does more (with a little effort it will also run their existing software)
4) it is very stable - almost never crashes
5) it never gets a virus (not known so far in common use at least)
6) it is completely free (compared to £70 to £250 one off costs associated with their existing software)

The group consisted of 11 people. One person in the group who was already using it and vouched strongly for it.

Nobody (10 out of 10) said they would change to it; one person out of 10 said in a very tentative and cautious manner 'I would try it'. I have since tried with another group of nine people where again only one person said 'I will try it out'. This was the situation for a proven idea/software introduced by a 'trusted' peer.

Change management

Change management is a huge challenge. It is not just in the NHS alone (or may be it is) where we love or we may not love but we will continue to do things that are slow, unstable, complication prone and costly just because we are familiar with it (as an aside, in the NHS anyone who is suspected of doing even mildly unfamiliar things will be accused of behaving in a risky way). In this example of mine, it was only software - its kind of okay. Do we do this in our clinical practice? Though all of us would deny that, there is enough evidence that we show such unnecessarily resistant behaviour and very importantly we are actively supported in such behaviour by some of our authority holders.

There are specific ways of making changes happen and proven methods in healthcare are already available. Many of us are working on it. However, only when 8 out 10 people will be willing to hear, try and change easily for the purpose of improving the safety and quality we provide will be the day where we find Success in Healthcare!!

Change Management and Homeostasis

The origins of this behaviour is far deeper than we think. Most clinicians will be familiar with the concept of homeostasis; human bodies are created to 'maintain' a stable environment for themselves. If things are not working, the body restores it to get back to its previous normality. It is possible to achieve a new/different level of 'normality' (whether it is positive e.g. body building or negative e.g. dietary related obesity) even when there is nothing broken/ill, but for that the mind and body needs to put in specific additional effort - most of the time our mind and/or body does nothing of that kind (except of course in the case of children where there is a continuous effort voluntary and involuntary to achieve an improved status till they get to be adults). Further interestingly it is possible to achieve a newer level of normality on the negative side with not much effort at all but any positive change needs focused prolonged effort (refer back to the examples of obesity versus body building); to get unfit does not need effort, to get fit we need to work very hard.

In our work life, we display similar individual and organisational behaviours. We get to work with an explicit intention of doing a 'normal' days work. Fire-fighting - looking for things that are broken so badly that it will stop us from functioning and restore it to functional levels - we do that. We easily slip into bad habits and behaviours (e.g. employing people to run a bad process rather than redesigning the process) - we do that.

Only some of us take positive efforts to make changes to improve the service. There could be problems in that. Imagine this scenario - if our hospital was the equivalent of a relatively unhealthy human body and one particular organ, say the right arm decided to improve itself by getting fit and muscular - we will have an unfit obese hospital with a well developed strong muscular right arm. Now, is that normal or beautiful? Neither. So the right arm gives up sooner or later surely encouraged by the rest of the body which wants the right arm to 'fit in' with the majority.

How to resolve this issue?

Obviously if you are running an organisation and want to improve it you will be uncomfortable accepting a worsening scenario; justifying it by some logical argument about homeostasis would sound dubious. You may want to try to meaningfully measure the performance of various parts of your organisation and present it transparently. No one likes to be part of a worsening performance graph.

If there is then a desire to go ahead and do something to improve the situation you could refer to ; try to answer my four fundamental questions with a 'Yes'.


Fixing a big bleeding artery is probably a shade easier than change management but managing change is where the really interesting challenges are.

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NB: I was comparing Ubuntu (Linux based) operating system versus Microsoft Vista as exists in my laptop computer on a dual boot. For personal use, I have been mostly using Ubuntu since January 2011 and have found it very good. Would you try it?

PS: I have nothing against Microsoft which has served me well over many years. As of date I have no vested interest in MS or Ubuntu or in any other software company.

1 comment:

Blockit said...

There's no denying that lack of leadership on our part has contributed to the healthcare crisis we are facing today .