Changing Minds

This American Life, the radio creation of Ira Glass, takes a weekly look at differing aspects of well, American Life. Last week he posed the following question:

“Do you know anybody who has changed their minds? Who firmly was on one side of the issue, and then they read a story in the New York Times or they heard something on Rush Limbaugh and now they are firmly on the other side? … when we’re confronted with evidence disproving what we believe, generally, we just dig in and we believe it more. And the rare times that people do change, it’s slow.”

Sounds to me a lot like the ‘discussions’ we have around changes such as surgical check lists or the now defunct SCIP requirements, autonomy for mid-level providers, order sets, the list goes on and on. The question was intriguing enough to listen to the podcast; an excerpt of the podcast can be found here (about 24 very worthwhile minutes), the transcript can be found here.

“And conventional wisdom among political practitioners is you don’t talk to the people who are against you.. OK, note what he’s saying here. It’s not just that you don’t try to swing them over to your side. You don’t talk to them at all.” (Italics added)

The necessary first step is to talk with one another. Duh. But the key point was that you reach out to those who clearly disagreed with you, not the individuals who were willing to ‘go with the flow.’ You talk to the resistors, those who disagree and ask why. You have to understand their viewpoint, not assume it. We often interpret resistance as foolish ignorance or fear of change when in fact we stop seeing the issue through their eyes. We are so engaged in understanding and initiating change for ourselves that we lose sight of the distance we have already moved, failing to share that journey with our colleagues. The first step is to see the issue from their experience – to see with the learner’s not the teacher’s eyes.

“…the first thing that they tried was an appeal to idealism, to principles. Stuff we all agree with. … . The problem with that, they found, is that it kept the conversation at this very rational, reasonable, intellectual level. And that’s not where people make their decisions about issues like this. People make their decisions about how to they’re going to vote on this at a gut level. And at a visceral level. And at an emotional level. “

I plead guilty to this because my rational, analytic side finds ‘logical principles’ appealing and believes others share that appeal – which they do at times. But changes in our work and practice habits are very personal; after all, we are talking about caring for our patients. Change must take the emotional context, our care in caring for our patients, into account. Understanding the emotional envelope of the issue comes from both our personal experience of change and attentive listening to our opponents concerns. The art of facilitation lies in the recognition of the commonality and using it as the basis to appeal for change.

These real conversations are made more difficult because of venue. These are not conversations that take place in forums, large or small. They take place in one on one moments, in the lounge over a cup of coffee, at the desk over a shared patient, in holding, recovery or the parking lot. Rarely is a conference room conducive to this sharing.

The podcast dealt with the divisive issues of gay marriage and abortion and found that an emotional connection changed attitudes not just for a few weeks, but also for long periods of time. The kind of sustaining change we seek. But this brings us to their third finding, which I found to be so fascinating, and upon reflection, true. The change agents had to be “the people most affected by an issue” the change agents had to be us.

There is a large body of literature about innovation describing early adapters (those buying an iWatch now), the early and late majority (the bulk of us) and the laggards (those whose watches are wound by hand). Most of that literature describes innovation diffusing from early adopters to the early majority and so on. This is an incomplete characterization. When issues were discussed, among peers, at an emotional level, around common concerns then even when the peers had very divergent views, minds could change.

“I think what’s kind of interesting about this is that when I talk to professionals about this technique, this does not inspire a lot of interest on their part. Because of course, it can’t be done on a large scale at low cost. And they don’t want to invest the kinds of resources and training ….  Cheaper, by far, to make a scare ad and run it on local TV around the state – you know, the way politics usually works.”

And that last line of Ira Glass is to me the most resonant. If we care about our professions and its members then as change agents we need to recognize the exceedingly personal journey, we are asking our peers to take along with us. We need to invest the time in the relationships. Change by fiat, our version of the scare ad, will not win hearts or minds. They are won in conversations between engaged individuals connecting over shared experience.