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CHIP HEATH

THE BESTSELLING AUTHORS

$26.00

Why is it so hard to make lasting

changes in our companies, in our

communities, and in our own lives?

The primary obstacle is a conflict that's

built into our brains, say Chip and Dan

Heath, authors of the critically acclaimed

bestseller Made to Stick. Psychologists have discovered that our minds are ruled by two

different systems-the rational mind and

the emotional mind-that compete for con­

trol. The rational mind wants a great beach

body; the emotional mind wants that Oreo

cookie. The rational mind wants to change

something at work; the emotional mind

loves the comfort of the existing routine.

This tension can doom a change effort-but

if it is overcome, change can come quickly.

In Switch, the Heaths show how everyday people---employees and managers, parents

and nurses-have united both minds and, as

a result, achieved dramatic results:

• The lowly medical interns who managed

to defeat an entrenched, decades-old medical

practice that was endangering patients (see

page 242)

• The home-organizing guru who developed

a simple technique for overcoming the dread

of housekeeping (see page 130)

• The manager who transformed a lackadaisi­

cal customer-support team into service zealots

by removing a standard tool of customer service (see page 199)

In a compelling, story-driven narrative, the

Heaths bring together decades of counterin­

tuitive research in psychology, sociology, and

other fields to shed new light on how we can

(continul!d on back flap)

(continu.d from front j/Ap)

effect trans formative change. Switch shows that successful changes follow a pattern, a pat­

tern you can use to make the changes that mat­

ter to you, whether your interest is in changing

the world or changing your waistline.

CHIP HEATH is a professor at the Graduate School of Business at Stanford University. He

lives in Los Gatos, California. DAN HEATH is a senior fellow at Duke University's Center

for the Advancement of Social Entrepreneur­

ship (CASE). Previously, he was a researcher

and case writer at Harvard Business School,

as well as the cofounder of a college textbook

publishing firm called Thinkwell. Dan lives

in Raleigh, North Carolina. The Heath broth­

ers write a monthly column for Fast Company magazine.

www.heathbrothers.com

Also available as an eBook and on audio

from Random House

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SWITCH

H OW TO

CH ANGE T H INGS WHEN

CH ANGE

IS H ARQ

CHIP HEATH and DAN HEATH

Broadway Books

New York

Copyright © 2010 by Chip Heath and Dan Heath

All rights reserved. Published in the United States by Broadway Books, an imprint of the

Crown Publishing Group, a division of Random House, Inc., New York. www.crownpublishing.com

BROADWAY BOOKS and the Broadway Books colophon are trademarks of Random House, Inc.

Library of Congress Cataloging-in-Publication Data Heath, Chip.

Switch: how to change things when change is hard / Chip Heath and Dan Heath.-lst ed.

l. Change (Psychology) I. Heath, Dan, 1973-11. Title. BF637.C4H43 201O

303.4-dc22 2009027814

ISBN 978-0-385-52875-7

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

First Edition

Contents

1 . Three Surprises About Change 1

D I R E C T T H E R IDE R

2. Find the Bright Spots 27

3. Script the Critical Moves 49

4. Point to the Destination 73

M OT I VA T E T H E ELEP H ANT

5. Find the Feeling 1 01

6. Shrink the Change 1 24

7. Grow Your People 149

S H APE T H E PA T H

8. Tweak the Environment 1 79

9. Build Habits 203

1 0. Rally the Herd 225

11. Keep the Switch Going 250

How to Make a Switch 259

Overcoming Obstacles 261

Next Steps 265

Recommendations for Additional Reading 267

Notes 269

Acknowledgments 293

Index 295

1

Three Surprises About Change

1.

One Saturday in 2000, some unsuspecting moviegoers showed

up at a suburban theater in Chicago to catch a 1 :05 p.m. mati­ nee of Mel Gibson's action flick Payback. They were handed a soft

drink and a free bucket of popcorn and were asked to stick

around after the movie to answer a few questions about the con­

cession stand. These movie fans were unwitting participants in a

study of irrational eating behavior.

There was something unusual about the popcorn they re­

ceived. It was wretched. In fact, it had been carefully engineered

to be wretched. It had been popped five days earlier and was so

stale that it squeaked when you ate it. One moviegoer later com­

pared it to Styrofoam packing peanuts, and two others, forgetting

that they'd received the popcorn for free, demanded their

money back.

Some of them got their free popcorn in a medium-size bucket,

2 T hr e e S u r p r i s e s A b o u t C h a n g e

and others got a large bucket-the sort of huge tub that looks

like it might once have been an above-ground swimming pool.

Every person got a bucket so there'd be no need to share. The re­

searchers responsible for the study were interested in a simple

question: Would the people with bigger buckets eat more?

Both buckets were so big that none of the moviegoers could

finish their individual portions. So the actual research question

was a bit more specific: Would somebody with a larger inex­

haustible supply of popcorn eat more than someone with a

smaller inexhaustible supply?

The sneaky researchers weighed the buckets before and after

the movie, so they were able to measure precisely how much pop­

corn each person ate. The results were stunning: People with the

large buckets ate 53 percent more popcorn than people with the medium size. That's the equivalent of 173 more calories and ap­ proximately 21 extra hand-dips into the bucket.

Brian Wansink, the author of the study, runs the Food and

Brand Lab at Cornell University, and he described the results in

his book Mindless Eating: "We've run other popcorn studies, and

the results were always the same, however we tweaked the details.

It didn't matter if our moviegoers were in Pennsylvania, Illinois,

or Iowa, and it didn't matter what kind of movie was showing; all

of our popcorn studies led to the same conclusion. People eat

more when you give them a bigger container. Period."

No other theory explains the behavior. These people weren't

eating for pleasure. (The popcorn was so stale it squeaked!) They

weren't driven by a desire to finish their portion. (Both buckets

were too big to finish.) It didn't matter whether they were hungry

or full. The equation is unyielding: Bigger container = more eating.

Best of all, people refused to believe the results. After the

movie, the researchers told the moviegoers about the two bucket

sizes and the findings of their past research. The researchers asked,

IJlrll::1I:: �url',,:atc::a HUUU' "'IIGII!lC'

Do you think you ate more because of the larger size? The ma­

jority scoffed at the idea, saying, "Things like that don't trick me,"

or, "I'm pretty good at knowing when I'm full."

Whoops.

2.

Imagine that someone showed you the data from the popcorn­

eating study but didn't mention the bucket sizes. On your data

summary, you could quickly scan the results and see how much

popcorn different people ate-some people ate a little, some ate

a lot, and some seemed to be testing the physical limits of the

human stomach. Armed with a data set like that, you would find

it easy to jump to conclusions. Some people are Reasonable Snack­

ers, and others are Big Gluttons.

A public-health expert, studying that data alongside you,

would likely get very worried about the Gluttons. "We need to mo­

tivate these people to adopt healthier snacking behaviors! Let's find

ways to show them the health hazards of eating so much!

But wait a second. If you want people to eat less popcorn, the

solution is pretty simple: Give them smaller buckets. You don't

have to worry about their knowledge or their attitudes.

You can see how easy it would be to turn an easy change prob­

lem (shrinking people's buckets) into a hard change problem

(convincing people to think differently) . And that's the first sur­

prise about change: What looks like a people problem is often a

situation problem.

3.

This is a book to help you change things. We consider change at

every level-individual, organizational, and societal. Maybe you

4 T h r e e S u r p r i s e s A b o u t C h a n g e

want to help your brother beat his gambling addiction. Maybe

you need your team at work to act more frugally because of mar­

ket conditions. Maybe you wish more of your neighbors would

bike to work.

Usually these topics are treated separately-there is "change

management" advice for executives and "self-help" advice for in­

dividuals and "change the world" advice for activists. That's a

shame, because all change efforts have something in common:

For anything to change, someone has to start acting differently.

Your brother has got to stay out of the casino; your employees

have got to start booking coach fares. Ultimately, all change ef­

forts boil down to the same mission: Can you get people to start

behaving in a new way?

We know what you're thinking-people resist change. But it's

not quite that easy. Babies are born every day to parents who, in­

explicably, welcome the change. Think about the sheer magni­

tude of that change! Would anyone agree to work for a boss who'd

wake you up twice a night, screaming, for trivial administrative

duties? (And what if, every time you wore a new piece of cloth­

ing, the boss spit up on it?) Yet people don't resist this massive

change-they volunteer for it.

In our lives, we embrace lots of big changes-not only ba­

bies, but marriages and new homes and new technologies and

new job duties. Meanwhile, other behaviors are maddeningly in­

tractable. Smokers keep smoking and kids grow fatter and your

husband can't ever seem to get his dirty shirts into a hamper.

So there are hard changes and easy changes. What distin­

guishes one from the other? In this book, we argue that success­

ful changes share a common pattern. They require the leader of

the change to do three things at once. We've already mentioned

one of those three things: To change someone's behavior, you've

got to change that person's situation.

,"ree :Jurprl5e5 ADOUt "nange

The situation isn't the whole game, of course. You can send an

alcoholic to rehab, where the new environment will help him go

dry. But what happens when he leaves and loses that influence?

You might see a boost in productivity from your sales reps when

the sales manager shadows them, but what happens afterward

when the situation returns to normal? For individuals' behavior

to change, you've got to influence not only their environment

but their heartS and minds.

The problem is this: Often the heart and mind disagree. Fer­

vently.

4.

Consider the Clocky, an alarm clock invented by an MIT stu­

dent, Gauri Nanda. It's no ordinary alarm clock-it has wheels.

You set it at night, and in the morning when the alarm goes off,

it rolls off your nightstand and scurries around the room, forcing

you to chase it down. Picture the scene: You're crawling around

the bedroom in your underwear, stalking and cursing a runaway

clock.

Clocky ensures that you won't snooze-button your way to di­

saster. And apparently that's a common fear, since about 35,000 units were purchased, at $50 each, in Clocky's first two years on the market (despite minimal marketing).

The success of this invention reveals a lot about human psy­

chology. What it shows, fundamentally, is that we are schizo­

phrenic. Part of us-our rational side-wants to get up at 5:45 a.m., allowing ourselves plenty of time for a quick jog before we

leave for the office. The other part of us-the emotional side­

wakes up in the darkness of the early morning, snoozing inside

a warm cocoon of sheets and blankets, and wants nothing in the

world so much as a few more minutes of sleep. If, like us, your

6 T h r e e S u r p r i s e s A b o u t C h a n g e

emotional side tends to win these internal debates, then you

might be a potential Clocky customer. The beauty of the device

is that it allows your rational side to outsmart your emotional

side. It's simply impossible to stay cuddled up under the covers

when a rogue alarm clock is rolling around your room.

Let's be blunt here: Clocky is not a product for a sane species.

If Spock wants to get up at 5:45 a.m., he'll just get up. No drama required.

Our built-in schizophrenia is a deeply weird thing, but we

don't think much about it because we're so used to it. When

we kick off a new diet, we toss the Cheetos and Oreos out of the

pantry, because our rational side knows that when our emotional

side gets a craving, there's no hope of self-control. The only op­

tion is to remove the temptation altogether. (For the record, some

MIT student will make a fortune designing Cheetos that scurry

away from people when they're on a diet.)

The unavoidable conclusion is this: Your brain isn't of one

mind.

The conventional wisdom in psychology, in fact, is that the

brain has two independent systems at work at all times. First,

there's what we called the emotional side. It's the part of you that

is instinctive, that feels pain and pleasure. Second, there's the ra­

tional side, also known as the reflective or conscious system. It's

the part of you that deliberates and analyzes and looks into the

future.

In the past few decades, psychologists have learned a lot about

these two systems, but of course mankind has always been aware

of the tension. Plato said that in our heads we have a rational

charioteer who has to rein in an unruly horse that "barely yields

to horsewhip and goad combined." Freud wrote about the selfish

id and the conscientious superego (and also about the ego, which

8 T h r e e S u r p r i s e s A b o u t C ha n g e

plan, to think beyond the moment (all those things that your pet

can't do).

But what may surprise you is that the Elephant also has enor­

mous strengths and that the Rider has crippling weaknesses. The

Elephant isn't always the bad guy. Emotion is the Elephant's

turf-love and compassion and sympathy and loyalty. That fierce

instinct you have to protect your kids against harm-that's the

Elephant. That spine-stiffening you feel when you need to stand

up for yourself-that's the Elephant.

And even more important if you're contemplating a change, the . Elephant is the one who gets things done. To make progress toward

a goal, whether it's noble or crass, requires the energy and drive of

the Elephant. And this strength is the mirror image of the Rider's

great weakness: spinning his wheels. The Rider tends to overana­

lyze and overthink things. Chances are, you know people with Rider

problems: your friend who can agonize for twenty minutes about

what to eat for dinner; your colleague who can brainstorm about

new ideas for hours but can't ever seem to make a decision.

If you want to change things, you've got to appeal to both.

The Rider provides the planning and direction, and the Elephant

provides the energy. So if you reach �he Riders of your team but

not the Elephants, team members will have understanding with­

out motivation. If you reach their Elephants but not their Riders,

they'll have passion without direction. In both cases, the flaws

can be paralyzing. A reluctant Elephant and a wheel-spinning

Rider can both ensure that nothing changes. But when Elephants

and Riders move together, change can come easily.

5.

When Rider and Elephant disagree about which way to move,

you've got a problem. The Rider can get his way temporarily-he

Thr e e S u r p r i s e s A b o u t C ha n g e 9

can tug on the reins hard enough to get the Elephant to submit.

(Anytime you use willpower you're doing exactly that.) But the

Rider can't win a tug-of-war with a huge animal for long. He sim­

ply gets exhausted.

To see this point more clearly, consider the behavior of some

college students who participated in a study about "food

perception" (or so they were told). They reported to the lab a bit

hungry; they'd been asked not to eat for at least three hours

beforehand. They were led to a room that smelled amazing­

the researchers had just baked chocolate-chip cookies. On a

table in the center of the room were two bowls. One held a

sampling of chocolates, along with the warm, fresh-baked

chocolate-chip cookies they'd smelled. The other bowl held a

bunch of radishes.

The researchers had prepped a cover story: We've selected

chocolates and radishes because they have highly distinctive

tastes. Tomorrow, we'll contact you and ask about your memory

of the taste sensations you experienced while eating them.

Half the participants were asked to eat two or three cookies

and some chocolate candies, but no radishes. The other half were

asked to eat at least two or three radishes, but no cookies. While

they ate, the researchers left the room, intending, rather sadisti­

cally, to induce temptation: They wanted those poor radish-eaters

to sit there, alone, nibbling on rabbit food, glancing enviously at

the fresh-baked cookies. (It probably goes without saying that the

cookie-eaters experienced no great struggle in resisting the rad­

ishes.) Despite the temptation, all participants ate what they were

asked to eat, and none of the radish-eaters snuck a cookie. That's

willpower at work.

At that point, the "taste study" was officially over, and another

group of researchers entered with a second, supposedly unrelated

study: We're trying to find who's better at solving problems,

10 T h r e e S u r p r i s e s A b o u t C h a n g e

college students or high school students. This framing was in­

tended to get the college students to puff out their chests and

take the forthcoming task seriously.

The college students were presented with a series of puzzles that

required them to trace a complicated geometric shape without re­

tracing any lines and without lifting their pencils from the paper.

They were given multiple sheets of paper so they could try over

and over. In reality, the puzzles were designed to be unsolvable.

The researchers wanted to see how long the college students would

persist in a difficult, frustrating task before they finally gave up.

The "untempted" students, who had not had to resist eating

the chocolate-chip cookies, spent nineteen minutes on the task,

making thirty-four well-intentioned attempts to solve the prob­

lem.

The radish-eaters were less persistent. They gave up after only

eight minutes-less that:I half the time spent by the cookie­

eaters-and they managed only nineteen solution attempts. Why

did they quit so easily?

The answer may surprise you: They ran out of self·control. In

studies like this one, psychologists have discovered .that self­

control is an exhaustible resource. It's like doing bench presses at

the gym. The first one is easy, when your muscles are fresh. But

with each additional repetition, your muscles get more exhausted,

until you can't lift the bar again. The radish-eaters had drained

their self-control by resisting the cookies. So when their Ele­

phants, inevitably, started complaining about the puzzle task-its

too hard, it's no fun, we're no good at this-their Riders didn't have

enough strength to yank on the reins for more than eight min­

utes. Meanwhile, the cookie-eaters had a fresh, untaxed Rider,

who fought off the Elephant for nineteen minutes.

Self-control is an exhaustible resource. This is a crucial realiza­

tion, because when we talk about "self-control," we don't mean

T h r e e S u r p r i s e s A b o u t C h a n g e 1 1

the narrow sense of the word, as in the willpower needed to fight

vice (smokes, cookies, alcohol) . We're talking about a broader

kind of self-supervision. Think of the way your mind works when

you're giving negative feedback to an employee, or assembling a

new bookshelf, or learning a new dance. You are careful and de­

liberate with your words or movements. It feels like there's a su­

pervisor on duty. That's self-control, too.

Contrast that with all the situations in which your behavior

doesn't feel "supervised"-for instance, the sensation while you're

driving that you can't remember the last few miles of road, or the

easy, unthinking way you take a shower or make your morning

coffee. Much of our daily behavior, in fact, is more automatic

than supervised, and that's a good thing because the supervised

behavior is the hard stuff. It's draining.

Dozens of studies have demonstrated the exhausting nature of

self-supervision. For instance, people who were asked to make

tricky choices and trade-offs-such as setting up a wedding reg­

istry or ordering a new computer-were worse at focusing and

solving problems than others who hadn't made the tough choices.

In one study, some people were asked to restrain their emotions

while watching a sad movie about sick animals. Afterward, they

exhibited less physical endurance than others who'd let the tears

flow freely. The research shows that we burn up self-control in a

wide variety of situations: managing the impression we're making

on others; coping with fears; controlling our spending; trying to

focus on simple instructions such as "Don't think of a white

bear"; and many, many others.

Here's why this matters for change: When people try to

change things, they're usually tinkering with behaviors that have

become automatic, and changing those behaviors requires care­

ful supervision by the Rider. The bigger the change you're sug­

gesting, the more it will sap people's self-control.

1 2 Thr e e S u r p r i s e s A b o u t C h a n g e

And when people exhaust their self-control, what they're ex­

hausting are the mental muscles needed to think creatively, to

focus, to inhibit their impulses, and to persist in the face of frus­

tration or failure. In other words, they're exhausting precisely the

mental muscles needed to make a big change.

So when you hear people say that change is hard because peo­

ple are lazy or resistant, that's j ust Rat wrong. In fact, the oppo­

site is true: Change is hard because people wear themselves out.

And that's the second surprise about change: What looks like lazi­

ness is often exhaustion.

6.

Jon Stegner believed the company he worked for, a large manu­

facturer, was wasting vast sums of money. "I thought we had an

opportunity to drive down purchasing costs not by 2 percent but by something on the order of $1 billion over the next five years, "

said Stegner, who i s quoted in John Kotter and Dan Cohen's es­

sential book The Heart of Change.

To reap these savings, a big process shift would be required,

and for that shift to occur, Stegner knew that he'd have to con­

vince his bosses. He also knew that they'd never embrace such a

big shift unless they believed in the opportunity, and for the most

part, they didn't.

Seeking a compelling example of the company's poor pur­

chasing habits, Stegner assigned a summer student intern to in­

vestigate a single item-work gloves, which workers in most of

the company's factories wore. The student embarked on a mission

to identify all the types of gloves used in all the company's facto­

ries and then trace back what the company was paying for them.

The intrepid intern soon reported that the factories were

T h r e e S u r p r i s e s A b o u t C h a n g e 13

purchasing 424 different kinds of gloves! Furthermore, they were

using different glove suppliers, and they were all negotiating their

own prices. The same pair of gloves that cost $5 at one factory

might cost $17 at another.

At Stegner's request, the student collected a specimen of every

one of the 424 different types of gloves and tagged each with the

price paid. Then all the gloves were gathered up, brought to the

boardroom, and piled up on the conference table. Stegner invited

all the division presidents to come visit the Glove Shrine. He re­

called the scene:

What they saw was a large expensive table, normally

clean or with a few papers, now stacked high with

gloves. Each of our executives stared at this display for a

minute. Then each said something like, "We really buy

all these different kinds of gloves?" Well, as a matter of

fact, yes we do. "Really?" Yes, really. Then they walked

around the table .. . . They could see the prices. They

looked at two gloves that seemed exactly alike, yet one

was marked $3.22 and the other $10.55. It's a rare event

when these people don't have anything to say. But that

day, they just stood with their mouths gaping.

The gloves exhibit soon became a traveling road show, visit­

ing dozens of plants. The reaction was visceral: This is crazy. We're

crazy. And we've got to make sure this stops happening. Soon Steg­

ner had exactly the mandate for change that he'd sought. The

company changed its purchasing process and saved a great deal of

money. This was exactly the happy ending everyone wanted (ex­

cept, of course, for the glove salesmen who'd managed to sell the

$5 gloves for $17).

14 T h r e e 5 u r p r i 5 e 5 A b o u t e h a n 9 e

7.

Let's be honest: Most of us would not have tried what Stegner

did. It would have been so easy, so natural, to make a presenta­

tion that spoke only to the Rider. Think of the possibilities: the

spreadsheets, the savings data, the cost-cutting protocols, the rec­

ommendations for supplier consolidation, the exquisite logic for

central purchasing. You could have created a 12-tabbed Microsoft

Excel spreadsheet that would have made a tax accountant weep

with joy. But instead of doing any of that, Stegner dumped a

bunch of gloves on a table and invited his bosses to see them.

If there is such a thing as white-collar courage, surely this was

an instance.

Stegner knew that if things were going to change, he had to

get his colleagues' Elephants on his side. If he had made an ana­

lytical appeal, he probably would have gotten some supportive

nods, and the execs might have requested a follow-up meeting

six weeks later (and then rescheduled it). The analytical case was

compelling-by itself, it might have convinced Stegner's col­

leagues that overhauling the purchasing system would be an im­

portant thing to do . . . next year.

Remember that if you reach your colleagues' Riders but not

their Elephants, they will have direction without motivation.

Maybe their Riders will drag the Elephant down the road for a

while, but as we've seen, that effort can't last long.

Once you break through to feeling, though, things change.

Stegner delivered a jolt to his colleagues. First, they thought to

themselves, were crazy! Then they thought, we can fix this. Every­ one could think of a few things to try to fix the glove problem­

and by extension the ordering process as a whole. That got their

Elephants fired up to move.

We don't expect potential billion-dollar change stories to come

dressed up like this. The change effort was led by a single employee,

T h r e e S u r p ri s es A b o u t C h a n g e 1 5

with the able help of a summer intern. I t focused on a single prod­

uct. The scope of the presentation didn't correspond in any way to

the scope of the proposal. Yet Stegner's strategy worked.

That's the power of speaking to both the Rider and the

Elephant.

8.

It's tru� that an unmotivated Elephant can doom a change effort,

but let's not forget that the Rider has his own issues. He's a navel­

gazer, an analyzer, a wheel-spinner. If the Rider isn't sure exactly

what direction to go, he tends to lead the Elephant in circles. And

as we'll see, that tendency explains the third and final surprise

about change: What looks like resistance is often a lack of clarity.

Two health researchers, Steve Booth-Butterfield and Bill

Reger, professors at West Virginia University, were contemplating

ways to persuade people to eat a healthier diet. From past re­

search, they knew that people were more likely to change when

the new behavior expected of them was crystal clear, but unfor­

tunately, "eating a healthier diet" was anything but.

Where to begin? Which foods should people stop (or start)

eating? Should they change their eating behavior at breakfast,

lunch, or dinner? At home or in restaurants? The number of ways

to "eat healthier" is limitless, especially given the starting place

of the average American diet. This is exactly the kind of situation

in which the Rider will spin his wheels, analyzing and agonizing

and never moving forward.

As the two researchers brainstormed, their thoughts kept

coming back to milk. Most Americans drink milk, and we all

know that milk is a great source of calcium. But milk is also the

single largest source of saturated fat in the typical American's diet.

In fact, calculations showed something remarkable: If Americans

1 6 T h r e e S u r p r i s e s A b o u t C h a n g e

switched from whole milk to skim or 1 % milk, the average diet would immediately attain the USDA recommended levels of sat­

urated fat.

How do you get Americans to start drinking low-fat milk?

You make sure it shows up in their refrigerators. And that isn't

an entirely facetious answer. People will drink whatever is around

the house-a family will plow through low-fat milk as fast as

whole milk. So, in essence, the problem was even easier than an­

ticipated: You don't need to change drinking behavior. You need

to change purchasing behavior.

Suddenly the intervention became razor-sharp. What behav­

ior do we want to change? We want consumers to buy skim or

1 % milk. When? When they're shopping for groceries. Where?

Duh. What else needs to change? Nothing (for now).

Reger and Booth-Butterfield launched a campaign in two

communities in West Virginia, running spots on the local media

outlets (Tv; newspaper, radio) for two weeks. In contrast to the bland messages of most public-health campaigns, the 1 % milk campaign was punchy and specific. One ad trumpeted the fact

that one glass of whole milk has the same amount of saturated fat

as five strips of bacon! At a press conference, the researchers

showed local reporters a tube full of fat-the equivalent of the

amount found in a half-gallon of whole milk. (Notice the Ele­

phant appeals: They're going for an "Oh, gross!" reaction.)

Reger and Booth-Butterfield monitored milk sales data at all

eight stores in the intervention area. Before the campaign, the

market share of low-fat milk was 1 8 percent. After the campaign, it was 41 percent. Six months later, it held at 35 percent.

This brings us to the final part of the pattern that character­

izes successful changes: If you want people to change, you must

provide crystal-clear direction.

By now, you can understand the reason this is so important:

T h r e e S u r p ri s es A b o u t C h a n g e 17

It's so the Rider doesn't spin his wheels. If you tell people to "act

healthier," think of how many ways they can interpret that­

imagine their Riders contemplating the options endlessly. (Do I

eat more grains and less meat? Or vice versa? Do I start taking vi­

tamins? Would it be a good trade-off if! exercise more and bribe

myself with ice cream? Should I switch to Diet Coke, or is the ar­

tificial sweetener worse than the calories?)

What looks like resistance is often a lack of clarity. Before this study, we might have looked at these West Virginians and con­

cluded they were the kind of people who don't care about their

health. But if they were indeed "that kind" of people, why was it

so easy to shift their behavior?

If you want people to change, you don't ask them to "act

healthier." You say, "Next time you're in the dairy aisle of the gro­

cery store, reach for a jug of 1 % milk instead of whole milk."

9.

Now you've had a glimpse of the basic three-part framework we

will unpack i n this book, one that can guide you in any situation

where you need to change behavior:

• Direct the Rider. What looks like resistance is often a

lack of clarity. So provide crystal-clear direction. (Think

1 % milk.)

• Motivate the Elephant. What looks like laziness is

often exhaustion. The Rider can't g�t his way by force for

very long. So it's critical that you engage people's emo­

tional side-get their Elephants on the path and cooper­

ative. (Think of the cookies and radishes study and the

boardroom conference table full of gloves.)

1 8 T h r e e S u r p r i s e s A b o u t C h a n g e

• Shape the Path. What looks like a people problem is

often a situation problem. We call the situation (includ­

ing the surrounding environment) the "Path." When you

shape the Path, you make change more likely, no matter

what's happening with the Rider and Elephant. (Think

of the effect of shrinking movie popcorn buckets.)

We created this framework to be useful for people who don't

have scads of authority or resources. Some people can get their

way by fiat. CEOs, for instance, can sell off divisions, hire peo­

ple, fire people, change incentive systems, merge teams, and so

on. Politicians can pass laws or impose punishments to change be­

havior. The rest of us don't have these tools (though, admittedly,

they would make life easier: "Son, if you don't take out the trash

tonight, you're fired") . In this book, we don't talk a lot about these

structural methods.

As helpful as we hope this framework will be to you, we're well

aware, and you should be, too, that this framework is no panacea.

For one thing, it's incomplete. We've deliberately left out lots of

great thinking on change in the interests of creating a framework

that's simple enough to be practical. For another, there's a good

reason why change can be difficult: The world doesn't always want

what you want. You want to change how others are acting, but

they get a vote. You can cajole, influence, inspire, and motivate­

but sometimes an employee would rather lose his job than move

out of his comfortable routines. Sometimes the alcoholic will want

another drink no matter what the consequences. .

So we don't promise that we're going to make change easy,

but at least we can make it easier. Our goal is to teach you a frame­

work, based on decades of scientific research, that is simple

enough to remember and flexible enough to use in many differ­

ent situations-family, work, community, and otherwise.

T h r e e 5 u r p rj 5 e 5 A b o u t e h a n 9 e 19

To change behavior, you've got to direct the Rider, motivate

the Elephant, and shape the Path. If you can do all three at once,

dramatic change can happen even if you don't have lots of power

or resources behind you. For proof of that, we don't need to look

beyond Donald Berwick, a man who changed the face of health

care.

1 0.

In 2004, Donald Berwick, a doctor and the CEO of the Institute

for Healthcare Improvement (IHI), had some ideas about how to

save lives-massive numbers of lives. Researchers at the IHI had

analyzed patient care with the kinds of analytical tools used to

assess the quality of cars coming off a production line. They dis­

covered that the "defect" rate in health care was as high as 1 in

10-meaning, for example, that 10 percent of patients did not

receive their antibiotics in the specified time. This was a shock­

ingly high defect rate-many other industries had managed to

achieve performance at levels of 1 error in 1 ,000 cases (and often

far better) . Berwick knew that the high medical defect rate meant

that tens of thousands of patients were dying every year,

unnecessarily.

Berwick's insight was that hospitals could benefit from the

same kinds of rigorous process improvements that had worked

in other industries. Couldn't a transplant operation be "produced"

as consistently and flawlessly as a Toyota Camry?

Berwick's ideas were so well supported by research that they

were essentially indisputable, yet little was happening. He

certainly had no ability to force any changes on the industry.

IHI had only seventy-five employees. But Berwick wasn't

deterred.

On December 14, 2004, he gave a speech to a room full of

20 T h r e e 5 u r p rj 5 e 5 A b o ut e h a n 9 e

hospital administrators at a large industry convention. He said,

"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, 200� 18 months

from today. Some is not a number; soon is not a time. Here's the

number: 100,000. Here's the time: June 14, 200�9 a.m."

The crowd was astonished. The goal was daunting. But

Berwick was quite serious about his intentions. He and his tiny

team set out to do the impossible.

IHI proposed six very specific interventions to save lives. For

instance, one asked hospitals to adopt a set of proven procedures

for managing patients on ventilators, to prevent them from get­

ting pneumonia, a common cause of unnecessary death. (One of

the procedures called for a patient's head to be elevated between

30 and 45 degrees, so that oral secretions couldn't get into the

windpipe.)

Of course, all hospital administrators agreed with the goal to

save lives, but the road to that goal was filled with obstacles. For

one thing, for a hospital to reduce its "defect rate," it had to ac­

knowledge having a defect rate. In other words, it had to admit

that some patients were dying needless deaths. Hospital lawyers

were not keen to put this admission on record.

Berwick knew he had to address the hospitals' squeamish­

ness about admitting error. At his December 14 speech, he was

joined by the mother of a girl who'd been killed by a medical

error. She said, 'Tm a little speechless, and I'm a little sad, be­

cause I know that if this campaign had been in place four or five

years ago, that Josie would be fine . . . . But, I'm happy, I'm

thrilled to be part of this, because I know you can do it, because

you have to do it."

Another guest on stage, the chair of the North Carolina State

Hospital Association, said: "An awful lot of people for a long time

T h r e e S u r p r i s e s A b o u t C h a n g e 21

have had their heads in the sand on this issue, and it's time to do

the right thing. It's as simple as that."

IHI made joining the campaign easy: It required only a one­

page form signed by a hospital CEO.