If you have ever lost patients when you felt like you were offering them the best treatment anywhere, you may have wondered what went wrong. Was it you or them?
Maybe you have questioned what more you can do to motivate your patients to do what is in their best interests. Have you ever had a dental team member who had great potential but you just couldn’t get him or her to rise to it?
Perhaps you, the dentist, the manager and leader, would like to make some changes in the way you do things but just never quite get around to doing it? So the question is, how can you get yourself, the members of the dental team and patients to do what’s best for them?
Get ready for some of the latest discoveries from psychology, neuroscience and linguistics that might surprise you and help you implement strategies that increase the odds of effective, long-lasting and positive change in your practice.
First, let’s deal with some psychology. It would be natural to think that when people can see how a change in behaviour or alteration in lifestyle would be beneficial to them, they would simply make that change. But that is far from what normally happens.
Let’s say that you are notified by your medical doctor that if you don’t make some fundamental changes in the way you go about your daily life then your health is at serious risk. Would you change? Of course you would, or so you think.
However, the most recent research has found that the odds of changing are one in nine. In other words, in cases where change was a matter of life or death, only one in nine made long-term, sustained changes to his/her life pattern.
It is natural to think that this statistic doesn’t apply to dentistry. But dentistry is an important part of health care, and patient attitudes don’t change towards dentistry any more than they do towards other types of health care. According to Dr Raphael Levey, founder of the Global Medical Forum: ‘A relatively small percentage of the population consumes the vast majority of the health care budget for diseases that are very well known to be behavioural. That is to say that they are sick because of how they choose to live their lives, not because of environmental or genetic factors beyond their control.’
Think about it. You see it every day in your practice. How many patients who have periodontal disease really take effective action to make their health a priority?
Compare your answer to that question with the fact that 80% of people who have gum disease continue to live with it despite the mounting evidence of the dangers of living with such a condition. They resist changing their behaviour even by adopting the most basic of habits such as brushing and flossing every day.
So why don’t people change? Perhaps it is because some commonly used methods of motivation turn out to be myths. Here are some of them.
‘Crisis is a powerful impetus for change’. Whether there is the threat of death or a major financial crisis, most people quickly revert back to their set patterns of behaviour. That is why 90% of coronary bypass patients don’t make any long-term lifestyle changes. It is why 66% of patients who are given a prescription for statin drugs to reduce their cholesterol in order to avoid another heart-related problem have quit taking the drug within one year.
It is also why many lottery winners who have lived with lower income or near poverty most of their lives are broke within less than ten years of becoming phenomenally wealthy. Crisis may create a temporary change, but not likely a permanent one.
‘People can be motivated to change by fear’. It is easy to think that we can create images of catastrophic consequences to create behaviour change. But images alone rarely work. It is too easy to rationalise and justify our behaviour and go into denial about the bad things that might happen if we don’t change.
The cigarette companies print a warning on every packet of cigarettes that says that smoking will kill you. But people continue to smoke because they don’t have any immediate evidence that the warning is valid. After all, the smoking didn’t kill them. They are still alive… for now!
Here is another factor that enters the fear motivation picture. In the face of overwhelming evidence, psychologists have concluded that there is a comfort factor that enters the picture, which is related to fear motivation. It is related to the typical patient who is told: ‘You must make these lifestyle changes or you will die’.
That is similar to the notice printed on the cigarette packages. Every morning the patient gets up and tells him or herself: ‘I have to do this or I’m going to die’. It only takes a few days before subconsciously the patient realises that an existence where death is always on the mind is not a pleasant experience. So the focus is changed, often causing the individual to revert back to old behaviours that feel more comfortable than the new behaviours that remind him/her of unpleasant things.
‘People can be motivated by education’. This myth would lead us to believe that education will change behaviour. This one of the great half-truths in dentistry. How often have you heard: ‘Educate patients and they will do what is in their best interests’? Yet how often have you educated your patients and they did nothing or even the opposite of what you advised? Surely education is important – after all, people don’t look for solutions to problems they don’t think they have. We have to know we have a problem if we are going to act.
But if education was the answer, and the only answer to making change happen, there would not be any fat physicians who smoke! Do they know better? Yes! Have they read all the scientific evidence to the contrary? Yes! But despite the facts, they continue engaging in life threatening behaviour. Education, or the facts, alone do not create long-term change.
‘Incremental or small gradual baby steps are easier to make and easier to sustain.’ Wrong again! This is a fact that even the most disciplined person may overlook. There is a fundamental ingredient that makes long-term change happen that is missing in this commonly held myth. It is that small changes rarely yield sufficient noticeable results to hold our attention.
If the benefit that we see and feel is not big enough, we rarely sustain the behaviour. It is too easy to rationalise away even subconsciously when we begin to wonder if what we are doing is really making any significant difference. Consider, for example, how many times the average person has resolved to cut back on sweets in their diet.
How do you quantify that decision? How much are you really going to cut back? Then, in the heat of the moment, the rational brain kicks in and tells us that it won’t hurt to slip this once. After all, it is just a little thing and the present course isn’t really making much difference anyway. It is no big deal.
While small changes may be easier to implement, they are harder to sustain because we don’t internalise their importance in our lives and there is very little evidence of results. After making one little exception after another, we are soon back to our old routine.
‘You can’t teach an old dog new tricks’. This is the myth that says we can’t change because our brains have become ‘hardwired’ in earlier days. You’ve heard this myth perpetuated often by people who say ‘that’s just the way I am’ as if they were a hopeless case. The reality is that neuroscience has proven that our brains have enormous growth potential during our entire lives, not just when we are young.
We can continue learning new things and forming new habits, provided we continue to stay mentally engaged and active throughout our lives. It is only when the brain is no longer exercised that the ‘new tricks’ aren’t learned.
The biggest challenge
These are just some of the myths that prevent us from changing our own behaviour and/or the behaviour of our dental team members and patients. Changing attitudes is not only the biggest challenge in health care, it is the most important. In order to compete and have a profitable practice, you have to grow people along with it. The central issue in helping people to grow is helping them to change.
John Kotter, professor at The Harvard Business School who has studied how many organisations when managed during turbulent times, said: ‘The central issue is never strategy, structure, culture or systems. The core of the matter is always about changing the behaviour of people.’ Change in the marketplace requires a change in how we approach the market. It requires a change in our behaviour.
In planning for any type of change in your own patterns, and/or those of your dental team and patients, make sure you avoid the myths of change. They don’t produce long-term results. There is, however, a better way; a way you will discover in my next article.