Today I'm standing in my laboratory. We perform immunology research here. Why am I standing in an immunology lab, you ask? Because today I want to talk to you about immunity to change. Just as our immune system blocks invading pathogens, mental immunity to change blocks the uptake of new ideas. For many decades it was assumed that you can't teach an old dog new tricks. The prevailing wisdom was, that as we all get older, our brains no longer have the capacity to learn new things. However, modern neuroscience has revealed that throughout life, our brain continues to break down and re-form connections called synapses, and these synapses create new long-term memories. Neuroscientists have discovered that neuroplasticity persists throughout life. Therefore, you can teach an old dog like me new tricks. However, many of us have oversimplified our world, and when it comes to healthcare there is a mismatch between the simplistic, Marcus Welby lone practitioner mental model of healthcare, and the true complexity of modern healthcare. It has been suggested that many of us do not significantly change our view of the world after we exceed the age of 30. Why do so many people fail to adapt and change? Well, it turns out it's not about our brains neural connections, but rather about the creation of filters that filter out discordant facts that don't fit with our underlying assumptions. Thanks to these filters, we fail to take in important new information. We become immune to change. In order to overcome these underlying assumptions that are preventing realistic adaptation, we need to overcome our immunity to change by looking at, not through, our mental filters. Our inability to adapt is analogous to an overly active immune system. In autoimmune diseases, our immune system attacks our joints, and in Mary's case, her nerves and other organs in the body, causing harm. Immunity to change does the same thing by preventing us from adapting to prevailing complexity. To overcome our personal resistance to adaptive change, we need to create personal plan, do, study, act cycles that include our underlying assumptions. These diagrams will allow us to to psychoanalyze our own motives and to question the underlying assumptions that hold many of us back. By acting in ways that contradict our assumptions, we can change. However, just as we discussed in our section on adaptive leadership, acting in a new way will cause emotional stress. However, repeating this new action dissipates stress, and generally after three times, the new way of acting will no longer be as stressful. Let's look at an example. As a patient, you are interested in improving patient care. You resolve to become an active participant on a hospital quality improvement team. You are an inherently shy person. You are fearful of interacting with physicians and you are a person who values getting along with others. These are your hidden commitments or the secondary drivers that will drive you to procrastinate in accepting the invitation to join the approving team. To fail to speak out at a meeting and, when you do speak, to avoid disagreements with others, all of these actions or inactions represent the primary drivers that will interfere with you becoming a member of the quality improvement team, sharing your perspective, and at times, disagreeing with other team members. Knowing your previous history and tendencies, you can predict your behaviors. But how can you change them? Many of us make New Year's resolutions to improve a personal or a physical trait, but how often do we succeed? Just as leaders mistakenly apply technical solutions to solve adaptive problems in their organizations, we make the same mistake when trying to achieve personal adaptive change. Simply resolving to follow a list of expected or ideal behaviors represents a technical solution that is unlikely to achieve your goal. By examining the underlying assumptions, you realize that you are fearful of interacting with physicians because, as a child, you had a number of unpleasant experiences with a pediatrician, and concluded that the best way to prevent being poked and prodded was to remain silent. This is a somewhat irrational assumption that has never been directly confronted. Similarly, you now realize that your intrinsic shyness was an adaptation to your childhood environment, where your overbearing, strict parents repeatedly warned that children should speak when spoken to. And finally, you now realize that your eagerness to agree with others stem from an assumption that disagreement would result in a loss of popularity and friendship. Each of these assumptions needs to be challenged by actions and each action followed by self reflection. You attend the first meeting and plan to speak in response to the input of the physician on the committee. This action will create significant inward emotional stress, but is unlikely to illicit a negative response on the part of any of the team members, including the physician. A self-reflective view of this data will allow you to question your underlying assumptions and encourage you to act again. By repeating the plan, do, study, act cycle three times, the emotional response to the actions that contradicted your assumptions will extinguish, and you will have corrected your overly active mental immune system and achieved a personal adaptive change. Let's return to Roger's Innovation Diffusion Curve that we talked about in week six. The early adopters are the key to change, and this population is uniquely open to innovative changes. When trying to implement an improvement, this is the population to recruit for the first initiative. How can we identify these individuals? Unfortunately, this group has not been very thoroughly studied in healthcare. However, a large body of research is available in agriculture. Investigators have examined which farmers first adopted new hybrid crops, fertilizers, and sprays in Iowa and Ohio. Others have examined adoption of new farming methods in Colombia and other developing countries. These investigations have revealed nearly identical results. Early adopters are respected leaders in their communities. Early adopters can be of any age, fitting with the studies of neuroplasticity, but do tend to have a higher level of education, are more intelligent, have a better abstraction capability, have a higher tolerance for uncertainty, and demonstrate greater empathy. In other words, they are able to view through the eyes of others. Consistent with their higher level of education, they usually have greater access to multi-media and are more traveled. Given the problems we are all encountering in healthcare, you should aspire to be an early adopter, and challenge your underlying assumptions. As an early adopter, you will embrace innovation and change, and you will develop a tolerance for uncertainty. By trying a new way of doing things three times, you can reduce your discomfort, and you can be the change we need. Our future and the future of our children are depending on you. Thank you.
