How do they get birds out of Costco?
My kids love to see birds fly around the warehouse. Costco must hate it.
No doubt, birds in Costco break a list of public health rules.
There are three ways to get birds out of a warehouse: kill them, trap them, or encourage behavioural change (see more here and here).
The first two options offer military solutions: dispatch or take custody. Neither approach works well with humans, outside of war or totalitarian control. Does government know this?
Behavioural Change
All leaders work to influence behavioural change. Everything else that they do is wasted effort or should be done by someone else.
Leaders work to change behaviour, not to write policy manuals, discipline protocols, or to file reports to regulators.
Leaders must understand behavioural change, or they are not leaders.
People in positions of leadership often do not understand what they are supposed to do and have no idea how to get it done.
Impossible to Manage
Humans find ways to break rules and turn the most well-intentioned incentives into perverse behaviours.
We can follow the letter of the law but deny its spirit.
We cannot be forced to act, any more than we can think or believe as instructed.
Humans are frustratingly free and complex.
Only people with damaged brains think, believe, and act exactly as told.
Given people’s tendency to make up their own minds, how can leaders change behaviour?
Not Rocket Science
It’s actually quite simple, if we think like a pre-teen. How does an older sister get her brother to play along with something he does not want to do?
She could offer a bribe, but that often ends poorly.
Her brother is young, not stupid. The bribe becomes a quest. He will anchor on the bribe and negotiate to the death. His sister will sacrifice more than she hoped for, or abandon the task.
Every older sister figures out how to manger her younger brother shortly after she learns how to skip rope. If we asked, she would tell us:
First, you need to catch your brother’s interest. Show him something shiny or dangerous.
Then, build on the excitement and invite him into relationship. Hint at the opportunity for more, bigger, shiny things: This sets the hook.
Invite him on a quest. Build a description of the destination together, in vivid detail. Let him shape what the destination looks like to him.
Set him loose with a title and a mission to accomplish.
Then, work together, offering encouragement and praise until the job is done. Remind him of how fun this quest was the next time you need him to do something.
Doesn’t government know this? They find doctors impossible to manage because they forget the basics. They should try to the following:
Catch doctors’ interest: show them an opportunity to fix a patient care problem that frustrates doctors, not accountants or Ministers of Finance.
Build on the interest by fostering relationship. Hint at the opportunity to solve bigger problems together.
Invite doctors on a quest. Let doctors shape and define the destination together with government.
Empower doctors to tackle the quest. Encourage them. Give them the materials they need to get the job done.
Work alongside doctors until the job is finished.
Offer praise liberally. Hint at the next exciting job to tackle.
Is this too simplistic? Probably, but that’s the point. It’s so simple that doctors can see what’s going on. Politicians should want doctors to see through what government is doing and get excited about it.
Politicians need to build trust with dozens of small projects before trying to change all of primary care at once, with something like Bill 210 (see Will Medicine Survive in Ontario).
Entice Change
Birds fly out of Costco when someone attracts the birds to leave. The only other way is to trap or kill them.
Government, regulators, and system managers need to take a new approach to ‘managing’ physicians. Regulatory and legislative traps do not work. System leaders cannot manage doctors like the military. They must entice docs to change. All other options kill doctors’ professional spirit.
photo credit: pbs.org
