[...] many patients could avoid the return of pain and the need to repeat the surgery -- not to mention arrest the course of their disease before it kills them -- by switching to healthier lifestyles. Yet very few do. "If you look at people after coronary-artery bypass grafting two years later, 90% of them have not changed their lifestyle, [...] Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason, they can't."
The conventional wisdom says that crisis is a powerful motivator for change. But severe heart disease is among the most serious of personal crises, and it doesn't motivate -- at least not nearly enough. [...] What is it about how our brains are wired that resists change so tenaciously? Why do we fight even what we know to be in our own vital interests?
Kotter has hit on a crucial insight. "Behavior change happens mostly by speaking to people's feelings," he says. [...] In highly successful change efforts, people find ways to help others see the problems or solutions in ways that influence emotions, not just thought."
Unfortunately, that kind of emotional persuasion isn't taught in business schools, and it doesn't come naturally to the technocrats [...] who pride themselves on disciplined, analytical thinking.
[Dr. Dean] Ornish published studies [...] showing that his holistic program, focused around a vegetarian diet [...] can actually reverse heart disease without surgery or drugs. [...] Researchers took 333 patients with severely clogged arteries. They helped them quit smoking and go on Ornish's diet. The patients attended twice-weekly group support sessions led by a psychologist and took instruction in meditation, relaxation, yoga, and aerobic exercise. The program lasted for only a year. But after three years, the study found, 77% of the patients had stuck with their lifestyle changes -- and safely avoided the bypass or angioplasty surgeries that they were eligible for under their insurance coverage. And Mutual of Omaha saved around $30,000 per patient.
[...] For a few weeks after a heart attack, patients were scared enough to do whatever their doctors said. But death was just too frightening to think about, so their denial would return, and they'd go back to their old ways.
[...] instead of trying to motivate them with the "fear of dying," Ornish reframes the issue. He inspires a new vision of the "joy of living" -- convincing them they can feel better, not just live longer. That means enjoying the things that make daily life pleasurable, like making love or even taking long walks without the pain caused by their disease. "Joy is a more powerful motivator than fear," he says.
[...] George Lakoff, a professor of those two disciplines at the University of California at Berkeley, defines frames as the "mental structures that shape the way we see the world." Lakoff says that frames are part of the "cognitive unconscious [...]
The big challenge in trying to change how people think is that their minds rely on frames, not facts. "Neuroscience tells us that each of the concepts we have -- the long-term concepts that structure how we think -- is instantiated in the synapses of the brain," Lakoff says. "Concepts are not things that can be changed just by someone telling us a fact. We may be presented with facts, but for us to make sense of them, they have to fit what is already in the synapses of the brain. Otherwise, facts go in and then they go right back out. They are not heard, or they are not accepted as facts, or they mystify us: Why would anyone have said that? Then we label the fact as irrational, crazy, or stupid." [...]
Reframing alone isn't enough, of course. That's where Dr. Ornish's other astonishing insight comes in. Paradoxically, he found that radical, sweeping, comprehensive changes are often easier for people than small, incremental ones. For example, he says that people who make moderate changes in their diets get the worst of both worlds: They feel deprived and hungry because they aren't eating everything they want, but they aren't making big enough changes to quickly see an improvement in how they feel, or in measurements such as weight, blood pressure, and cholesterol. But the heart patients who went on Ornish's tough, radical program saw quick, dramatic results, reporting a 91% decrease in frequency of chest pain in the first month. "These rapid improvements are a powerful motivator," he says. "When people who have had so much chest pain that they can't work, or make love, or even walk across the street without intense suffering find that they are able to do all of those things without pain in only a few weeks, then they often say, 'These are choices worth making.' "
While it's astonishing that most patients in Ornish's demanding program stick with it, studies show that two-thirds of patients who are prescribed statin drugs (which are highly effective at cutting cholesterol) stop taking them within one year. What could possibly be a smaller or easier lifestyle change than popping a pill every day? But Ornish says patients stop taking the drug because it doesn't actually make them feel any better. It doesn't deal with causes of high cholesterol, such as obesity, that make people feel unhealthy. The paradox holds that big changes are easier than small ones.
This is why I think that an incremental approach to adopting agile practices is less likely to work: people who make partial changes in their work environment can get the "worst" of the agile and non-agile work experiences instead of seeing improvements; it will not encourage them to go further with adopting new practice.
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