From Conviction to Volition

Austrian physician Ignaz Semmelweis discovered in the 1850’s that hand washing was the number one means of preventing the spread of infection between care providers and their patients. The Centers for Disease Control and Prevention, Centers for Disease Control and Prevention Foundation reports 160 years later, in the United States, nearly 100,000 patient deaths occur annually as a result of hospital-acquired infection. Private organizations, advocates, and public health entities spend countless hours and dollars to provide training and literature on the benefits of hand washing. Yet, until the recent pandemic, many health care professionals continued to disregard these hand washing protocols. In fact, prior to the pandemic, studies indicated that health care providers were more likely to wash their hands when leaving a patient’s room rather than entering the patient’s room. This variance reflects that health care workers, prior to the pandemic, were more concerned about transmission of infection from the patient to themselves than they were about transmitting infection to the patient.

The simple practice of hand washing indicates that knowledge alone does not compel people to change behaviour, even when they have been educated repeatedly about what to do and how to do it. Innovative thinking alone does not compel people into new practices. People must behave their way into a new way of thinking. It is action innovation, not thinking innovation that makes the difference to improving patient care outcomes in safety, quality and the service experience of care. Hand washing during the pandemic is a prime example.

So what makes people who possess knowledge about what they need to do actually change their behaviour? The answer is volition- a purposeful, intentional choice. People choose to change their behaviour when they have a compelling interest to do so. Sometimes the reason for such a decision boils down to dissatisfaction or unhappiness with the status quo; the consequences of not changing are too hurtful or unpalatable. Richard Beckhard and Rubin Harris offer this classic equation regarding change resistance: Dissatisfaction is an emotional reaction that is so negative it prevents a person from continuing routine or usual functioning.

Although it is a negative experience, dissatisfaction provides a motivation to change. Desirability is the emotional reward for making a change. It is the “what is in it for me” driver. Practicality is the realistic, attainable, and emotional acceptance of the change. Keep in mind that when it comes to behaviour and brain we are talking biology not psychology. f-MRI studies show beliefs are generated by complex recurrent firing of patterns of neurons accompanied by subtle but very specific changes in hormones and neurotransmitters.

This brain activity is developed by experience and linked to the feelings that the experience engenders. In other words, our brains are hardwired by experience and feelings about dissatisfaction, desirability, and practicality. The stronger the positive or negative feeling and the more frequent the experience, the more we become hardwired to behave the way we do. To change behaviour you almost always must first use experience to change beliefs. A person must be convinced that the change will improve their personal performance, outcomes, and workplace satisfaction. Honing your skill of Positive Presence creates the mindset that will easily allow you to change beliefs, feelings and your behaviour.