Influencer: The Power to Create Sustainable Results by Changing Behaviors

David Maxfield, for HealthLeaders Media, February 8, 2008

When it comes to influence, we stink. Consider a few examples:

  1. Dieters spend $40 billion a year and 19 out of 20 lose nothing but their money (National Eating Disorders Association)
  2. 70 percent of smokers quit and then resume in less than 12 months (American Heart Association)
  3. Two years after receiving life-saving coronary bypass surgery, 90 percent of patients are back to old behaviors (Edward Miller, Johns Hopkins University)
If influence is the capacity to help ourselves and others change our behavior, then it is clearly one of the most vital and most unavailable capacities in the world. We all want influence but few know how to get it.

Fortunately for us in the healthcare profession, we can count two of the most gifted influencers in the world as colleagues: Donald Berwick MD, the founder of the Institute for Healthcare Improvement; and Donald Hopkins MD, associate executive director at the Carter Center.

Berwick and his team led the 100,000 Lives Campaign-a campaign that in 18 months saved more than 122,000 lives in US hospitals by influencing the behavior of healthcare professionals. Hopkins and his team reduced Guinea Worm disease by more than 99 percent by influencing the behavior of 100 million villagers across 20 different nations.

Both of these master influencers used the same powerful principles-principles that are honest, non-manipulative and effective. These are tools that anyone can use to solve problems that involve changing behavior-whether it's your own behavior or that of others.

The key to successful influence lies in three principles:

  1. Find Vital Behaviors. Identify a handful of high-leverage behaviors that lead to rapid and profound change.
  2. Change How You Change Minds. Use personal and vicarious experience to change thoughts and actions.
  3. Over-determine change. Marshall multiple sources of influence to make change inevitable.

Find Vital Behaviors. The first step to any successful influence strategy is to decide what you're trying to change. There are three big ideas here:

Focus on behaviors. Don't even begin to develop your influence strategy until you've carefully identified the behaviors that need to change. Interventions, such as courses, reorganizations, and new equipment should only be considered after you've determined the behaviors that will lead to success.

The right few behaviors can drive a lot of change. Successful change agents don't spread their efforts across many priorities. They understand that profound change requires a precise focus. For example, Don Berwick focused on six behaviors to create safer hospitals and Don Hopkins focused on three to eliminate the guinea worm.

Validate these vital behaviors as you move forward. Don't assume you've found the right few behaviors. Track the behaviors and results. Make adjustments as you determine which behaviors are most effective.

Change How You Change Minds. Changing behavior requires changing minds. People base their actions on two critical beliefs: "Can I do it?" and "Will it be worth it?" Unless you can change these beliefs you won't change much behavior.

The vast majority of attempts to influence these beliefs rely on various forms of verbal persuasion. But the evidence is clear that verbal persuasion doesn't work, at least not with the kinds of profound, persistent and resistant problems that most of us care about.

Personal experience is the gold standard for changing beliefs. It's far more convincing to show than it is to tell. Create a pilot, take people on field trips, or otherwise immerse them in a safe version of the experience. Don Hopkins brings political, military and village leaders to villages that have conquered the Guinea Worm. Seeing for themselves the improvements that are possible brings hope and resolve that can never come through a PowerPoint presentation.

Over-determine Change with Multiple Sources of Influence. When trying to influence persistent and resistant behaviors, don't ask, "What's the least I can do to influence change?" Instead ask, "How do I over-determine the behavior with every possible source of influence?"

Persistent problems don't stem from a single cause; they persist because they are supported in multiple ways. Successful influencers scrutinize every system that supports the status quo, and then proceed by turning each system on its head. In short, they leverage a number of powerful influence strategies to solve the same few vital behaviors.

For example, both Don Berwick and Don Hopkins use a rich mix of incentives, social support, education, peer pressure, recognition, structural change and moral appeals. At the end of the day, it's no surprise they achieve remarkable success. In fact, by targeting multiple sources of influence, they make success inevitable.

Using these influence tools, you can solve any problem that requires changing behavior. From the simplest aggravations to the most persistent, resistant, and profound problems, positive change is within your reach.

David Maxfield is the co-author of the New York Times bestseller, Influencer: The Power to Change Anything. He is also a sought-after speaker and consultant and leading research at VitalSmarts, an innovator in corporate training and organizational performance.
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