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“Culture eats strategy.”

      — Peter Drucker


Culture eats strategy. Indeed, this often repeated phrase has it right. But even organizations with the best of intentions and the most enviable cultures struggle with change. We know it’s true, yet in spite of that knowledge, our companies, departments, and teams still get stuck.

Change is a struggle, particularly when we’re talking about change at an organizational level. Implementing personal change is tough enough—but when we have to do it for an entire staff, it is a chore. The prevailing sentiment? "Just leave me alone and let me get my work done." When asked recently about an implemented change, my colleagues used these terms: "exhausting," "annoying," "a waste," "stressful," “pointless,” “ ineffective," and, “it’d be okay if it worked.” Those implementing the change had similar feelings: “why don’t they get it," "it’s not that hard," "why is everything such a big deal,” and, "we just have to do it!”


As I think about it now, it isn’t too hard to see where both sides come off in voicing their frustration.


Some years ago, the hospital I was working in had a big problem with the flow of charts and documents. As is still true in many emergency departments, a full transition to computerization had been elusive, and we were still relying on paper for much of our work. I came up with a novel way to organize the flow of charts as a patient moved through their course of care. I even stayed three hours late one evening on my own time to rearrange the system. Staff curiously watched as I made the changes; several thought it was a good idea and offered their support.

Driving home that evening, I could hardly contain my excitement. The prospect of a more efficient and effective layout that would save time and fix the frustration and hassle we dealt with each and every shift was just too good to be true. The next day I was eager to go back to work. I had not felt like that in a long while. But as I rounded the corner into the central station, my

anticipation collapsed. Everything was changed back to the old setup. I was convinced the new change would be a real improvement in everyone’s work life, but now we’d never find out. No one said a word, and the idea never came up again.


I was shattered.

Later, I thought about this experience and started asking questions. Where did I go wrong? What had I missed? Had I aimed too high? What was wrong with everyone? Was it even possible to implement change within my department, or was it a waste of time to try? To my disappointment, one answer was clear: a really good solution alone was not enough. I was back to the drawing board.

This effort at change may have failed, but I came across other instances that suggested otherwise. Change is possible, even at a global scale. In a 2007 BBC Reith lecture entitled ‘Bursting At The Seams,’ Jeffrey Sachs used the 1987 international agreement known as the Montreal Protocol to describe how effective change happens.


The Montreal Protocol, an international treaty that banned the use of chlorofluorocarbons (CFCs), was put forth for ratification in September 1985. In just sixteen months, by January 1987, nearly two hundred countries had ratified the treaty. UN Secretary General Kofi Annan called it the most successful international agreement to date. Here was a blueprint for change, and it only had three steps, each offering a crucial insight.


Step One: Science

The evidence that illuminates the issue is necessary, but it is insufficient by itself.

By 1987, researchers had known for at least fifteen years that CFCs affected the ozone layer, posing a threat to the global climate. As a propellant used in aerosol products, CFC use had become widespread throughout the world. Despite lobbying efforts, there had been little traction politically to do anything about the problem.


Step Two: Catalyst

A catalyst is required to make the issue visible and immediate, but it still is not enough.

By producing their own experts and challenging the data, the manufacturers of CFCs fought any suggestion that the problem actually existed. However, in the early 1980's, NASA provided satellite images that documented the deterioration of the ozone layer. It was no longer an abstract concept. Now, even the company executives had to acknowledge the effect⎯not just for themselves, but also for their children and grandchildren.


Step Three: Research and Development

A period of research and development is necessary so each party can figure out how to survive in the new circumstances.

The executives understood the need to change, but curtailing production would have a devastating impact on their businesses. What followed was research and testing to produce an alternative. When the company executives saw a path forward that assured their businesses could be fine, they communicated to the politicians that they had no objection to the treaty.


Once that happened, the treaty was ratified by nearly two hundred countries in record time; then, the change could happen acceptably.



The story behind the Montreal Protocol paints a clear picture of how improvement happens: the science + a catalyst + R&D = a successful change. It was fascinating. Over two hundred countries with widely divergent interests and a history of disagree- ments had been able to overcome their differences and agree on a large, sweeping, and impactful change. I, on the other hand, could not even mobilize a small department of people to handle their records in a new way. I had certainly missed some

important stuff. But if it was that straightforward, why didn’t it happen all the time?

It’s All In Our Heads. Really.

The missing link revealed itself when I heard a Fresh Air podcast in which the interviewee described how researchers came to understand the way our brain operates. To say that it threw me down a rabbit hole would be an understatement. The more time I spent learning about the neuroscience research, the more it became apparent why intelligent and thoughtful people with the best of intentions still manage to get it so wrong so often.

The more I studied, the more I could put the pixels together enough to form a picture of what goes on in the brain, and the more I could test it against what I observed. I began to understand why my brilliant idea failed to take hold in the department so many years before. It was no longer a matter of ill will or misunderstanding, or laziness or not caring. It was not for a lack of effort. My colleagues weren’t dummies! Rather, there is just more to changing than I ever imagined.

What Does It Take?

The more I learned and retraced my steps, the more I realized how much I had overlooked (or never even considered) when I presumed that a swell idea was all it would take to get my colleagues on board. Several key elements must be taken into

account if you’re going to have a prayer of implementing change, and we’ll be digging into them in-depth in this book.

First, for any change to be successful, it has to work, but it also has to be workable. An ideal change not only improves the

current situation, but people also have to believe it is doable, given the way they currently work. They must see the change as a step forward in getting the work done successfully.

It does not matter whether you are in a for-profit, non-profit, private, public, academic, charitable, or volunteer organization. All teams are made up of people who must work together to tackle issues. The real challenge is achieving an ideal change in the eyes of each and every stakeholder: the organization, the people who work in that organization, and those who stand to benefit from that work, whether they be customers, patients, clients, or the community.Whether that means doing so in less time, with less hassle, and/or at a lower cost, an ideal change is one that leads to achieving organizational goals while at the same time enabling people to be successful in their individual work responsibilities. Achieving that is no easy task, as I am sure you know.


No doubt we have all experienced resistance to a change that falls short of the ideal standard I just outlined. What we will also see shortly is that judging what works and what is workable takes more than you think. Then there are the key ingredients to craft such a change (and encourage the cooperation needed to overcome resistance and make it happen): curiosity, respect,

credibility and trustworthiness. There’s a lot more going on in there than meets the eye.

It might sound like a no-brainer, but once I had a better grasp of what these concepts meant from the brain’s perspective and paid attention to how they overlap, I began to see them at play in almost every sphere of my day-to-day life. Whether I was interacting with colleagues at work, addressing conflict in regional health care collaboratives, negotiating river access issues among kayakers, canoeists, and landowners, or working through unfortunate and unforeseen contract disputes, a common denominator emerged. These were all circumstances in which people were bringing different perspectives to the table to solve a shared issue, the very situations we each face day in and day out in the workplace.




Finally, we can all agree that change may not be easy, but at the same time, it doesn’t have to be so difficult, stressful, or exhaus- ting. Changing can be exhilarating and joyful. When you understand how the brain operates, the door opens to achieve the ideal condition for improvement. You can engage with your colleagues and collaborate in the real sense of the word. You can find the proper next step worth everyone’s investment, and discover the creativity and innovation necessary to find the best option:

a solution that works and is workable. The way our brains work holds the crucial insight into what is needed to create an ideal change.


In this book, we’ll look deeply into the dilemma of change by examining how the brain operates in making its decisions. Real world examples will show how and where people and organizations struggle so much. The details in your experiences may be different, but the themes will be all too familiar. No doubt you’ll see yourself in these organizational insights. What you learn about the brain will explain why some methodologies work. Finally, I’ll suggest a model you can use to navigate this dilemma in a fashion that takes advantage of what the brain does so well, while also overcoming the impact of those features in the brain’s operating system that serve us well but get in our way nonetheless. The secret resides not only in how the brain works, but in how you can work with the brain.

So, come along for the ride. If you will, suspend your judgment, follow the science, and be willing to question what you ‘know’ to be true. These insights will change the way you think—about yourself, about others, and about how you interact each day

together with your colleagues to solve the issues that keep you from being successful in your organization. Above all, this book will help you work with the brain, not against it, to chart a path that frees the brain—both yours and theirs—to be the innovative, problem-solving machine it can be. In doing so, you can create the organization you want to be part of, one that is more productive, more meaningful, and more successful.

A couple of disclaimers:

First, I am not a neuroscientist, so if you are one (or married to one), you'll likely find much to quibble with in what follows. My goal, however, is not so much to be a textbook, as it is to suggest a framework of understanding that we can use to facilitate change.

Second, I am not an academic. As an emergency physician, my time has been spent on the frontline, “in the pit,” so to speak. Nevertheless, this role has also taken me other places: managing and leading as a partner in a professional group; as medical di- rector of a countywide, government-based EMS ambulance system; in a support role coaching managers, leaders, physicians, and others, including patients, and being supported and coached by them; and learning much along the way. Like you, I have been asked to change and have asked others to change. Like you, I have suffered at the altar of change. Unlike some of you, though, I have been to the proverbial mountaintop and seen how it can be. It is this experience I hope to share.

Third, this discussion of the brain’s operating system contains a lot of information. We will return to the critical concepts over and over, so don’t feel like you need to grasp every detail fully the first time you read about it. There are lots of opportunities for review throughout the book.

Finally, there are ideas for action and organizational insights throughout these pages. These are an opportunity not only to reflect on your own beliefs, but to recognize your organization in the stories. “A Deeper Dive” accompanies some chapters and adds a further supplement. You may choose to skip these, but given the fuller perspective they bring, you may not want to miss out.

So if you are ready, let’s get started. 

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