Journal of Sacred Work

If we can make loving care the norm instead of the exception, health care will undergo a revolution!.  – Erie Chapman
 
   About fifteen years ago, talk show host Larry King told me on my nationally syndicated T.V. show, Life
Choices with Erie Chapman (1987-1995),
that his first heart attack wasn’t enough to get him to quit
smoking. Instead, he continued his four-pack-a-day habit that
included his practice of smoking in the shower (he rested the cigarette in
the soap dish!) It took a second heart attack, impending by-pass
surgery, and a deal with God for King to finally give up his beloved
smoking habit. (former President Clinton, pictured with King, had his own challenges with behavior change as did numerous American President’s before him.)
   Changing core behaviors its astonishingly difficult. Educational psychologists tell us that, on average, we remember 10% of what we hear, 20% of what we read, 70% of what we do, and 90% of what we teach. If this is true, it would seem that the way for us to learn, and to change, is to spend more of our time teaching and less time trying to learn in the usual way education is offered – through lectures…

   We are so attached to our habits that it’s incredibly difficult for anything to penetrate our consciousness deeply
enough to change how we act. Even more challenging is for any process
that happens outside us to reach so deeply inside us that it alters
any of our basic thought patterns including our biases.
   We agree with the sermons we hear and the motivational talks we listen to and we may be touched by a movie we see or a book we read. But any one or all of these experiences rarely change us for even ten mintes afterwards, much ten days or ten years. We’re too anxious to move onto the next thing to absorb the impact of what we have just seen or read, and to hold onto the way we’ve always behaved.   
    Consider the hypothetical surgeon with an anger problem. Lecturing him or her on
anger will causes little or no enduring behavior change because they rarely change core thought patterns. Reading books on anger won’t do
much more. Practicing anger management has a much better chance of
working but only if the surgeon is truly motivated to change. Asking the offending doctor to teach anger management, according to learning theory, would
have the best effect of all. Ultimately, the angry surgeon must undergo a deep change in attitude. And this change must be sustained for it to have a chance of becoming an enduring new pattern. Like any of the twelve-step programs, it may also require constant reinforcement.
   But how do we get the surgeon, or
ourselves, to the point where we recognize that we need to change any aspect of ourselves?   
   Of the various questions posed in the Journal, the one posed here is one of the most important. For the goal of the Journal is to help each of us change – to learn how to be better lovers.      
   Based on what I have just written, you are only likely to remember 20% of this article for up to twenty-four hours after you read it. The chance of one essay changing your behavior is non-existent unless you actually try to practice one of the ideas offered here on a regular basis.
   If we really want to change, we need to follow a well acknowledged four step process of cognitive change. Here are the steps:

1) Awareness – We need to be aware of a given behavior. For example, we may be aware that every Monday morning, we wake up with a bad attitude toward Mondays/
2) Acceptance – This is the decision to accept that a given behavior warrants enough of our attention to make us want to change it. Where attention goes, energy flows. To change a habit requires lots of attention. To think differently about Monday mornings, we would need to accept that this is worth the effort to create change.
3) Integration – This involves picturing the change we want to make. To change my attitude about Mondays, I would need to start imagining a thought pattern different from the one I usually use. I would need to wake up on Monday mornings with a whole new attitude toward that day.
4) Actualization – This is about putting the new thought process into practice.

   For cognitive change, this is the only process that works. It’s not very hard to understand but its incredibly difficult to implement. First, you would have to remember this four-part process. Then you’d have to try it out. Finally, you would have to integrate it into your everyday thought process and, if the change is a big one, you may need a regular reinforcement process to make the change permanent.
   Is there anything ahout your life you want to change enough for you to do all this work?
   I know very few people who accomplish life change by themselves. One of two things needs to happen. Either they need long-term help from a counselor, or they need to experience a traumatic event like Larry King went through. New Year’s resolutions about fitness don’t last even thougn the steps to fitness are well established and easy to understand.

The Force!  But I have forgotten one of the biggest forces that affect our behaviors. It’s the one that is responsible for much of the mediocrity in health care as well as for elements of its excellence as well.
   Most of us are chameleons. We are so desperate to be accepted by groups that we will bend our behaviors to accomodate the group norm. This is how many of us keep our jobs and our social relationships. We reach into our bag of tricks and slip on the mask we need to "fit in."
    If I am employed by the Mayo Clinic, I will practice the "Mayo Way" or I won’t last long. If I am signed by the New York Yankees, I will adapt to their particular ethic or get ejected from the team. Sadly, if I bring my own brand of excellence to a team that prefers mediocrity, I will be subjected to ridicule unless I conform.
   This is the secret of health care transformation. If we can make love the norm instead of the exception, health care will undergo a revolution!

   Tomorrow, I will address another way that our brains work – the way that explains some our best actions – and some of our worst. By then, if the theory holds true, you will have already forgotten at least 80% of this article. Hopefully, you’ll remember this truth adapted from Gandhi – you can "be the change you want to see in the world." And in so doing, you can begin to change the norm of the group of which you are a part.

-Erie Chapman