Perception or reality: the best driver of change?

Do you want to change something? Well, start with ‘why’. People will follow you because they believe.  So, if you can explain ‘why’ you want to change something and people believe your message then you’re more likely to get them on board. That’s the message shared by Simon Sinek in one of TED’s most popular talks of all time.  We need to meet people where they are and start from there.  Working with beliefs boosts motivation and motivation kick-starts change.  It also helps to sustain efforts when the going gets tough.  We regularly explore these concepts during our Essentials of Medical Leadership & Management course.

Our perceptions are closely related to our beliefs. But how do we know if our perceptions match up with reality?  Well, if they are such a key driver for change, does it really matter?

A Case Study in Reality

A recent NHS case study from Brighton’s Seven Dials Medical Practice is worth considering. The GP’s who worked there were considering the number of ‘inappropriate’ appointments made by patients. These were the cases where the service could have been provided by another healthcare professional, such as a practice nurse or pharmacist. Their estimate was that these probably represented around 20% of their appointments. However, their analysis revealed the true figure to be closer to just 8%.

It would have been easy for the disparity between initial perception and significantly lower reality to have dulled their motivation. However, putting the reality into context created a new perception. The 8% represented 31 appointments. That is the equivalent of two full GP sessions a week being spent on inappropriate appointments for the practice. Resolving this inefficiency then became the focus of their attention.

Through a combination of staff training, a better system to promote consistency and improved communication, the practice successfully converted the equivalent of two full GP sessions a week from inappropriate to appropriate appointments. This meant more availability for patients with shorter waiting times. At the same time, there was an increase in patient awareness of the services available to them from other healthcare professionals plus an increase in the consistency of approach by the reception team.

Perception AND Reality

This is a great example of the initial perception being far removed from the reality. Our gut feel and hunches are useful indicators for telling us where to look, but they can be misleading. There was every chance that, rather than the inappropriate appointments being lower than the GP’s believed, the numbers could have turned out higher once measured. Establishing reality can confirm a hunch, dispel a myth or even reveal a new truth. This is an important element of any well conducted review or good audit process.

Clarifying reality should reveal what has gone well and where things have or are going wrong. All too often we jump directly from here to deciding what to do differently.  But first we must establish the reasons behind the issues and define how we will know that we’ve made a worthwhile, sustainable change. These are the skills that we focus on during our Practical Leadership & Management Course for Doctors. We also explore how to take such information, put it in context and present it in a motivational manner. After all, if the people you are trying to lead don’t believe in ‘why’ or that the change is unachievable, then you are likely to fall at the very first hurdle.

So which is the best driver of change?

Perception and reality are both relevant.  They need to match up and this is the basis of what we at Oxford Medical call Evidence Based Medical Leadership.

Stephen McGuire – Director of Development