Want to start an epidemic?

It would seem reasonable to think that being responsible for starting an epidemic would be the last thing any doctor would want. We usually consider epidemics in the physical sense. But we also see behavioural epidemics infecting a population. The recent escalation of parents not ensuring their kids are vaccinated is a good example. And we typically think of epidemics in the negative sense. We flip this idea round during our Essentials of Medical Leadership and Management Courses. Being responsible for spreading positive behaviour, ensuring improved working practices take a grip across your team and then beyond is a wonderful thing.

We often know what we want to achieve when it comes to leading quality improvement, championing new techniques or transforming attitudes. But how often do initial changes in team behaviour really stick. How often do initially well received ideas slowly evaporate and fail to take a grip? This happens for a broad range of reasons.

The tipping point

Malcolm Gladwell came to prominence through his book Tipping Point: How Little Things Can Make a Big Difference.  He begins by exploring the factors which contribute to a major outbreak of infectious disease.  He then goes on to look at historical events, cultural phenomena and human behavioural trends. His focus is on how things spread through human populations. Along the way, he aims to identify the key factors which contribute towards the reaching a ‘tipping point’. That’s the point when something moves from being small and contained to a few, to become an outbreak which impacts on the many.  These key forces can be applied to the deliberate spread of ideas and behaviours. They can be utilised to start a positive epidemic.

Gladwell proposed that reaching a tipping point requires three active agents:

  • The right people
  • A fertile context and
  • ‘Stickiness’

The right people

Leadership is often a ‘team sport’. We rarely achieve sustained behavioural change with a group of people on our own via one single act of influence. Change requires maintaining contact with our team members. Shift patterns, busy workloads and people working in different locations are just a few factors which make this challenging. So it helps to involve colleagues who are natural connectors, who are good at networking with people. It’s also useful to involve people with credible expertise who have the ability to distill any complexity or confusion into simple concepts. And support from people who can ‘sell’ an idea, who make it directly relevant to individuals will help ensure that everyone is onboard.

Fertile context

Epidemics require the correct ‘breeding ground’.  An infective agent may have a major impact in one situation.  Yet transferring the same agent to a different time, place or culture may mean that it has no impact at all. Timing is essential. People need to be ready for change. This might mean taking an opportunity as it arises, waiting for the right time or taking steps to ensure your team are going to be receptive to your initiative. As well as there being a ‘right time’ there’s also usually a ‘right place’. These two elements can be guided by understanding the prevailing culture which also informs what is expected, respected and accepted.


You have to genuinely engage people if you want them to follow your ideas. You need them to pay attention to receive your message clearly and unambiguously. So the way that you communicate is important. It needs to be personally relevant to people for them to commit. This works best when they understand ‘why’ and “what’s in it for me or the things I care about” is apparent. But one single instance of relevant engagement rarely has a lasting impact. So follow-up is an essential element of making your message or need for change sticky.

What do you want to change and how will you start your epidemic to make sure your ideas spread?

Stephen McGuire – Managing Director