‘No evidence it works’ – Postscript NHS Change Day

 

blog-noevidence

Do you know the one about the frog in the kettle, the one about the battleship and the lighthouse, or the one about the electric monkey cage? Surely you do. According to experts, if you put a frog into a kettle of boiling water, it jumps out, but if you put a frog into a kettle full of cold water and gradually raise the temperature, it will boil to death because it does not notice the change. According to numerous accounts, a battleship saw a light bearing on its bow, and issued a signal instructing the other ship to change course. The return signal was a refusal. The incensed commander insisted that he was a captain, and that the other should change course. The reply was that the other was a seaman second-class, and recommended that the captain changed course. The commander then replied that he was a battleship, and demanded that the other change course. The reply came back ‘I am a light house — suggest you change course’. The battleship did. According to many management seminars, a group of monkeys were put into a cage with bananas at the top. However, the bars were electrified, giving the monkeys a shock whenever they tried to climb up. After a while, the monkeys ceased to try, even when the electricity was switched off. Subsequently, the monkeys were replaced one by one with monkeys who had not been part of the original experiment, and the other monkeys savagely attacked them when they tried to climb. Even when all the monkeys had been replaced, the new monkeys did not climb.

These stories indicate, respectively, the dangers of gradual, unnoticed change, the importance of a paradigm shift, and the dangers of accepting culturally learned patterns. There is, however, a problem. It turns out that no experiment has been conducted in the last fifty years which agrees with the frog in the kettle results. Apparently, around 35 degrees, the frog jumps out, no matter how gradually you raise the temperature. A frog thrown into a boiling kettle dies, and does not jump out. Likewise, there is no evidence that the story with the battleship and the lighthouse ever happened. You may have read it in Steven Covey’s 7 Habits of Highly Effective People, or you may have read it in one of the more recent Facebook-powered versions. However, as far as can be determined, it never happened, and no credible source has ever been cited to say that it did. Furthermore, it seems that the monkey cage experiment was never actually conducted. Feel like you’ve been had? Unlike ordinary urban myths with their lurid tales of deaths and decapitations, these stories are told and retold because they underline lessons that we are sure must be true — or, at least, we are sure once we’ve heard the story.

In each case, however, the story originally appeared as a joke or a moral lesson, and the ‘evidence’ was later added to it. If you’ve been involved in any kind of change, you’ve almost certainly learned the importance of being willing to question the convenient myths that keep organisations and individuals thinking the way they always thought, and doing the things they always did.

Top Down, Expert-led, Grassroots Change in the world of care and health is a given: on the one hand, technology advances, working practices improve, problems are solved, on the other, the impact of demographics, pressure on budgets, and an ever more demanding population mean that new problems arise at an ever increasing pace. Traditionally, Britain’s National Health Service, and many other health and care organisations across the world, have responded with top-down change, and with expert-led change. These two approaches have brought about many benefits over the last sixty-five years, but, on their own, they can never bring about the daily, repeated and iterative changes which truly transform the experiences of patients and clients.

However, these kinds of changes not only often fail to become embedded in patient-facing practice, but they often grow out of the kettle-frog, lighthouse-battleship, electric-monkey thinking that grows up wherever the people leading the change do not have current, day to day, grassroots experience of what they are trying to change.Change Day is a grass roots movement of hundreds of thousands of people giving themselves permission to make the changes that they know should be made, and which are within their expertise and authority. A sceptic might ask — indeed, some have — why such obvious changes were not made years ago, and why an artifice such as Change Day is necessary.

However, our old enemies inertia, hierarchy and the tyranny of the urgent often prove too much. It is easier to keep doing what we have always done, it is less likely to get us censured, and it is more convenient given the often frantic pressures under which we are operating. NHS Change Day, and the Change Days it has inspired in the USA, Canada, Jordan, the Netherlands, Australia, Northern Ireland and Sweden, offers just the impetus which we should not need but which we do need to get on and fix things which have been broken for years. Grass roots change is not capable of dealing with everything.

There are kinds of change which need to be led by experts, and there are kinds of change which need to be led at an organisational or multi-organisational level. However, from the nurse who dramatically reduced the numbers of people who failed to attend appointments by adding a simple hand-written sticky note to their letters, to the painter and decorator who is now repainting an entire hospital in dementia-friendly colours at no additional cost to the health budget, the kinds of change which grass roots, crowdsourced action brings about could seldom be accomplished by other approaches.

I hope that through this blog, you will be stimulated to further ask the unasked questions, challenge the comfortable truisms, question the often repeated stories, and be inspired to lead the kind of small changes which together change the world.

I am proud to say that the biggest outcome for me personally is that after the 2nd Change Day in 2014, my daughter, decided to make a career change, join the NHS and become a nurse. Let us say goodbye to the frogs, kettles, lighthouse battleships, and electric monkeys. May your curiosity never diminish. References:http://www.snopes.com/critters/wild/frogboil.asphttp://www.snopes.com/military/lighthouse.asphttp://skeptics.stackexchange.com/questions/6828/was-the-experiment-with-five-monkeys-a-ladder-a-banana-and-a-water-spray-condu

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