Small Steps to a Better Me

Applying tested business principles for continuous self-improvement.

Sitting with my brother-in-law and his family over dinner the other night, we got into an animated debate. He had just stumbled into what he thought was a profound life lesson from a Swami’s discourse on how to control anger and greed. At his insistence, I read the passage — indeed a well articulated one that made me pause to reflect on what we do behaviorally and why we do it. However, for me the advice was not actionable enough — if only I knew how to do it, I retorted, I certainly would.

A lot of self-help advice, whether from religious texts or indeed at doctors offices, is too generic and therefore poorly effective in changing human behavior. It often falls in three categories: create a “burning platform” for change (If you continue to smoke you may die from lung cancer), analyze using evidence as to why you may be behaving the way you are and broadly define what you may do to change (Conflicts occur because of your ego. Shed your ego and conflicts and stress will decrease), or providing advice that seems specific but is poorly effective (You must exercise three times a week, at least twenty minutes with each session). Any or all of the above can be excellent starting points or triggers and indeed identify what needs done, but not how it should be accomplished. Clearly, something more is needed.

Interestingly, much of my own learning on behavior change in my personal life has come from lessons learned and extrapolated from my professional experience as a physician–executive and indeed as a practicing clinician.

As a physician what frustrated me the most was my relative lack of ability to have my patients make behavioral changes (stopping smoking, making healthy diet choices, regularly exercising). When I stepped into management, I began to better understand why this might be happening. My foundational learning came from a lunch meeting with the leadership of the Center for Innovation at the nationally reputed Mayo Clinic in Rochester, Minnesota. I took home a major principle that I have since used regularly — Think big, Act small (well-described in Jason Jennings’ management book of the same name, that draws attention to nine highly profitable companies’ strategies of making small changes to realize big goals). The underlying premse is that most change processes are complex and can be broken down into “bite size” pieces and then fixed one at a time. For me as a professional, this translated to changing goals from “We will lower unnecessary tests across the hospital” to “ We will lower un-necessary CAT scans for headaches in the emergency Room”. In my clinical practice, I began to tell patients “Consider reducing two pounds of weight in the next month” instead of “you are currently at 180 lbs. and you need to lower it to 160 lbs.”

The second transformative lesson was that after conceptually breaking down the problem into small, manageable chunks, one must have a planned process of immediate action steps. In this context, my professional learning in trying to improve quality in health care had led me to the work of W. Edward Demming and the PDSA cycle (Plan, Do, Study, Act) — originally developed to improve quality of products and processes in business, and subsequently applied in many settings including health care improvement. In this model, Plan refers to identifying a specific goal (reducing un-necessary CAT scans for headache in the ER), Do refers to a specific action to accomplish the goal (administer a directed training program to physicians), Study refers to rapidly checking the effect of the intervention (check use of CAT scans 30 days after intervention) and Act refers to changing course if necessary based on study results.

As I tasted success using these two principles in improving processes at work, I began applying them to my own behavior. Faced with intense stress in running operations for a health care organization, I used the first principle first. “Thinking big” meant: “ I need to lower my stress levels”. “Acting small” meant: “I will reduce or eliminate at least one source of stress”

I then applied the PDSA cycle to this process of self- improvement. A 30-day Plan (Goal) was crafted: Change my approach to dealing with one source of stress: two physicians who strongly and consistently disagreed with me. Do (Concrete steps): (a) Not respond immediately to their criticism during weekly meetings and (b) Whenever their seemingly unreasonable behavior came to my mind (often at 3 am!) , consciously tell myself to stop and remind myself that this was like “drinking poison myself and expecting someone else to die”.

Study: on a weekly basis, self-assess as to what was working and what wasn’t. I particularly monitored if I was getting longer, uninterrupted sleep. Act : The “drinking poison” analogy was working very well during the day but not helping me go back to sleep at night; a few doses of a simple sleeping aid helped.

Over the years, I have applied these two principles hundreds of times to try and make continuous, small improvements in my quality of life both at home and work. Goals have included diverse themes such as improving quality of interactions with my wife or children, improving the quality of sleep, investing in relationships with close friends or siblings or increasing time spent in hobbies.

Last night, re-reading the illuminating passage from Swami Viditatmananda Sarawasti, I was inspired to decrease anger and greed in my life. Religious texts are replete with such inspirational life-changing material, as are countless secular self-help books. After being inspired, consider taking the next steps: Thinking big but acting small, followed by tackling the “small” problem using the PDSA cycle.

It works.

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