Adaptation: A Shot in the Arm for Progress

Changing behavior in service to a larger aspiration--whether in healthcare, education, social media, or technology--is at the very heart of the work of leadership. And to change behavior is to understand what those involved in the change value, while recognizing there’s no silver bullet when it comes to changing hearts and minds. The Center for Disease Control and Prevention reports: “Influenza has resulted in between 9.2 million and 35.6 million illnesses, between 140,000 and 710,000 hospitalizations and between 12,000 and 56,000 deaths annually since 2010.” While the impact of this seasonal epidemic is clear, just how to reduce that impact has been much more ambiguous. Over the past decade, we’ve seen concrete adaptations—think well-crafted experiments--designed to contain the spread of the flu. Sanitizing spray units have popped up in public places.  Many grocery stores provide anti-bacterial wipes for the handles of their carts.  Signs that illustrate proper hand-washing and how to contain a cough or sneeze are common in schools and restaurants.  Vaccines formulated to combat anticipated flu strains are available each fall; however, the healthcare community has struggled to persuade even half of American adults to take the shot. This time last year, as the flu shot push was on full tilt, the CDC reported, “If just 5 percent more people in the U.S. got the flu shot, 800,000 illnesses and 10,000 hospitalizations could be prevented.”  Last flu season? Only 41.7% of American adults got the shot. When the goal is to change the behavior of millions of people who tell themselves they are too busy, too healthy, too wary to roll up a sleeve to get the flu shot, the challenge is clearly adaptive.  Without a guidebook with step-by-step instructions for getting everyone to the clinic, you need a different path for progress: thoughtful experiments designed to surface those strategic adaptations that will shift choices and behavior. Adaptations are next best guesses.  If the healthcare community knew the exact lever to flip to draw crowds to the shot, they would do it.  They simply don’t know. Each adaptation is then experimental and aimed at varying barriers they theorize are keeping more Americans from heading to the doctor. As we move through our lives in both big cities and small towns, we can see those adaptations emerging along with the changes in the air that signal fall.  Each adaptation is the result of a different diagnosis about the nature of the challenge.  Diagnosis: it’s inconvenient to go to the doctor’s office Adaptation: flu shots are available at the grocery and the pharmacy, at big box stores and community health fairs, at schools and even via Uber Diagnosis: people are afraid of needles Adaptation: clever pharmaceutical companies have launched both “jet injector” (needle free!) and nasal spray versions of the flu vaccine Diagnosis: financial incentives are key Adaptation: a 20% discount on everything you purchase at the pharmacy chain while getting that gratis shot; in-store gift card with every arm bared Diagnosis: connect the shot with a greater cause Adaptation: this season one grocery chain is donating a meal to Feeding America for each compliant patient Given that flu shot coverage has been significantly higher in children—last year almost 60% of kids got the shot—yet another adaptation might both leverage those trends while capitalizing on convenience and modeling: allowing adults to get the shot alongside their kids while at the pediatrician.  Note that the adaptations go both ways—public health has to learn how best to meet the needs of the community and the community has to be willing to adapt some of their own thinking and behavior. On both ends a willingness to learn and bend is vital. Big picture, each adaptation is an experiment built to gather data about how to shift change-resistant behavior.  And with each season, the healthcare community is learning more about what works and what doesn’t when the leadership work involves getting the attention, buy-in, and upper arms of busy adults in service to a larger public health initiative.Leadership is mobilizing the many to make progress on a seemingly intractable challenge.  It involves embracing uncertainty, holding open multiple interpretations of the challenge at hand and persevering even as new pressures emerge.  As such: it is the long-term practice of optimism driven by an abiding purpose--like keeping communities healthy.

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