The ceiling is not going to come down here

You hear it more and more: "Let's figure out why this isn't working, so we can remove the blockers". Sounds logical, but if you think about it for a moment, in most cases it actually makes no sense at all. Mostly it just leads to a lot of extra pointless meetings. That's because this reasoning assumes that removing blockers automatically leads to movement and progress in whatever it is that needs to get moving. And that's not true. Think about it: if you line up a row of athletes on a running track, and that track is covered in clutter, they won't run. Obviously. So if you clear away the clutter, you'd almost think they'd start running on their own. My proposition: that's not the case.

Let me give you a better example from working life, rather than from sport. Imagine you run a small company, and you're looking for talented new people. You place adverts and even hire a recruiter. But nobody's interested in the vacancy. So you go and investigate: "Why isn't anyone responding to this vacancy? What's the blocker?".

At a job fair you speak to a few talented candidates, and one of them is honest enough to tell you: she's heard that the building your company is in isn't safe. And that's true. A few weeks ago the ceiling came crashing down. Two people suffered concussions, one of them is even in intensive care. And the same thing had already happened two months earlier. The building is basically on the verge of collapse. You realise this blocker needs to be removed, so you move to a different building. A brand new office building where the ceiling is guaranteed not to come down for years to come. Blocker removed, problem solved, bring on those candidates!

Guess what: still no interest. Off you go to another job fair. Again you speak with some very talented people: "Come work for me, because the ceiling is guaranteed not to come down!". The prospective candidates walk away laughing. Until one of them is willing to be honest about why he still doesn't want to come and work for you: "The work just doesn't appeal to me".

“A safe building doesn't suddenly make people come flocking to you.”

And that's how it goes with many things: hygiene factors and motivating factors. If the basic conditions aren't in order, nothing happens. The building has to be safe, but it remains what's called a "hygiene factor": an unsafe building makes people leave, but a safe building doesn't suddenly make people come flocking to you — quite different things are needed for that. So what does actually move people in this example? Autonomy, opportunities for development, intellectual challenge, purpose, enjoyment at work, nice colleagues, and so on. "Money!", some will add. And that's a big misconception. Pay and benefits are a hygiene factor; if the pay is too low, or is experienced as too low, people will indeed leave. But if you keep raising the salary, they don't become steadily more motivated or enthusiastic about the work.

Back to the athletes on the running track. Why do they actually start running once you've cleared the clutter away? Because they were already motivated beforehand — otherwise they wouldn't have come to the running track in the first place. In fact, I'd wager they would have happily cleared that clutter away themselves if you'd simply appealed to their motivation: "Hey folks, fancy an hour of exercise? Yes? Could you clear those blockers out of the way then? Thanks!".

“Above all, ask yourself what will actually lead to progress.”

So don't ask yourself "Why isn't our approach working?", and certainly don't ask the other person that question; they'll come up with a reason on the spot for why not. In a commercial setting that sounds like: "Why aren't you buying our product?", to which the customer will say: "It's too expensive, and I'd like it to also do this or that". The pitfall is then to think they'll buy it once you make it cheaper, or once you add this or that feature.

Above all, ask yourself what will actually lead to progress. Often people can't put this into words spontaneously. Henry Ford already said it: "If I had literally listened to my customers, I would have bred faster horses". The art is to figure out for yourself what your stakeholders want, by uncovering the other person's motivation: what does that person actually want, and what will therefore actually work? And to base your approach on that. This is precisely why more behavioural scientists — and even marketers — need to work in healthcare and in prevention. Not that I believe in market forces in healthcare, but I do believe in the power of marketing. That's sorely needed, because the implementation and acceptance of innovations and changes in healthcare keep getting stuck on behaviour, attitude and perception, not on knowledge.