It's all about education - and not just reaching doctors

Twenty years ago, you could spot a pharmaceutical sales rep from 50 paces:  If you saw a good-looking 20-something with one of those briefcases on wheels heading into an office building, chances were good that they were a drug company rep looking to push their products to doctors.  Armed with flashy detail aids, plentiful supplies of samples, and an aggressive sales pitch, they were crucial to a drug's success.

In the past few years, however, things have changed:  Pharma reps can no longer come bearing expensive gifts; doctors are busier than ever and less inclined to give up patient time for sales reps; and with more information at their fingertips, physicians have less incentive to spend time with reps in order to learn about a particular product or drug.  In fact, 25% of doctors say they no longer see pharma reps in their offices, and almost as many are reluctant to take samples.

More importantly, many practices don't function the way they used to, thanks to doctor shortages and economic constraints.  These days, a single doctor may be supported bya  whole team of nurses, RNs, nurse practitioners, physician's assistants and other healthcare professionals - all of whom play a role in influencing the medication a patient receives.

What does this mean for the role of the pharma sales rep?

1.  They must be able to educate

Spending time with reps whose knowledge doesn't go beyond the detail aid or whose only goal is to sell more product just aren't a good use of a busy doctor's time - and aren't providing any better information than a doctor could find online, more conveniently.  In order to be effective, pharma reps have to be able to provide more in-depth, unbiased information.

2.  They must demonstrate they can add value

A rep who stops by only to 'push' products, without regard for the overall practice goals, patient needs, or market knowledge, simply isn't adding value to the practice.  Reps who can provide practical help, such as assistance with getting approvals from HMOs or educational opportunities for patients, will stand a better chance of getting through the door - and allowed to return.

3.  They must reach the support staff as well

In more and more practices, it's the RNs or other nursing staff who do the most patient counselling - they're the ones who get the questions from patients about treatment plans, medications, prescription alternatives, etc., and they're the ones providing recommendations and advice to the doctors, who don't always have the time to review all the options themselves.  Reps who hope to influence a doctor's prescribing behavior need to be prepared to spend time with the other people in the process.

4.  They must be perceived as unbiased

GlaxoSmithKline's recent $3 billion settlement of the "largest healthcare fraud in US history", based on the sometimes shady promotion of prescription drugs for unapproved uses, highlighted a growing concern among doctors, healthcare practitioners and patients about access to unbiased information.  Pharma reps need to acknowledge side effects, ongoing issues, and even the efficacy of competing products in order to be taken seriously.

So what does all of this mean for the pharmaceutical companies?

Well, many pharma companies are cutting back on the use of traditional sales reps.  They say they're too limited by legislation, they aren't able to gain access to doctors, and they can't impact sales the way they used to.

However, I think that if the pharma companies rethought the way they trained, deployed and incented their reps - and thought in terms of 'support providers' rather than 'salespeople' - they might just find they had a highly effective team at their disposal.

Across most industries, the role of 'sales' has changed significantly over the past 10 years.  Now that consumers have more information about almost everything at their fingertips, they no longer appreciate hard-core sales pitches or salespeople who do more selling than listening.  Salespeople who provide honest answers, good advice and value-add follow-through do better - and build a better reputation for their organization - in the long run.

Big pharma is no different:  Companies who strive to fully educate their sales reps (and perhaps gave them a less sales-oriented name like 'consultants') about their products, encourage them to understand the larger issues at play in today's medical practices, and provide them with the ability to add value via educational materials, patient seminars or administrative advice, may find themselves not only with better-performing drugs but improving the image of pharmaceutical companies in general.

Of course, this requires a major shift in thinking - we're not going to do away with 30+ years of traditional pharma sales reps overnight.  But isn't that where change management can make a positive difference?

Change management can get derailed by the weirdest things

A few years ago I was working on a change management initiative:  Implementing a new CRM (Customer Relationship Management) process within a mid-sized organization.  The project mostly involved changes to the way customer inquiries and issues were managed and monitored, but the software was staying the same.

I thought the project was going quite well, until one Monday morning I checked my email to find 4 messages from the manager of the sales team.

"I can't stand this new system!" the messages said.  "You never told me you were going to change the whole computer system!  I thought were were using the same software as before!  I can't find anything!"  There were a lot of exclamation points, and the messages got progressively more strident.

I was confused, because I knew we hadn't changed the software.  The project was really about providing a better customer experience and ensuring that we had a more consistent message across all touchpoints.

Luckily I happened to be on-site with the client that day, so I stopped by the sales manager's desk to ask for more information.  I was glad I did.

It turned out that over the weekend (typically a slow time), the IT team had made some changes to the look and feel of the back-end of the CRM system, to make it more consistent with the front end of the website:  They'd added the company logo, changed some fonts and colors, and added a background image to the login page.  Nothing about the functionality had changed:  Users still logged  in the same way, entered the same information, and navigated through the same screens.

The problem?  The IT team hadn't told anyone that they were making the changes over the weekend, so when the sales manager called up the CRM system on that Monday morning and saw an unfamiliar background image, and was then faced with a system that looked different, she panicked.

The lesson?  When people are in the midst of a change initiative, they can feel more insecure and uncertain than usual, because they know they're going to have to learn to work - and be successful - in different ways.  That kind of stress can lead them to misread information (mistaking new colors and fonts for a whole new system) and then over-react (sending 4 panicked emails).  This is why it's crucial to communicate - and keep communicating - even the smallest details, throughout the process.  If the IT team had simply sent out an email on Friday saying they'd be making some cosmetic changes to the CRM system, the sales manager would have been prepared for what she saw on Monday.

BONUS LESSON:  Your sales team can be your most effective allies in a change management initiative - but they tend to be emotional engaged, so it's extra-important to manage their experience throughout the process.

Sometimes it takes a physical change to spark a behavioral one

The countries of the former USSR are in a difficult period:  They know they need to hange, but are caught in the grip of hundreds of years of often-difficult history.  History is frequently a barrier to change, but a country isn't like an office:  You can't just buy some new office furniture, paint the walls and invite everyone in for a lunch'n'learn when you want to signal - and foster - a major change of direction.

But maybe you can do other things.

Recently, Georgia - the one in Asia, not the one in the US - unveiled its brand new parliament building in Kutaisi.  The new building has been described as a "sci-fi bubble" and represents a deliberate departure from Soviet-era architecture (a Soviet war memorial was, in fact, demolished to make way for the new building).

The whole point of the $83 million structure, uniquely modern in its landscape, is to be a tangible expression of Georgia's commitment to moving past its Soviet history and towards a more global, independent future.  Ramaz Nikolaishvilli, Georgia's Regional Development and Infrastructure Minister, said:  "We don't want our children's taste to be ruined by communist architecture.  We want beautiful buildings and we want the next generation to grow up with good taste.  This will help them live in a better and more dignified way."

Of course, the project hasn't been without its difficulties:  Demolishing the war memorial caused injuries; there have been cost and deadline overruns; and there are plenty of detractors who think the building is both ugly and a misuse of public funds in what should be a time of austerity.

Is the big risk going to pay off in big results for Georgia?  It's probably too soon to tell, but early signs suggest that bold moves like the new parliament buildings, combined with other efforts to remove Soviet-era reminders are helping Georgians to see themselves as independent, entrepreneurial, and ready to compete in a global economy - all of which will put it ahead of other former USSR countries in the long run.

Lessons for change management practitioners

It's tempting to think of 'change management' as something that happens in big companies, in 6-month cycles with tidy little project plans.  Georgia's new parliament buildings are a good reminder that sometimes 'change' is much, much bigger than implementing a new enterprise-wide CRM system.

At the same time, however, all business-related change management really involves many of the same things:

1. Driving better business results - whether within an organization, an industry, or even a continent
2. Knowing that sometimes you have to take big risks in order ot have a chance to achieve big rewards
3. Having a clear vision of what you're striving towards will help you weather the criticism
4. Remembing that visionary change involves more than just this year's fiscal reports - it's about making investments that will set you up for success in the long term
5. Sometimes changing one thing changes everything else.  You may not be able to change everything (or at least not as quickly as you'd like to), but taking the first big steps at least gets you moving.

What is motivation, and what happens to it during a business transformation?

MOTIVE noun \ˈmō-tiv : something (as a need or desire) that causes a person to act

Motivation is simply the drive that moves us to take an action.  These drives might be physical (to have a drink of water when we're thirsty); intellectual (to read a book when we're bored); or emotional (to call a friend when we're feeling sad).  As humans, we're motivated to do what we believe is in our best interests.  Sometimes that results in positive achievements; sometimes in (retrospectively) stupid mistakes.

Our beliefs about what our beset interests really are can make motivation in times of change particularly challenging for an organization.  When a new direction is announced, and involves potentially painful changes like reorganizations, staffing changes or business process restructurings, a quite complex web of motivations can arise:

Employees may feel their 'best interest' is simply to survive the change
Department managers may feel their 'best interest' is to keep delivering results at any cost - and to survive the change
Senior leadership may feel that their 'best interest' is to avoid being blamed if the promised results don't happen - and to survive the change

But how do you keep an organization moving forward when motivations are evolving, and so many people are going into 'survival' mode?

Establishing new direction

As a leader during a business transformation effort, establishing a new direction doesn't mean simply announcing a new strategy and then walking away as if the business will just continue as usual and the changes will magically appear.  It means putting a process in place which encourages and supports each individual as they define wha the new business direction means to them.

This isn't 'touchy-feely, sing kumbaya' stuff.  It's about helping employees understand their role in the transformation, how it will affect them, and what they can do to move forward - because it's only by helping them understand these things that the business change will achieve the ROI that it should.  After all, it's the people in the equation who make or break a transformation.

Removing barriers

The number of barriers the organization faces depends on the nature of the business change.  Barriers to change can be as simple as ensuring everyone in a specific department has adequate education in a new technology, or as complex as inspiring an entire organization to buy into a whole new strategic vision and approach to the marketplace.  Either way, they need to be taken seriously.

Engaging the individuals who are involved in or creating the barriers is the first step to easing them.  You can motivate a department to become engaged in a new technology by helping them understand how it will make their work lives easier; you can motivate an organization to become engaged in a new strategic vision by helping them understand how it will drive their long-term career goals and security.

Providing support

A key role for leaders is to provide support to the team as they change the way they operate on a day-to-day basis.  Supporting individuals means listening, empathizing, and concentrating on their progress through a change.  By providing assistance, feedback and counsel, you're helping them to see that their 'best interests' really do involve moving forward with the changes - and that helps keep them motivated to continue.

Remember:  Support may also involve reiterating why a change is being implemented, what the goals of the change are, and why the timing of the change is important.  This will help drive motivation.

Good leadership = Good motivation

People need leaders to lead, especially during a time of change.  Sounds simple, right?

Except that 'announcing' a change isn't the same as 'leading' one.  Leadership during a change requires a leader who is actively and visibly engaged during the entire process; someone who is seen to be removing barriers, providing support, and communicating the process in a credible way.  When leaders do this, individuals become more and more motivated to work towards a goal which doesn't just benefit 'management' or 'the company', but their own best interests as well.

6 ways to get ahead of the problem

It's every CEO's worst nightmare.  You're in the midst of a change initiative, but you've had to make some tough decisions, and a few people have been asked to leave.  But you're sticking to the plan, and you think things are going as well as can be expected.  You can see the light at the end of the tunnel.  

Then one of your best clients calls to say that they're worried about next year's contract and thinking about reducing their spend with you.  You reassure them that everything is fine - and you think that it is.  But then you hear from a supplier who's wondering if you're still going to be paying your invoices on time, and expressing concern about their long-term relationship with you.

You're perplexed - until you happen to call a former colleague with whom you've stayed friendly and he greets you with, "What the hell is going on over there? I hear you won't be around this time next year!"

And suddenly you discover that a couple of employees involved in the change have been more confused and disgruntled than you realized.  They've been spreading the word, and it hasn't been positive.  They've been so vocal, in fact, that the word on the street is that your organization is on a collision course with disaster - and that's starting to make your clients, suppliers and other stakeholders nervous.

So what do you do, before someone forwards a confidential email to the competition, or, worse, decides to pen an op-ed about the state of affairs in a daily newspaper?

Managing change communications in a crisis

1.  Don't panic.  When you start hearing negative rumors from a couple of different sources, you can start to think that 'the whole world' is saying you're about to capsize, or that your entire workforce is staging a mutiny.  Chances are, things aren't that bad, and you've probably caught it early.  So don't go into full-on crisis mode until you've had a chance to speak to your senior management team and get an accurate assessment.

2.  Don't look for scapegoats.  You're probably feeling betrayed and angry, but looking for someone to blame, fire or castigate is only going to exacerbate the problem.  What's really happening is that you're getting negative feedback about the change - you're just not getting it through the most productive channels.  But negative feedback can be a good opportunity to gain insight about how the change is being implemented - so instead of looking for someone to blame, look for the opportunity the situation is providing you to improve the change.

3.  Help employees to see the big picture.  When quite a few of your employees are speaking to outsiders in a negative way, it's usually a good sign that they don't really understand why the changes are happening or why they're a good thing for the organization.  So you probably need to beef up your messages about what these changes mean for the long-term health of the company.

4.  Help employees to see the little picture.  If the source of the negative messages is a handful of people or a specific department, it's likely that those people or that department is feeling disengaged from the change or that they're being shortchanged in some way.  Arrange for one-on-one (or one-on-small-team) mentoring and communication to help thosse people understand their role in the changes and how their full participation is important.

5.  Be as honest as possible, as often as possible.  I've said it before and I'll say it again:  During a change process, it's virtually impossible to communicate too much or too often.  The more honest information you can share with employees, the more likely they are to 'get' the reasons for the change, and the less likely they are to spread negative messages outside the organization.

6.  Revisit your communication plan.  It's always better to prevent a crisis than to have to address it after the fact - that's why every change management initiative should have a well-defined communication plan built into the overall strategy.  However, if you find yourself facing challenges, don't just go into defensive mode:  Revisit your communication plan and make adjustments (more communications, additional channels, refined messages) as required.

It's all about balancing internal and external focus

The surveys are in; the results are tallied, and you are thrilled:  Compared to last year, your employee engagement numbers are up.  Way up.  You've done presentations on the feedback data, you've set up employee task forces to keep the momentum going, and you know you must be moving in the right direction because everyone says that employee engagement leads to a terrific bottom line.

And yet...

Somehow, the sales force - whose engagement numbers improved the most - still aren't hitting their (very realistic) numbers.  What the heck is going on?

The short answer is that, as important as employee engagement is, it really doesn't help you sell more product.  It's a measure that focuses on the internal, not the external - and therefore will do little to change your sales numbers.

DENISON CULTURE MODEL

According to Dan Denison, success involves a combination of Internal and External focus.  By doing so much work on your employee engagement inititatives, you've successfully transformed your sales force's internal focus.  That's great - you've got a sales force which believes in the organization and has a good team spirit.  But now you need to concentrate on their external focus, because now they have to get out there and spread the word beyond the organization.  

Now that you've got them engaged with the organization, it's time to focus on leveraging that to drive Adaptability (creating change and focusing on customers) and Mission (understanding the goals, objectives and vision).

Employee engagement may be the first step to increased business success - but when it comes to sales, real success happens when you ensure that the internal and external foci are working together.

The right fit can make or break your change initiative

If you've been thinking that Change Management consultants are flakes who spend all their time talking about 'feelings' and not enough time demonstrating a commitment to the bottom line, you're not alone.  But the truth is that the right change management expertise can make all the difference to a chance initiative.  They can help improve ROI, speed the pace of change, help you retain your top performers, and prevent the project from going off-track.

It's just a matter of partnering with the right consultant.

Here's what you need to consider in order to choose the right consultant for your change initiative:

1. Experience:  What changes have they implemented as part of an organization?  What changes have they experienced as an employee?  As a manager?  As a leader? Someone who has experienced change from a variety of perspectives is going to bring more understanding to your initiative.
2. Who will actually be doing the work?  A senior consultant may be the one creating and overseeing the change plan, but delegating the actual work to specialists or juniors.  That's fine - but make sure you know who's on the team and how they'll be working together.
3. Their role in the changes:  Change consultants can have experience in the technical, logistical or people components of change.  Be sure you know what component(s) you need, and look for someone with the right experience.
4. Buzzwords vs results:  The best consultants are good at straightforward communications and outlining clear expectations.  If you're hearing a lot of terms like 'change agent' and 'transformation catalyst', call someone else.  Remember, a $25,000 diagram may look great in the boardroom, but isn't a guarantee of results.
5. Approach:  Effective change management consultants ask good business questions and are looking to understand how all the pieces fit together before outlining a plan.  If they say they can just jump in and start delivering results, no questions asked, they may not have the skills you need.
6. How many people will the consultant be bringing in?  An outside consultant may be able to bring clear vision and specialists to the table, but in order for a change to be successful, your internal employees should be fully engaged in the process.  Leaving change entirely to external consultants can mean the change leaves when they do.
7. Pragmatism:  Good change management isn't about holding hands and singing folk songs with employees - it's about making smart business changes that ultimately lead to a better bottom line.  An effective change management consultant is one who knows that managing the people piece will drive business success.  That means demonstrating they understand the business and can balance the people side of things - if they only pay lip service to the people side, you'll have problems in the long run.  Remember:  People are your most important asset.
8. What is their success rate?  Don't be afraid to ask. If they can't tell you it's higher than 98%, don't hire them.  It's that simple.
9. Ask about their biggest failure - and how they turned it around.  Anyone who tells you they haven't had a failure is lying - and anyone who can't tell you how they fixed a big failure isn't ready to lead a change initiative.
10. Does their process include a 'Lessons Learned' component?  It should.  Successful change management generates valuable knowledge and insight about the organizations, and it's important that this knowledge is articulated, documented, and transferred to the organization.  Otherwise all that knowledge just walks out the door along with the consultant at the end of the project.

IT has almost killed change management - but it's had help

So the other day I read a funny-because-it's-true piece over on Toby Elwin's blog:  "Change management is dead - the rumor". 

Toby writes:

"OK, Information Technology, you win.  You can have it.  You've ruined it beyond all recognition anyway.  Only left me a shell of a concept that, at one point, had so much to offer an organization.  The 'it' I longingly refer to: change management and today change management is dead because the I and T of Information Technology has killed it."

Change management isn't quite dead, yet, but it's starting to look like Shaun of the Dead out there, and IT had a lot to do with it, especially when it comes to technology-related projects.  However, IT wasn't alone:  Companies, looking for an easy way to 'transform' their organizations without having to spend money on the messy transformation of actual 'people', have a lot to answer for as well - and their culpability extends well beyond the technology-related change initiatives.

Organizations talk a lot about how people are their 'most important asset', but it's funny how when it comes to enterprise change, their often reluctant to spend money on the expertise to manage the people component of that change.  Which is odd, because when you think about it, it doesn't matter how great your new systems are - if your people aren't ready to make the shift to them, they aren't going to deliver the value you were hoping for.

Mind you, IT has been an accomplice in this process.  IT consultants tend to think that if the technical specs and Gantt charts are mapped out in sufficient detail, the people piece will magically follow.  The "and then a miracle occurs and it works!" line in the project plan.  Except that people are more emotional than Gantt charts and mostly don't care about the delights of a new relational database.  They tend to need a little more communication, a little more training, and a little more engagement than even the best GUI can offer in order to successfully navigate a change.

Are people even included in the diagram?

I can't even tell you the number of times I've sat in a boardroom listening to C-suite execs tell me how frustrated they are with the fact that the last 3 technology-related 'transformations' have been a disaster and failed to deliver the ROI they'd promised at the outset.

And then they show me the diagram that the IT department/consulting firm gave them, and I see the problem:  There's no 'people' component.  The diagram usually looks something like this:

When there's more time allocated to bug testing than to ensuring that the end users not only know how to use the system, but have fully engaged with the change and are equipped to get the most out of it, it's no wonder that the 'transformation' never delivers the promised ROI.

Successful Change = People + Process + Technology

In an effort to drive ROI, there's a push to commoditize change - and assume the people are mindless zombies who will fall in line when the launch happens. 

It's easy to say that the problem is that IT types don't 'get' people, but I think it's more helpful to remember that successful change is a combination of People + Process + Technology.  The IT team - and the organization - knows they need specialzed Technology and Process experts.  They just often forget that they need specialized People experts, too.

When people talk about 'great leadership', they tend to talk about things like inspiring employees, having a great vision for the organization, or being able to create effective growth strategies.  But change leadership is a skill unto itself, and it's important not to make assumptions.  Today we'll look at  the top myths about change leadership.

Image via Graphic Designers of Canada.

1.  I can control what happens during this change.

You can plan for the change, you can make predictions based on your knowledge of the organization, you can make as many charts and spreadsheets as you want - once a change starts, things will happen that you didn't foresee.  Remember that you can manage yourself and others through the unexpected, but you can't necessarily control it.

SOLUTION:  With a well-thought-out plan and clarity around roles and responsibilities, you'll be able to navigate effectively through any change.

2.  I don't need to be visible during this change; I'll just be a distraction.

People need to physically see you - the leader - during a change.  If you're absent, your people will feel like they're on a ship with no captain.  This is distracting and will get in the way of their work - and of the changes you want to make.

SOLUTION:  Being more visible will give your employees confidence that you're steering the ship.

3.  This change is not big enough to warrant a plan.

In today's organizations, departments and divisions are more interdependent than ever, and partnerships both inside and outside the organization are common.  In that environment, there's rarely a change that isn't 'big enough' to warrant a plan.

SOLUTION:  Creating a map of who is affected, and how deeply, will allow you to more effectively plan for change.

4.  Everyone knows what they need to do - we don't need a plan.

Unless your organization has just invented telepathy, I guarantee that not everyone knows what they need to do - and that people who think they know what they need to do aren't necessarily on the same page as everyone else.

SOLUTION:  Creating a plan which clearly articulates what people need to do in order for change to be successful will not only ensure everyone's on the same path, but will reassure them that change is being effectively led.

5.  People won't leave - the job market isn't that good

Remember that people don't actually have to quit their job in order to 'leave' it.  In a tough job market or an isolated location, people may stay with a company, but 'check out' emotionally or intellectually if they become disengaged.  In order for a business to survive and thrive, you must have the whole person working for you.  (And even in a tough economy, your top performers are often vulnerable.)

SOLUTION:  Ensure employees are engaged and invested in the change.

6.  Resistance is bad.

Resistance to change is information.  You're being told that there is a problem of some kind and resistance is giving you the opportunity to partner with the resisting group or individual to solve the problem.  In fact, if you announce a change and there is no resistance, it's time to be concerned.

SOLUTION:  Don't automatically assume that resistance to change is simply a result of a 'negative attitude'.  Investigate further.

7.  Saying everything once is enough.

Any time you announce a business change, it's important to remember that your audience is comprised of individuals, all of whom listen to and absorb information a little differently.  

SOLUTION:  Use the 10x rule when it comes to communication:  Use varied communication channels and repeat, repeat, repeat!

8.  No news is good news.

During a change, a lack of information will result in people making up their own, or listening to misinformation from others who have made up their own.  People have a much higher need to know what's going on during a change - because they're concerned about how it's going to affect them personally - and a lack of information will only cause the rumor mill to go into overdrive.

SOLUTION:  Give people as much accurate information as possible, as often as possible.  The more they 'know', the less likely they are to 'invent'.

9.  Saying nothing is better than saying 'something may change'.

You hired your employees because they're smart, capable people - and smart, capable people often intuit that changes are 'in the wind'.  When you don't address this, they start to feel a lack of stability and security.  Productivity and morale decline.

SOLUTION:  Being forthright with "This is the situation today.  It's possible it will change..." followed up with "...and I will tell you immediately if that happens" is not only reassuring but also reinforces your position as a leader who can be counted on.

10.  People know I'm always going to do the right thing - they should trust me.

Don't count on it.  Most people generally overestimate their credibility within an organization.  Ask yourself these questions - and be honest:  What public actions have you recently taken that show people that 'You always do the right thing'?  Do you have a network of individuals throughout the organization that can, and will, publicly support you and the changes you've announced?  Your answers will dictate the plan of action you need in order to successfully lead changes.

SOLUTION:  Don't underestimate the importance of honestly assessing your credibility within the organization - and act accordingly.

In the movie Dead Poets Society, the teacher makes students stand on desks in order to change their perspectives.  I've used this tactic myself when a group seems 'stuck', and I have to say it works beautifully: It's amazing how doing something a little differently can lead to a positive change.

Maybe we need to do more of this with some of the societal problems whose solutions seem to elude us. Take Diabetes Self-Care, for example.

Diabetes is one of the biggest healthcare challenges facing the US at the moment, with more than 8% of Americans diagnosed with  Type 1 or Type 2 diabetes.  In the 65+ age group, that number rises to 27%.  Worldwide, the WHO predicts diabetes to afflict as much as 10% of the population by 2025.  The result is enormous pressure on healthcare resources - and budgets.  In the UK, diabetes-related care already accounts for 10% of the total NHS budget.

Overall health - and quality of life - for people living with diabetes can be improved dramatically with efficient self-care, but as many as 75% of people with diabetes don't stick to the self-care plan provided by their doctors.  They don't exercise enough; they don't adhere to a low-glycemic diet; they don't take insulin when they should.

Hundreds of studies have been done in an effort to understand this non-compliance.  Some conclude that individuals' 'health beliefs' or lack of 'societal supports' are the problem.  Others suggest that it's a lack of numeracy or literacy that's getting in the way.  Still others find that the problem is that healthcare providers simply don't have the time to sufficiently educate patients.  No doubt these researchers are on to something. But in the meantime, maybe we need to stand on a few desks.

Maybe we need to stop spending so much time studying psychosocial behaviors and societal beliefs and external barriers to compliant self-care.  Maybe we need to look at a person's instincts and how that affects the way they approach their life in general, and their diabetes in particular.

Leveraging striving instincts to generate more effective results

At a recent conference, Kathy Kolbe - who has been studying conation (striving instincts) for more than 30 years - revealed that when a person strives in harmony with their instincts, their brain clearly shows minimal engagement with maximum results.  And the opposite is also true: When working against instincts, the brain is highly engaged but produces minimal results. Kolbe calls these striving instincts Action Modes®.  She considers these Action Modes to be 'talents'.

The Four Kolbe Action Modes are:

Fact Finder - how we gather and share information

Follow Thru - how we arrange and design

Quick Start - how we deal with risk and uncertainty

Implementor - how we handle space and tangible solutions

Each Action Mode has three operating zones: Prevent, Respond or Initiate.  We may initiate in Quick Start, respond in Follow Thru and Implementor and prevent in Fact Finder.  According to Kolbe, any possible combination creates a unique way in which we initiate actions, respond to opportunities or prevent problems.  The combination of the modes and zones makes up a person's MO (modus operandi).

How can we apply this to Diabetes Self-Care?

Imagine you've just been diagnosed with Type 2 diabetes and your doctor/healthcare team provides you with an approach which has been customized for your striving instincts.  Suddenly your self-care plan will require less energy while yielding better results.

Now we're standing on a desk!   Instead of the doctor wondering how to get you to comply with the required protocol, they approach you ready to engage your unique talents to effectively manage your own Diabetes Self-Care.

Using the Kolbe approach, your doctor knows your MO because, in addition to your blood tests, s/he also had you complete the Kolbe A instrument during your first office visit.  Now the whole staff - the doctor, the nurse practitioner or PA, the nutritionist, maybe the social worker - all know your talents and how you approach the world, and can tailor your self-care education process accordingly.  And now, managing your life with diabetes doesn't seem as difficult - because they're engaging you at your striving instinct level.

This is just my theory.  But maybe, instead of studying the same things over and over again hoping that we'll suddenly find the answer all the previous researchers have missed, we need to study this:  How can we make better use of our knowledge of how people interact with their world, via the Kolbe instrument, to make a huge difference in Diabetes Self-Care - and thereby prolong and save lives?