A Resolution on New Year’s Resolutions

I find the desire to make new year’s resolutions to be fascinating given that there are two truths collectively assigned to them:  one is that everyone makes one, and two is that everyone gives up on it a week or two in.  It almost feels like we enjoy setting ourselves up for failure and we like feeling bad or ashamed about our lack of willpower.¹  Even those out there who will proudly boast that they won’t make new year’s resolutions still make decisions to change, either personally or professionally.  So while they don’t label it as a new year’s resolution, it functionally is one.  In the corporate space, while no one calls them that, any action plan is just a new (fiscal) year resolution, albeit perhaps with a Gantt chart. 

So, no matter what we call it, or who owns it, the question is: what makes a successful resolution?  Is there a way to turn this ritual into a long-standing change and not another reason to berate ourselves and our failures?  My personal track record with life-changing decisions is spotty, but I have identified four things that make the process more successful.

Be Incremental

The real problem with resolutions is that since they target the biggest flaw that we see in ourselves (or our department, hospital, clinic, etc.), they carry a sense of importance and urgency.  As a result, we tend to make grand sweeping statements of change.  “I will do the treadmill an hour every day and eat only crackers and dust until I am back at my high school graduation weight!”  You may smile at this and feel confident that this resolution did not make more than seven or eight hours after it was uttered.  But before you smugly dismiss this, consider the resolutions you have made.  The resolution itself seems to demand some broad all-encompassing promise.  But because they demand significant behavior change immediately, they rarely last until the ink is metaphorically dry. 

Instead consider something more incremental.  Instead of life-changing exercise regimens, try “I will take the stairs instead of the elevator” or “I will take the stairs once a day instead of the elevator” or “I will take the stairs DOWN once a day instead of the elevator.”  These still require immediate change, but since they ramp down the initial commitment, they are more likely to survive the first week.  While they seem less dramatic, I would argue that a successful, but less dramatic resolution is better than a broad sweeping and completely ignored resolution.  Plus, it allows room to grow.  So, after successfully taking the stairs once a day for a week or a month, it allows you to up that to twice a day.

Be Concrete

Whether focusing on a resolution or an action plan, one needs to be explicit with the work.  The problem with directional words such as “more” and “less” is that they are only comparable to a baseline and that baseline is usually not clearly established or honestly understood.  So, for example, if someone pledges to “eat less junk food,” the first question is how much junk food to they currently eat?  Most people will give an answer to that question that is unclear, unhelpful, and perhaps delusional. 

• I eat some, or I eat too much.  Neither of these answers give a good baseline.  The person is committing to eat less junk food than some, or less junk food than too much.  Eating less than some would still be, by definition, some.  Likewise, eating less than too much might still be too much.  Even if there is improvement, it might not be noticeable given the vague baseline.
• It depends on what you consider junk food.  Like with the quantity, this throws open the door to how to define the target of the resolution.  A bag of chips or a soda may count at junk food, but is the bag of chips and soft drink you have with a healthy salad for lunch considered junk food?  Is a fast-food breakfast sandwich or hamburger that you wolf down as you are busy working considered junk food? 

Here even the benchmark is ill-conceived even if one is not being delusional or unaware.  I remember keeping track of the sugar I consumed.  I don’t generally eat candy and do not buy cans of soda out of a vending machine.  I might have one or two beers a week.  So, I did not think sugar was a major element to my diet.  But in documenting it, I realized that I did drink soda when I went to lunch with my friends, even when I would otherwise have a healthy lunch.  I would have a healthy dinner, but I would also not pass up dessert.  I wouldn’t eat candy bars, but I do make a mean bowl of homemade caramel corn.  So, clearly I had a belief that was divergent with the facts. 

Because they are not clearly quantifiable, it is difficult, if not impossible, to mark improvement.  So, it is better to ask the question, “how many cans of soda do you drink?” or “how many fast-food lunches do you eat?” or “how often do you eat between meals?” 

These have baseline values and therefore have opportunities to create measurable improvements. 

Likewise, a patient experience action plan that simply says, “Be nicer” is destined to fail.  Since we don’t know what ‘nice’ means, we cannot set standards for improvements in niceness.  Or, like junk food, we may all have different definitions of what ‘nice’ looks like.  Once we define ‘nice’ as sitting down when talking, or making eye contact while talking, or not interrupting when someone else is talking, we can take inventory of our performance.  It also can allow us to identify gaps.  I once worked with a physician’s group, and we collectively decided that the key metric was sitting down when talking with a patient.  Once we had that goal, we could round on that goal and ask doctors, “how often did you sit down?”  Not only was this less subjective and potentially insulting that asking, “how often were you nice?” it also allowed us to identify gaps.  It turned out, for example, that the number one reason why a doctor didn’t sit was because there was no available chair, either because a family member was in it, or the chair had gone missing.  We then worked on Plan B strategies for what to do when the chair was occupied or missing.  This included getting more chairs, where appropriate.  None of this would have happened if the doctors were simply charged with just being nicer.

Focus on Integration

Pledging to do the treadmill for an hour every day often fails because it misses the core question: Where is this hour?  You might say, “I waste more than an hour every night watching TV so I have the time…” and that may be true, but keep in mind the context of the resolution and not just the resolution.  When you sit down to watch TV, you may be tired from a day at work, and you just ate, and you don’t want to go to bed sweaty.  These are all good excuses for not getting up, going to the gym and working out.  If you decide to do it in the morning, before you eat and shower, you need to get up an hour earlier, which means going to bed an hour earlier.  It is often not the act itself, but all the collateral issues associated with that act.  It isn’t always about time, but that is the most obvious issue to identify. 

I remember working with a lab manager and he was frustrated because he could not get his staff to do AIDET before engaging in care.  He said, “I mean it only takes TWO MINUTES!”  I asked how many patients his staff saw on an average day and he said “about 40 or 50”.  I pointed out that two minutes times forty patients meant that he added eighty minutes on to his staff’s day with this request.  Confronted with this math, he realized that we needed to help his staff more efficiently integrate the service element into the workflow.  This meant retraining his staff to not see this as a two-minute thing added onto the existing work, but something that could effectively be done WHILE doing the work. 

Pick something you like

This may strike some as odd, since a resolution is supposed to address a flaw and somehow we all believe that you address a flaw by being miserable—by denying yourself pleasure, or snapping a rubber band on your wrist, or eliminating all free time in the quest of an aggressive exercise plan.  That flaw is bad so we must punish ourselves for being bad.  Not exercising?  Well, then, an hour on the treadmill or stationary bike for you!  You must atone for your sins!  Pain is just weakness leaving the body!  Some can respond to this.  I have a friend who has one of those stationary bikes that allows you to virtually join a spinning class and he likes the German woman who shouts insults (in German) to motivate the group.  That is certainly not my kink, but who am I to judge what works for him?²

But many people (most people?) do not respond well to dreary soviet-style exercise, full of repetitive monotony and insults.  They will engage, but you must meet them half-way.  My doctor got me to exercise more not by telling me to create a window for treadmilling or cycling, but by having me reframe what exercise looks like.  Taking my dogs for a walk and doing yardwork both count as exercise.  Since I enjoy doing those things, it is also exercise that I will do.  This also reframes what ‘more’ looks like.  I already like playing with my dogs, so having me play a bit more with them does not feel like a sacrifice. 

But I can hear you say, “Action plans at work are different than resolutions because I don’t choose them.  They are thrust upon me.”  This is true, but this truth does not change the reality of what a successful one looks like.  Too often action plans at work focus on the punitive and not the celebratory.  They focus on the failure and not the success.  This is because action plans are generally assigned to people who are failing.  So, the very act of building one is punitive busy work.  Given this, they rarely focus on doing more of something you like but instead focus on forcing you to endure doing something you don’t like.  The best-case scenario is that they focus on abstract concepts that cannot be measured well, like “pay greater attention to…” or “focus on the data more…” which is just as vacuous and unquantifiable as “be nicer.” 

 But the real question is why does leadership keep demanding the same thing over again and expecting different results?  It is because leadership often misdiagnoses the problem.  They often think that people fail because they aren’t trying hard enough to succeed.  If I had a nickel every time I heard the c-suite at a hospital say, “You gotta want it hard enough!” I would be able to take my wife out to more restaurants that have cloth napkins.  When they start with this mindset that people fail because they don’t want to succeed bad enough, everything that flows from this feeds on that judgmental negativity. 

There is a reason why the staff at many organizations view process improvement strategies as “the beatings will continue until morale improves” or that every time they are called to present at senior leader meetings, they feel as if they are taken to the woodshed.  It is not surprising that in this environment, calls for improvement are not seen as liberating, but as confining.  Can this managerial style raise scores?  Sure.  Can this approach lead to sustained success?  No.  You can only beat on staff so much before they tune out the message.  Further, the moment that the scores creep up, some leaders will use this as a bullet point on their vita and apply for other jobs.  Usually any gains realized are quickly lost in staff turnover.

Yes, as I have discussed before, there are people who are able, but not willing, but when it comes to improvement, most people want to improve, but don’t know how to set incremental concrete goals that dovetail with current process and focus on the joy of work.  They feel pressure from leadership to FIX IT NOW! and so they immediately skip useful incremental change and focus on the broad flashy work that sounds sexy but cannot be sustained. 

As the new year settles in, and we all dig out from that delayed work³ it is important to remember that incremental improvement is the only way to build success in the outcome and appreciation in the process.

¹Now, I will happily concede and even celebrate that there are some out there who can make a grand resolution and stick with it just as there are those who can successfully remain in recovery from an addiction. It certainly is NOT easy or simple.

²Though, I guess calling it a kink is really me judging him.  In my defense, I don’t do it behind his back, but to his face, so perhaps this is less about judgement and more about me being a poor friend. 

³My biggest pet peeve are all those people who I told “Let’s circle back to this in the new year” who have the temerity to circle back to me in the new year.