Brothers Chip Heath, Stanford Graduate School of Business Professor, and Dan Heath, Duke University Center for Advancement of Social Entrepreneurship senior fellow, have followed up their Made to Stick with an excellent piece on how change can occur despite the myriad of forces that oppose change. A very dramatic case study they cite is that of changing the culture of how many hours hospital interns should be allowed to work. Anyone who is related whatsoever to someone in the healthcare profession knows two things: One, interns are expected to work infinite hours because that’s the way it’s always been done. Two, getting egotistical doctors to change doesn’t happen very easily- unless they think it is their idea.

However, the Heath brothers bring out a great example about how a hospital was able to change its intern work hours from 120 hours per week (the peer-pressure expectation) to 80 hours per week (the best medical practice maximum). This study takes into account two hospitals trying to make the same change, with one succeeding and the other failing. In the study, Hospital B had 66 percent of their superiors supporting the change while only 44 percent of Hospital A’s superiors supported the change. On the surface, the odds favored Hospital B to make the change. However, Hospital B failed miserably while Hospital A successfully implemented the change. Why?

The Heath brothers eloquently state that you can’t change behavior by implementing rules (or forcing people to do reports): “Change was coming into conflict with culture, and let’s face it, a new rule is no match for a culture.” The major difference between Hospital A outperforming Hospital B with the change implementation was obviously not the numbers of superiors who embraced the change. It was not the fact that superiors embraced the change (another false assumption about change: if the boss is for it, it will happen).

The reason Hospital A succeeded over Hospital B was there was a strategy involved with making the change occur. This strategy included creating a change incubator vehicle- a dynamic gathering, exchange, and discussion forum for those involved in the change process. It allowed for those that supported the change to reinforce each other and to prepare not only for the resistance to the change – but how they would counter the resistance to change- much like a salesperson prepares for objections on a sales call. Finally, by focusing on the goal and staying the course, the change occurred.

But change can’t be some random thing. Working with Bobby Unser on Winners Are Driven (Wiley, 2003), Bobby told me that “We always had a plan for a race, which put us ahead of about two-thirds of the competition right away because they didn’t have a plan. Then the race would be won by the teams that prepared the best, executed the plan, and ultimately were the quickest at adapting to changes during the race.”

Change can’t occur by assuming the numbers are in your favor. Change can’t occur by directive. Change can’t occur for the sake of change- it can’t be random- it has to be productive. Productive change occurs when the people who want to implement the change are allowed the opportunity to do so unfettered- and supported.