The rider and the elephant: Switch book details how to create change.

• Author: Linden, Russ
• Position: The Bookshelf - Switch: How to Change Things When Change Is Hard - Book review

Switch: How to Change Things When Change Is Hard

Chip Heath and Dan Heath

Random House

2010, 320 pages

If you'd like to read a book on making organizational change happen that's very practical, organized around an easy-to-understand framework, and filled with great examples, I recommend you put Switch: How to Change Things When Change Is Hard at the top of your reading list. The authors, Chip and Dan Heath, successfully integrate the latest brain research into a simple (not simplistic) model for leading change, and they delight the reader with amazing examples told in a smart, colorful manner.

The model has three parts, all of which are demonstrated in this extraordinary story.

On December 14, 2004, Don Berwick, who was then CEO of the Institute for Healthcare Improvement, delivered a talk at a hospital administrators' convention. Berwick had ideas for saving large numbers of lives by significantly reducing the "defect rate" of certain procedures using process-improvement procedures that had been very successful in other industries. His research convinced him that these procedures would make a huge difference, but he couldn't require physicians to change their practices. So he challenged the hospital administrators in the room to step up.

"Here is what I think we should do," Berwick said. "I think we should save 100,000 lives. And I think we should do that by June 14, 2006. 'Some' is not a number; 'soon' is not a time. Here's the number: 100,000. Here's the time: June 14, 2006, 9 a.m."

No doubt the administrators' jaws dropped. But Berwick was just getting started. He then spelled out six specific interventions that had been shown to save lives (such as keeping a pneumonia patient's head elevated at a certain angle so that oral secretions wouldn't go into the windpipe). But the administrators needed more than information; they had to be motivated to take on the many barriers to change in their institutions.

Berwick then introduced a mother he'd invited to the convention. The woman's daughter had died because of a hospital's medical error. Then a second person spoke, the chair of the North Carolina State Hospital Association, who said that "an awful lot of people for a long time have had their heads in the sand on this issue [of injuries and death caused by hospital errors], and it's time to do the right thing. It's as simple as that."

The campaign to save 100,000 lives began. IHI provided participating hospitals with step-by-step...