The Snooze Button, a Physician Leader’s Enemy
Chris McCarty DO, MBA
Leadership Evangelist and Medical Doctor at WellSpan Health
For as long as I can remember I have hated the snooze button. I couldn’t put my finger on it (no pun intended… seriously). I tried it but, I would spend those few minutes dreading the next time the alarm would go off. Even today, I get mad at my iPhone because often I accidentally hit the snooze button instead of turning off my alarm in the morning.??
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It was not until recently that I figured out why I have a vendetta against the snooze button.?
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It is not that it is just delaying the inevitable, like slowly removing a Band Aid. It is that the snooze button starts of my day off with something that can be draining; making a decision.?
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We are all confronted each day with so many decisions that the term “decision fatigue” has been coined. Some estimate that we make around 35,000 decisions every day.? As a family doc I think this seems a little low.? Who wants to start their day off by having to make a decision the moment their eyes open in the morning???
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Let me bring you in on my typical morning routine. I wake up at 6 am (Yes, I know that many reading this article wake up before then. Good for you. For me 6 am is still a struggle). Then I have a 45-minute time for physical and spiritual exercise.??
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Of course, that is on a “typical” day. Is there such a thing? Not if I stayed up to watch a game, I don’t feel 100%, or one of my four young kids did (fill in the blank here). On these days, I used to play it by ear whether I was going to get up or early or hit the dreaded snooze button. As you can guess, that meant I did not have my time for physical and spiritual exercise, which I always regretted.?
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How do we "play it by ear” less and actually do what we know is best for us? How do we decide that we are going to decide.?
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Habits.?
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When I first started digging into the research around habits, I thought about those common things that everyone says they want to change. You know; exercise more, eat healthier, spend less time on my phone. Yes, these are all habits that we need to practice, however, they are just the tip of the iceberg. If we want to excel as physician leaders, we need to practice many, many good habits, and encourage them in our patients and colleagues too.??
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We can start by understanding the power, structure and formation of habits.?
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One of the pioneers of habit research is Charles Duhigg who wrote the bestseller “The Power of Habits.” With example after example, he shows how habits are incredibly powerful and practicing them enables us to make huge changes in our lives and the organizations we work for. One of my favorite examples is how Target advertises for specific items we want before we even realize we want them. If you want to argue the power of habits, think about some of the simple ones that have vastly improved the practice of medicine over the past 100 years: hand washing, timeouts before surgery, dual patient identifiers. These all required habit change and have led to countless lives saved.?
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As physician leaders, I think we can learn some lessons about forming good habits from B.J. Fogg, the author of “Tiny Habits.” Fogg proposes a model that shows that behaviors occur due to a combination of motivation, ability and prompting.??
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Let’s apply these principles to a common situation for a primary care doctor; encouraging patients to form the habit of undergoing colon cancer screening. The patient most likely to get a colonoscopy is someone concerned about colon cancer due to a friend or relative’s recent diagnosis (motivation), has good insurance and a support structure to help drive them to a colonoscopy appointment (ability), and just saw a flyer in your office advertising the benefits of early cancer detection (prompting). Just as we can find ways to support and encourage our patients to form habits, we physician leaders need to find ways to support and encourage our teams to form powerful habits through motivation, ability and prompting.?
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If we want to make a habit more likely to occur, we must focus on these three factors. Fogg, as you probably guessed it from the title of his book, is a fan of making tiny changes. Making these small changes becomes? a way of life that allows us to consistently accomplish our goals, which creates positive emotions and an increased desire to continue the habits.??
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Here’s another example. Maybe you want to give more positive encouragement to your staff. Instead of making a goal to daily encourage each member of your staff, you make a goal of daily saying one nice thing to one of your staff. You can do more if you want (and you likely would), however, to succeed you only need to do one nice act. Regularly achieving your goal makes the process fun, a key factor that Fogg thinks is vital to developing a habit.??
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Another excellent source is “Atomic Habits” by James Clear. What has made Clear’s book so popular is his simple formula to make a habit more like likely to occur:?
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These are all steps we can teach our patients to help them make habit changes that last. As physician leaders we can take this to a whole new level by creating system changes that ultimately create a positive effect on the health of our community. I love the example of British Cycling described in “Atomic Habits.” For decades their team struggled until they started a program of many small habit changes such as rubbing alcohol on their tires for a slightly better grib and painting the inside of their trucks white to identify dirt that could damage their bikes. These many small steps?created a system of “marginal gains”. While no one habit may have made a huge impact, the sum of each change lead to multiple Tour de France victories from several different riders.??
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As the healthcare field continues to rapidly change we need to think like British Cycling when it comes to forming habits. By working together and having each physician leader strive to improve their team’s performance, we can start our own system of “marginal gains” such as utilizing AI technology to improve the efficiency of our documentation or offer improved patient access using asynchronous care models. This aligns with our organization’s (WellSpan Health) vision of “Reimagining Healthcare” and allows us to work toward constant improvement.?
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As I was studying this topic, it dawned on me that forming desirable habits is?lean management in action. With lean management we continuously strive to take small steps to provide better care. We start to develop standard work, which could just as appropriately be named “standard habits”. These habits remove the wasteful variability and get everyone on board with the best and most efficient process to completing a task. Imagine if we had no standard work and every task you did throughout the day required contemplation of the best sequence of steps. You would quickly blow past that 35,000-decision quota! That is the scenario where mistakes occur.??
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This takes us back to that obnoxious snooze button. When my alarm goes off, my “standard habit” now is to get out of bed. I am at least one step into my day. ?
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Goodbye snooze button!?