Factfulness by Hans Rosling and Moment of Lift by Melinda Gates are two of the best books I read in recent times. They expand your worldview, and they both share valuable lessons in leading change. I developed boundless respect for them after reading their books. For those leading change in healthcare, the principles described in these books are profoundly applicable. I believe everyone in healthcare must read these books, and internalize their approaches to improvement work.
Factfulness refers to the habit of carrying only the opinions for which one has strong supporting facts. Through a number of questions, he encourages the reader to embrace a fact-based worldview and to use data to tell the truth and not as a call to action. The world is not as bad as it seems. In the book, he describes ten instincts that we need to be aware of and consciously overcome.
Gap instinct makes one have a strong dramatic instinct towards binary thinking. To avoid this instinct, look for the majority. Negativity instinct makes one think that things are getting worse. To control the instinct, expect bad news and beware of rosy pasts. Straight line instinct makes one think that straight line trends in the past will continue to grow in a straight line. It is important to remember that the trends may bend in different ways. Fear instinct is triggered by our natural fears of violence, captivity and contamination that make us overestimate the risk. Calculating risks is a way to control the fear instinct. Risk = danger x exposure. Hans Rosling advises us to make as few decisions as possible until the panic has subsided. Size instinct is triggered when a standalone number seems impressive. Remember that you could get the opposite impression if it were compared with or divided by some other relevant number. Generalization instinct makes us use one category to explain another category. Questioning the categories and looking for within group differences and between group differences is important to overcome this instinct. Destiny instinct is triggered by labeling people, countries and cultures as being a certain way and that they will not change. Remembering that slow change is still change, helps one control the destiny instinct. Single perspective instinct highlights how a single perspective can limit one’s imagination. Using a toolbox and not a single tool is a way to control the single perspective instinct. Blame instinct is the urge to find a scapegoat. Looking for causes and systems and not villains and heroes helps control this instinct. Urgency instinct makes a decision feel urgent. Taking a breath, insisting on data, and taking small steps is a way to control this instinct.
He emphasizes that humility and curiosity are the most important tools to fight ignorance. We need to spread a fact-based worldview as it is more useful in navigating life. It also creates less stress. How wonderful it would be if we used a fact-based worldview to navigate the current healthcare industry!
Melinda Gates walks the reader through moments of lift in her own life and the people who created them for her, while she making a strong case for inclusion and lifting up everyone, particularly those who are not heard. Although leaders in healthcare address problems that are different in nature, scale and complexity, the approaches she used are very much applicable in clinical care improvement. She begins work on a new issue by thoroughly researching and analyzing it. She learns as much as possible from the people living with the issue and observing them, and stays open to learn new facts and acknowledge incorrect assumptions. “Their cup is not empty. You can’t just pour ideas into it. Their cup is already full, so you have to understand what is in their cup.” She argues that there is something empowering about being asked what their story is and what they think. By discovering hidden biases and balancing relationships, we can break a culture of dominance and activate power in everyone. We need strong voices, not loud voices.
Like Hans Rosling, who was a good friend to her, she emphasizes that false information is disempowering. The art of change is subtle; it hinges on not judging from the outside, but on discussing from the inside. Change comes from inside the group when the members talk about actions that are commonly accepted, rarely discussed, and often considered taboo. She says that great leaders never combine a call for justice with a cry for vengeance. There is immense power in the act of people coming together to collectively reflect on their deepest values, to question if current attitudes and behaviors were in fact violating those values. The stories she tells break your heart, inspire and illuminate the process of change.
At the heart of culture change in a group is empowerment and creation of a new culture of inclusion. Every one whose voice was not heard previously deserves education and support to find their voice and confidence. She says that a sign of an abusive culture is the view that members of the excluded group (e.g., women in leadership) “don’t have what it takes.” Gender diversity is not just good for women; it’s good for anyone who wants results. She makes a case for workplaces compatible with family life. Overcoming the need to create outsiders is our greatest challenge as human beings. We have to wake up to the ways we exclude some people and see the whole picture. An inclusive world is a better world to live in.