I recently wrote about Robert Maurer's new book in this post: “Start 2013 with “The Spirit of Kaizen“
I think the one core lesson from the book, related to new year's resolutions, would be to start small. If you're wanting to exercise more (and maybe have already given up on that), start with just a minute of exercise a day or start with one pushup… and then move up and increase your workouts gradually from there.
Why start small, with goals that are less scary? Because big changes ARE scary. Maurer talked about that brain science in Podcast #153 last year. I now have a podcast of that episode to share for those who don't listen to the podcasts.
You can also now buy an eBook that contains some of my favorite podcast transcripts (including this one), via Amazon.
Partial Transcript:
Mark Graban: Hi, this is Mark Graban. Welcome to podcast 153 for July 24th, 2012. Joining me today is Robert Maurer, PhD. He is director of behavioral sciences for the family practice residency program at Santa Monica UCLA Medical Center, and he's a faculty member with the UCLA School of Medicine. In this episode, we're talking about an excellent book that he wrote called “One Small Step Can Change Your Life: The Kaizen Way.” Yes, that's right, kaizen, and it's a topic near and dear to my heart, of course. I discovered Dr. Maurer's book when doing research for our book, “Healthcare Kaizen,” with Joe Swartz.
I blogged about the book. There's a review posted. I'll link to it here in the show notes at leanblog.org/153. It's really interesting to hear Dr. Maurer write about and talk about applying this kaizen, continuous small change approach, in the realm of therapy instead of the workplace.
He writes about the brain chemistry that causes people to fear change, this is, if you will, our reptile brain, except when it's small changes. It's really fascinating stuff. I'm thrilled to have a chance to talk to him and to share our conversation with you. For this and all episodes, you can go to leanpodcast.org. Thanks for listening.
Mark: I'm really curious how you first go exposed to kaizen from your perspective. We think of kaizen and lean as being workplace improvement methodologies. You're working with individuals focused on their lives. How did you get started with this?
Robert: In a very roundabout way, given this opportunity I have in family medicine, it presented some unique fascinations and some amazing frustrations, because most therapists sit in an office or a clinic waiting for people to create enough pain in their life, run out of excuses. Then they come in late in the process, whereas the average Americans go to the doctor three or four times a year for relatively ordinary kinds of concerns.
Here's this amazing opportunity, Mark, to be in an exam room, seeing a patient before they get married and create marital problems, before they have children that they have problems with, before they become depressed, yet we had no tools on how to predict health in people who are essentially there for brief amounts of time.
Long story short, I began collecting studies from around the world on people who were succeeding in their jobs, their health, and relationship over long periods of time. There are about two dozens studies that have followed people anywhere from 15 years to 70 years to see, again, what predicts success in all three areas of life, health, relationship, and work.
One day, I was reading the newspaper, and there was a full page ad for the Toyota brand of Lexus. For the umpteenth year, they had won the J.D. Power customer satisfaction award.
A thought went through my mind, “Well, maybe metaphorically, there's something about building a highâ€'quality car consistently year after year that, metaphorically, I might be able to apply to human behavior.”
I started to look at the history of Toyota and Lexus, and there's a book called “The Machine that Changed the World,” I think by a man named Womack, if I remember right. I thought it would be about computers, but as you probably know, it's about automobiles.
In it, he talks about Dr. W. Edwards Deming, and the idea of small steps that they introduced in manufacturing in World War II, and that was then Dr. Deming and the concepts of small steps to improve quality products was incorporated into the whole Japanese philosophy embraced by Toyota, etc.
That was how I got introduced to kaizen, through trying to see metaphorically if there was something about a quality car I could apply to a quality life.
Mark: How did you get started with applying these ideas, then, with the patients in the realm of therapy?
Robert: In the clinic in which I work, our major focus is, of course, in terms of physical health. That was my first interest, although I'll take you through a little bit of the research on the couples work, which has even more dramatic impacts for kaizen, because we see a lot of people, like a lot of your listeners, who are leading very busy lives, and have very little time to do the kinds of things that we know people need to do in terms of exercising an hour day, etc., etc.
We found that if we could get people to exercise one minute a day, every single day, all of a sudden we took away all their excuses, because if I ask you to exercise an hour a day, you've got all kinds of good reasons why you don't have time to do that, but if I ask you to exercise in place while you're watching TV one minute a day, then all of a sudden you're developing a habit.
Years ago, Mark, before I heard of kaizen, there was this world famous expert at UCLA giving a two evening course on cancer pain. At the end of the night, he said to these cancer patients, “I want you all to go home and meditate for one minute.”
I waited for all these patients to leave, and I went up to the professor and said, “Sir, why are you asking them to meditate for one minute? It's not enough to do them any good.” He patiently said to me, “How old is meditation?” I said, “Thousands of years old.”
He responded, “Correct. There's a good chance everybody in this room has heard of it before tonight. Those who like the idea have already found a book or a teacher, and are doing it. For the rest of the people in this room, meditation's the worst idea they have heard of.”
“I'd rather they go home and meditate for one minute than not meditate for 30. If they discover they like it, they may forget to stop,” which is what the research argues. It was a study done in Seattle, where they looked at people who, over the course of an entire, gardened or walked for just an hour.
That's a total in the whole week, which is about 450 calories, and lowered their risk of cardiac death by 70 percent.
A study in the Journal of Clinical Nutrition, a couple of years ago we found, talked about the fact that if you exercise three minutes at a time for a total of 30 minutes a day, but just three minutes at a time, even climbing steps in your office building, you had the same reduction in cardiac risk as someone that was exercising 30 minutes a day.
The Framingham study, the most famous of the prospective studies, were in 1984, they began following 5,200 people, and they found if you took one pound off a year for four years, that is, again, four pounds total, and kept it off, you reduced your risk of hypertension by 25 percent.
My favorite study, and then I'll talk a little bit about the couples research, was done at the Mayo Clinic, where they developed essentially a pedometer that you wore. It's called a “data logging underwear” You have to see it to believe it. They looked at people who never set foot in a health club, but who were, in spite of that, either thin or quite heavy.
What they found from the data logging underwear is people who were thin simply moved more doing the day. On an escalator, they walked up instead of just standing there motionless. In their office, they would pace when they were on the phone. When they went to the Costco lot, they'd park at the very end instead of driving around, trying to find a space close to the door.
They simply moved more, which added up to, on average, 300 calories a day, and an average of 30 to 40 pounds of weight loss in a year.
I'll give you some more of these studies if you want, but again, in our 70 millimeter Dolby, super-sized, extreme makeover culture, it's just hard to believe these small steps could have such profound influence on the body.
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Good stuff, Mark. I think we sometimes forget the human behavior aspects of change, and the idea that many small changes will add up to significant improvements.
Thanks, Dean. I think it’s also important to talk about how looking for small improvements (and implementing small improvements) often allows us to stumble across a large opportunity… the research and experience seems to show the “small improvements” approach is more likely to work than going out and intentionally looking for big improvements.
But you’re right that lots of little improvements, without any big ones, will add up to a large benefit.
And my somewhat educated guess on why we focus on the big improvements, and not the small, is because the small can’t be measured, put into a Powerpoint presentation, and shown to the board of directors to allow us to fund more improvement activity. Sad, but true in some instances. That’s why enlightened leadership is a HUGE part of what we do.
Agreed. Here’s to hoping we can inspire more healthcare senior leaders to be so enlightened.
As Dr. Deming said (and we quoted in Healthcare Kaizen):
“One cannot be successful on visible figures alone … the most important figures that one needs for management are unknown or unknowable, but successful management must nevertheless take account of them.”
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