Practice Matters

Pooling the power of goodness to create change

Hospitals have always seen shortages, suffering, and death. But recently greed and competition have entered the mix. Nonetheless, some communities still manage to serve the neediest. Grand Junction, Colorado, is one such place-a model of low-cost, high-quality, near-universal health care, even though "doing the right thing" costs money. The community has achieved this by focusing on human values and public service. No competition, no cornering the market, and no market-driven product lines.

For most of us, the last 25 years of organizational change have not been humane or effective in reducing costs. Resistance typically engenders a response that blends authority, power, and dominance. This robs managers and staff alike of the qualities human beings value most‚Äîcaring, kindness, cooperation, and love-things that patients (today’s "customers") need as much as they need competence.

Change is effective‚Äîfor good or ill‚Äîto the extent that persons, situations, and systems are aligned. According to author Phillip G. Zimbardo, "The Person is an actor on the stage of life whose behavioral freedom is informed by his or her makeup-genetic, biological, physical, and psychological. The Situation is the behavioral context that has the power, through its reward and normative functions, to give meaning and identity to the actor‚Äôs roles and status. The System consists of the agents and agencies whose ideology, values, and power create situations and dictate the roles and expectations for approved behaviors of actors within its spheres of influence." Today’s system and its leading actors are aligned with a competitive business model, creating situations in which certain patients (chronic, long-term, medical) aren’t profitable-and therefore aren’t desirable. The same goes for healthcare professionals whose values, specialty, or seniority make them unprofitable. We’ve managed to create a business system that encourages the worst characteristics any caregiver (actor) could have: greed, speed, and indifference.

Can we change it? We might, like Grand Junction, Colorado, try pooling goodness, step by step. This involves the "foot-in-the-door" (FITD) technique, which begins by asking someone to do something small (the person usually agrees to this), then later asking for a related but larger request (the actual goal). The same approach works with other positive behavior. Researchers found that merely signing a petition leads to increased monetary support for the handicapped, filling out a brief questionnaire increases willingness to donate organs after death, and making a small public commitment increases recycling efforts.

Providing role models is even more effective than FITD. Studies show altruistic role models increase
the likelihood that those around them will engage in positive behaviors. Specifically, they found that role modeling:

  • increases donations to the Salvation Army
  • encourages people to help strangers fix a flat tire
  • lowers aggression rates
  • promotes nonviolent responses and a willingness to share resources with others.

Models persuade far more effectively than words. However, if leaders don’t model altruism, they will sow cynicism.


Finally, communicate positive expectations. When you tell people they are helpful, altruistic, and kind, they tend to do helpful, altruistic, kind things. Studies show that thanking people for their generosity encouraged them to make larger contributions, noticing a kindness frequently increases the likelihood that people will help others, and identifying blood donors as such makes them more likely to continue to donate blood.

Grand Junction, Colorado, achieved the seemingly impossible by pooling the residents’ goodness, with community leaders demonstrating the values they proclaimed. (Some may call it expertise; I prefer the term values.) I have a deep respect for them and a heightened awareness of how commitment and compassion can do more to transform health care than any competitive business model can.

Leah Curtin, RN, ScD(h), FAAN
Executive Editor, Professional Outreach
American Nurse Today

Visit www.AmericanNurseToday.com for a complete list of references.

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4 thoughts on “Pooling the power of goodness to create change”

  1. Leah Curtin says:

    I think RNexcellence has a point: relying on altruism sounds good,but a well run, publicly funded program helps assure some measure of fairness for all. I also think Joanne is right: one cannot promote excellence by rewarding or promoting greed. Financial incentives are not effective — and the data, particularly with ‘pay-for-performance’ support this statement!

  2. RNexcellence says:

    Grand Junction Colorado is one thing. New York City is quite another. We need a system that can serve both equally as well!

  3. Joanne says:

    If, as you say, goodness is a paramount value, why is it that government and private. Sector alike try to change behavior by offering financial incentives and disincentives?

  4. Marilyn says:

    It is so good to read something uplifting and hopeful! Thank you Dr. Curtain!

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