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g the Switch: Practical Advice on Changing Behavior

Aug. 9, 2011
Carol Jahn offers some practical advice on changing behavior among dental hygiene patients.

by Carol Jahn, RDH, MS

Every day, as dental hygienists, we are faced with the challenge of trying to get patients to adopt healthy behaviors. Sometimes we are successful; sometimes (let’s be honest, many times) we are not. And most of the time, we really aren’t sure what contributed to either success or the lack thereof.There are a plethora of books on the psychology of changing behavior. One of the more recent is called Switch: How to Change things When Change is Hard. The authors are Chip and Dan Heath, brothers with backgrounds in psychology, business, and organization behavior. Of all the books I’ve read on this subject, Switch is the one that truly resonates and has great application for dental hygienists.Using the analogy of an individual riding an elephant (stay with me), the Heath brothers postulate that there are three critical strategies you have to do to get things to change. 1. Direct the ride by appealing to their rational sideMore than anything, this is about providing clarity. And one of the most important things to get clear on is what works. Follow the bright spots by figuring out what’s already working and building on it. Think about the patients that you have had success with – ask them what made a difference. This is important because what they tell you and you think it is are likely two different things. Once you see what trends emerge, you can move forward with other patients by scripting the critical moves or those specific things that might work for them. This might sound something like "Other patients like you with orthodontics have found the Water Flosser really helpful, and I would recommend it for you." The final piece of this is pointing out the destination. In many ways, we do this already; yet if we want behavior change, we also have to help people know why it’s worth it from a positive perspective. So rather than saying something like if you don’t do this it will become worse and you might need surgery, try saying, if you do this, you can stop the bleeding and have healthier tissue.2. Motivate the elephant by appealing to their emotional side
When patients aren’t compliant, our natural instinct is to provide more information/education on why they should change their behavior. Yet the Heath brothers found that knowing something isn’t enough; it’s feeling something that drives change. How can we do this? One way might be to take a photo of the problem — swollen tissue, decay, broken filling, etc. — and another photo of a healthy area and show it to them. Why do things like this work? Who among us hasn’t seen a photo of ourselves and had that "a-ha" moment that it was time to lose weight, change our hair style, or color our gray. Another key element is to try and shrink the change. What this means is to break it down into manageable bits. If you patient seems overwhelmed by having to do something every day or multiple times a day, start out by asking them how often it would be reasonable for them to do it, and begin there. What does this do? It helps build confidence. New runners don’t start out running marathons; they train to get to that point. Start small and develop a growth mindset — if you did this, next time you can do this.3. Shape the path — clearing the way to help them succeedRemember the definition of insanity — doing the same thing over and over again and expecting a different result? If you want to change behavior, change the situation. If your patient hasn’t flossed in five years, they never will. Recommend something easier. If you want to build the habit, help them find things that they like and will use. It’s human nature to like something that makes life easier. Help them find triggers to encourage new habits. A Water Flosser on the counter is a lot harder to ignore than floss in the drawer. Finally, share your successes — not just with the patients but with your co-workers. If you recommend the Water Flosser and the doctor walks in and asks if the patient is flossing, you’ll create confusion and erode the confidence you’ve worked hard to build. The clearest path is one where everyone walks the talk.This is just a brief synopsis of the wisdom of the Health brothers. For more examples and greater depth visit

Carol Jahn, RDH, MS, has been a dental hygienist for 28 years and is the Senior Professional Relations Manager for Water Pik, Inc,