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Making training work – a final thought


Over the last few weeks the blog has been looking at why it seems that training doesn’t work and what you can do, as managers and the people commissioning training, to change that. I’d like to return to the topic for last look and to share with you something that I found whilst researching the topic.

Let me being by asking you a question. If you were diagnosed with a life-threatening illness but could avoid it by changing your behaviour, would you change your behaviour? If you said something like “yes, of course” you’re like most other people that I’ve asked that question. And, like most other people, you’re probably wrong: the sad fact is, statistically, you’re highly unlikely to change your behaviour.

Think about it this way. Healthcare in the US costs around $1.8trillion a year – the overwhelming majority of that is spent on illnesses caused by five behavioural issues: too much smoking, too much drinking, too much eating, stress, and not enough exercise.All of those things can be prevented or avoided by behavioural changes – but aren’t.

The most shocking example of this that I found was a quote from Dr. Edward Miller, the dean of the medical school and CEO of the hospital at Johns Hopkins University, one of the most prestigious medical institutions in the world. He was talking about patients with heart disease so severe that they have to undergo surgery, a traumatic and very expensive operation that can cost more than $100,000. About 600,000 people have bypasses every year in the United States, and 1.3 million heart patients have angioplasties -- all at a total cost of around $30 billion. These operations temporarily relieve chest pains but rarely prevent heart attacks or prolong lives - about half the time, the bypass grafts clog up in a few years; the angioplasties, in a few months. The causes of this are complex. Sometimes it’s a reaction to the trauma of the surgery itself but most patients could avoid the return of pain and the need to repeat the surgery – not to mention stop a disease that could kill them – by adopting healthier lifestyles. But very few actually do.

Says Dr Miller, "If you look at people after coronary-artery bypass grafting two years later, 90% of them have not changed their lifestyle. And that's been studied over and over and over again.And so we're missing some link in there. Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason, they can't."

Change is not hard to do – change can happen in an instant. We can all change things – and things can change for us – in a heartbeat. But, in the words of the Japanese proverb with which I started this blog, nearly a year ago, beginning is easy, continuing is hard. Studies in the US find that what doctors often do is try to motivate people to change with fear – they confront their patients with the ultimatum, change or die. The surprising thing is that people get used to anything: even the fear of death as a motivator stops working as we get used to the idea that we’re going to die.Now, doctors are changing to a more positive message: change and live consistently proves to be more motivating. People can change – we just need a positive reason

3 Responses

  1. a positive reason?

    I think it’s less about a positive reason.  I think it’s about people WANTING to change.  And if you want to change, you do.  People who find they can live without pain without them having to do anything (they are operated on by someone else, all they have to do is lie down and take the anaesthetic) see no reason to change their lifestyle. 


    — Karen, fe3 consulting

  2. Training “Change”

    I think there is an interesting, and important point that we as training designers need to examine in this post. People don’t like change. Especially people who have been doing some process for a long time do not like to change how they do things. As trainers and training designers it is our job, not only to give the workers the ability to make the change, but the desire to make it.

    How we can accomplish this motivation varies widely based on the task being trained, the corporate structure, and the audience. Still, this is something often overlooked when developing training, because we look at the subject and say, "Well of course they will want to change to do it right. It is the new way of…."

    If the audience is not trained in such a way that makes them want to change their behavior, the training will be less efficient if not entirely useless. 

  3. Training “Change”

     @W K P – You make a very good point and I agree with you completely; I think it’s more evidence for why trainers need to be involved in the process of understanding the need for training at a very early stage, way before we ever get to designing or delivering it.

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