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The power of habit

I’ve just had a few weeks away, once again holidaying in Portugal. Yes. I’m a creature of habit but I do love the Algarve. I love the sun, playing tennis, eating lots of fish and reading lots of books which I don’t always get the chance to do when I am back home.

And I decided to re-read the brilliant The Power of Habit but Charles Duhigg. I love this book because it talks about how habits are formed. Apparently 40% of the actions we perform on any day are not actual decisions, but habits. From brushing your teeth or driving, to whether you go for a run when you get home or slouch in front of the couch. All are habits and it’s possible to create both good and bad ones.

The book looks at how habits emerge. It looks first at individuals and how we build new habits and change old ones; apparently it’s because the brain is always looking to save effort through creating new habits so brain power can be saved for other tasks. When a habit emerges, the brain stops being involved in making decisions. So to change a habit you have to fight it!

Duhigg then explains how marketers use their knowledge of how habits are formed to get us to buy their products. Apparently there is always a cue, a routine and a reward. So, to first market toothpaste in the US and turn it into an international habit and (good) obsession, they used the cue of “get rid of the film on your teeth” - through the routine of brushing with the reward of a fresh tasting mouth (which is unrelated to the effectiveness of the toothpaste).

The book also explores how people have lost weight, or given up smoking or alcohol through knowledge of how to change habits. I love this because unless we think about the psychology of how we are all programmed and the best way of supporting our patients and our staff to make positive lifestyle changes, we will continue to eat, drink and smoke too much and not exercise enough, which will all mean that we be in poor health for longer as we age.

This is one of the reasons we are increasing support for our patients to achieve their improvement goals. Did you know we have a child psychiatrist, Emily, who supports kids and their families to improve their management of children’s diabetes or childhood obesity? It’s also one of the reasons that we have a public health consultant and a public health registrar, to think about how we shift a focus onto prevention rather than just cure. And it’s one of the reasons we have rolled out health coaching, led by the brilliant physios Trudi, Nina and Zoe, to give more than 300 of our staff in the hospital and community the tools to support patients to achieve their goals.

The book then looks at the habits of successful companies and organisations. It explains how Paul O’Neil became CEO of ALCOA, a struggling aluminium manufacturer, and turned it around by having a relentless focus on safety, what Duhigg calls a keystone habit. O’Neil set the company, which had a poor safety record, a goal of zero injuries. Using something like an incident reporting system, like DATIX, and giving people the freedom to speak up and improve, O’Neil transformed ALCOA into one of the safest and most profitable companies in the world.

Our keystone habits are contained in our trust values. FIRST. First for patients. Integrated. Respectful. Staff focused. Team working. They are all keystone habits that have transformed our hospital and community services into some of the best in the country. Indeed, I don’t know whether you saw but latest figures from NHS England highlight that our areas is the best in the country for minimising the amount of time that patients stay in hospital; technically, because of close working with partners, we have fewer excess bed delays than any other part of the country. Wow!

I thoroughly enjoyed the book and will continue to think what more we can do to develop successful habits and routines in our hospital and in our community to ensure that we continue to provide some of the best care in the country.

I also read the brilliant This is Going to Hurt by Adam Kay, and Complications by Atul Gwande. Kay’s book is another must read. It’s a funny and poignant narrative on what it means to be junior doctor in obstetrics and gynecology. It makes me even more appreciative of what our junior doctors have to do and it reinforces to me what a noble thing it is to work in the NHS. Gwande’s book is equally worth a read, especially the chapter on hand washing and the struggles the medical profession has had in trying to make this a keystone habit.

So go on. Change a bad habit for a positive one. Like reading instead of watching the TV. But get a bit of help by understanding some of the science!

It’s good to be back.

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Chief executive, Steve Dunn

Chief executive, Steve Dunn