Here is my premise: “Everyone is changing and adapting. Not everyone has completed the change.” I never believed this until about two weeks ago. My observations in the past always had me wondering why people don’t just change when they realize that their progress or results are not keeping up with where they want to be. So I’m looking at a doctor who, from my perspective, is self-sabotaging his/her practice by not adapting to an ever-changing Dental Culture. The new Dental Economy demands that we embrace change. Well, a couple of weeks ago I read a study on behavior. In this I was introduced to the Stages of Change Model that was originally developed in the late 1970’s and early 1980’s by James Prochaska and Carlo Di Clemente at the University of Rhode Island when they were studying smokers and their habits and addictions. They found that behavior change does not happen in one step. Rather, people tend to progress through 5 different stages on their way to successful change. Also, each of us progresses through the 5 stages at our own rate. So my revelation is that expecting behavior change by me simply writing an article, speaking to them, or even showing them how to do it better is rather naïve and counterproductive because they are not ready to change. Well there goes all my work for the last 30 years. This study showed that each person must decide for himself or herself when a stage of change is completed and when it is time to move on to the next stage. Moreover, this decision must come from inside you. Stable, long term change cannot be externally imposed. In a way I was forcing compliance but not really getting commitment from some of our doctors.
So allow me to “Dentisize” the five steps of change. The five stages of change with a sixth area that some of us will find ourselves in are:
- Pre-contemplation: You really have not acknowledged that there is a problem that needs to be changed. At this point you are not thinking about changing and are not interested in any kind of help. You will probably find yourself defending your old ways or be in abject denial. For me, I feel like sometimes doctors are defensive in the face of my efforts to pressure them to change. These same doctors seem to selectively filter information that even confirms this “denial” stage. I apologize to anyone that has felt that way. It is just that from my perspective (from the outside) it is so obvious that this course of action or change could make a huge difference in the results you are getting.
- Contemplation: Acknowledging that there is a problem but you are not yet ready or sure of wanting to make a change. For me, it is finding that you are becoming more aware of the personal consequences of your bad habits and this is the point where each of us begins to think about the problems.
- Preparation/Determination: This is the stage where you are getting ready to change. You have made a commitment to make a change. The “aha moment” is when you begin to think that you have to “do something about this, this is serious, or something has to change”. This is where Summit comes in to help the research process while teaching you those steps toward change. Too often I see doctors skip this stage and try to move directly from contemplation into action and fall flat on their faces because they have not adequately researched and, for some, accepted what it is going to take to make this major lifestyle change. It is the partnership between the doctor and a trusted coaching partner that makes this the most important step.
- Action/Willpower: This is the actual behavior change stage. At this point we believe we have the power to change and are actively taking steps to change behavior on multiple fronts. This is often times the shortest of all the stages. I would say on average about 6-12 months, but it can be as short at one hour. Willpower should push you to make overt efforts to quit or change the behavior. At this point you are at the greatest risk for relapse.
- Maintenance: Maintaining the behavior of change. For me this stage is all about avoiding any temptations to return to the poor performance of your past. The goal should be to maintain the new status quo. If you are like me, this is the point where I reformulate the rules of my life while simultaneously acquiring additional new skills to deal with my practice challenges and avoid relapse. As we mature in this stage we begin to anticipate situations in which a relapse could occur and prepare coping strategies in advance. We tend to remind ourselves that what we are striving for is personally worthwhile and meaningful. NOTE: It is normal and natural to regress slightly; to attain one stage only to fall back to a previous state. This is a normal part of making changes in behavior.
- Relapse: Where you return to the older behaviors and abandon the new changes. While relapse can be discouraging, most of us do not follow a straight path to a lifetime that is free of self-sabotage and poor results. Rather, we cycle through the five stages several times before achieving a stable life change. If you do slip back, the winners in life use this moment to analyze how the slip happened and use it as an opportunity to learn how to cope differently. For me, my relapses or failures have become opportunities for learning and becoming stronger.
Eventually, if you “maintain maintenance” long enough, you will reach a point where you become unconsciously competent at the process. This is where success is no longer an accident but a standard that you live by. This culture of change becomes the foundation for a future of consistent progress that will change your entire life. This is how you Summit.
Michael Abernathy, DDS
PS — We are always in a stage of change. Which stage are you in? Remember: When you are done with change, you are done.