Two Simple Steps to Fix Willful Non-Compliance 

By Steve Harden

Most people at work do most of what they are supposed to do, most of the time. Unfortunately, sometimes even good performers do it wrong or not at all. Those are the times when your patients are at most risk.

Assuming the wrong performance was not just an inadvertent human error - a slip, trip, or lapse - there are usually only four reasons a person doesn't do what they are supposed to do:

1. They don't know what they are supposed to do (the expectations have never been made clear)

2. They know what, but don't know how (they were never trained properly with the 4 steps to effective training)

3. They know what and how, but can't (they have physical or cognitive limitations that prevent them from doing the job - the wrong person has been hired for that job)

4. They know what, how, and can - but choose not to do it.

That last reason people don't do what you want them to do is the one that causes us the most frustration and angst. It seems so willful, so needless, and consumes so much of our time and energy to fix. But there is help! Management coach and expert Ferdinand Fournies conducted a 15-year research project involving over 20,000 managers and his studies revealed that the most common reason people choose not to do the job the way you want it done is because they don't know why they should do it that way. After working with 20,000 managers he realized that not enough of them answered the "why question" for the their employees when training them to do a task or follow a process.

I think this is especially true in health care where people are required to do things a certain way for reasons that are very clear to administrators, managers, safety officers, risk managers, and quality directors but are not so clear to staff.  

Fortunately, Fournies' research uncovered two clear-cut action steps we can take to address this sort of willful non-compliance. 

Step 1. Provide information about why a task, process,or protocol is important. The WHY has four distinct parts, and all four parts must be explicitly answered for your staff during the training process.

• Provide a clear description of the benefit to the organization and the patient for doing it right;
• Provide a clear description of the harm to both the organization and the patient for doing it wrong;
• Provide a detailed description of the benefit to the employee for doing it right as well as...
• Providing a description of the consequences to them for doing it wrong.

Step 2. When you want people to change for the purpose of solving problems, improving quality or safety, you must do these five things in your training process:

•  Explain the problem in detail;
• Explain the goal (what does success look like) in detail;
•  Discuss the specific steps in the solution in detail
• Explain the benefit of success (benefit to them, the organization and the patient);
• Explain the agony of defeat (consequences to them and the harm to the patient);

Both of these steps are so simple, but so often overlooked. Sometimes the most effective solution is the simplest solution.

People will do things because you tell them they should do them only as long as you watch them. But you can't and shouldn't have to watch them all of the time. The reason for doing things a certain way must be important enough to your staff to influence their choices of how to perform when the boss is not watching. Following these two steps will help you influence their choices, increase your compliance, and make your patients safer.