Why People Don't Do What You Want Them To Do

By Steve Harden

Jane is a nurse responsible for getting compliance with the process of care that gives heart attack patients an aspirin at arrival. She shows the nurses in her unit quarterly reports with data related to this measure. The unit's numbers are not where they need to be. Many of the nurses say that they don't pay attention to these reports. Explaining why they don't, one of the nurses said "I don't believe the report because I know that I am doing everything I can for my patients." Jane is disappointed because she thinks the instruction on the policy and her colorful reports make it clear to all what their current performance is and what is needed to meet the goal.

Here are four possible reasons why her team is not doing what she wants them to do, and the questions she can ask to help fix the problem: 

1. They don't know what, exactly, they are expected to do to comply with this core measure.

Surprisingly, this is the most common reason for non-compliance. As leaders, we think we have adequately explained what is required, but because we didn't make words come out of their mouths (or make pencils move correctly during written testing), we can't really be sure.

Jane can ask this question to determine if this is the reason for non-compliance: "Tell me in your own words the expectation we have about this core measure?" Jane will say this sounds too easy and basic, but based on 10 years of helping hospitals implement processes, I think she will be very surprised at the results of asking this question.

2. They know what they are expected to do, but don't know how to do it.

This is a training problem and indicates the four steps of training--information, demonstration, practice, and feedback-- have not been done adequately. Jane might have fallen into the trap of thinking that "telling is training."

She can ask this question to determine if this is the reason for non-compliance: "Describe for me in your own words the exact steps you take to comply with this process." Again, Jane will be amazed at the gaps in knowledge she will uncover. The danger is that Jane will attempt to fill in these gaps by "telling" and not by using the four steps of learning.

3. They know what they are expected to do, have been effectively trained to do it, but can't do it -- due to physical or cognitive limitations.

(Or, they can't learn to do it in the amount of training you are willing to give them.) In effect, the unit leader has made a hiring mistake and has the wrong person in the position.

To fix this, Jane can ask herself these questions: "Am I absolutely sure this person knows what to do, and that I have effectively trained them to do it?" If the answer is "yes," then Jane asks herself this question, "Am I willing to invest more training to see if this person will be able to do the job?" If the answer is "no," then the remedy is to either terminate the employee or move them to another position more suitable for their skills.

4. They choose not to (even though they know what and how).

There are multiple reasons that employees choose not to do it the way you want it done, but in my experience the most common are:

• They think their way is better (also implying that they think that compliance is optional).
• They don't think Jane is really serious and therefore is not willing to impose negative consequences for non-compliance.

Once Jane is sure the reasons for non-compliance are rooted in "choosing not to," the question she should ask of the person in this situation is, "Why?" Jane cannot be satisfied with the first answer and will have to dig and probe to get at the real truth. Once she has it, there are a number of tactics at her disposal. Two of the most important are:

• Behavior that get's rewarded gets repeated.
• Behavior that creates negative consequences is avoided.

In the next issue, we will explore more fully what do when  employees "can, but they won't."

Bonus! (Read Carefully)