In my book “ONE”, I have described many scenarios – some of them life-threatening – which show how we are hard-wired to resist change. Typically, only about 10% of us will change our behavior permanently from a long-standing habit or practice. The solutions may seem obvious, but they are elusive and very complex.

Since much of my work is in healthcare, it has amazed me that so few medical staff wash their hands, despite the rock-solid evidence that many of the deaths caused by hospitals can be tracked to this lack of discipline.

A facinating article by Stephen Dubner and Stephen Levitt (of Freakonomics fame) in the New York Times Magazine describes in stunning detail not only how and why we do not change, but novel ways for bringing about a greater willingness to change.

I see leadership practices every day that defy the imagination. I wonder why, given the concrete evidence that such practices do not work, we find it so hard to do what we know will work, rather than continuing to do what we know does not work.

One of the most important reasons is that it is hard to change in isolation from a shared dream of what we could collectively accomplish. It’s one thing to tell doctors to wash their hands. It’s another thing to share a dream to reduce the number of iatrogenic deaths (those caused by treatment or diagnostic procedures – 98,000 per annum according to the National Institutes of Health) and bulding passion towards realizing such a dream. Any hospital that reaches the top 15th percentile of patient safety statistics – a dream for most hospitals – can’t get there without a 100% handwashing effectiveness (the last letter of the CASTLE® Principles). In our work with clients, especially in healthcare, we have found that identifying a dream, realizing a dream and then sustaining the dream is almost a guarantee to achieving remarkable successes in effecting change.