This report is a summary of a webinar presentation by Gretchen Rubin, author of The New York Times bestsellers, The Four Tendencies, Better Than Before, The Happiness Project, and Happier at Home.
Gaining an understanding of how other people think and operate can allow healthcare professionals to communicate more effectively, and, ultimately, enable patients to make good healthcare decisions. The Four Tendencies is a personality framework developed by The New York Times bestselling author Gretchen Rubin that divides people into four distinct types: Upholders, Questioners, Obligers, and Rebels. A person’s tendency shapes each aspect of her behavior, so understanding this framework can help people achieve their goals, meet deadlines, engage more effectively, and more.
This report covers the following:
One of the challenges healthcare professionals face every day is determining how to get people, including themselves, to comply with health guidance or recommendations. The Four Tendencies framework can make this task easier by revealing how each person responds to expectations. By asking this question, healthcare practitioners can gain exciting insights into how patients respond to expectations to in order to help them achieve their goals.
Everyone faces two types of expectations: outer expectations, such as a work deadline or a request from a friend; and inner expectations, such as the desire to keep a New Year’s resolution or start a meditation habit. How someone responds to the combination of outer and inner expectations determines his personality profile. When we know how others respond to expectations, we have a better understanding of how to help them be more effective.
Each of the Four Tendencies deal with expectations differently:
One of the challenges in healthcare is that patient behavior is the biggest factor in determining length and quality of life. Roughly 40 percent of how long and how well people live is determined by personal behaviors. In comparison, traditional healthcare delivery has very little impact–around 10 percent. Because the Four Tendencies framework can indicate patient motivations and behaviors, it can be an effective tool to encourage healthy behaviors.
As the healthcare industry shifts towards population health and value-based care strategies, practitioners are thinking more about preventative health than they ever have before. Once healthcare professionals have a basic understanding of the Four Tendencies, they can begin thinking about how it affects healthcare patient compliance and discover unique ways of communicating with patients.
Can we reduce healthcare costs as a result of more people adopting healthier lifestyles? Can we prevent a patient from ending up as a diabetic? This framework is extremely applicable as we think about population health strategies.
Upholders are self-directed, so for the most part, they will faithfully follow advice to take medication, exercise, improve their diet, and be otherwise compliant.
Obligers require supervision, deadlines, and monitoring. Healthcare professionals should ensure that crucial systems of accountability are in place.
Questioners put a high value on reason, research, information, and efficiency, and will meet health expectations only if convinced of the justification.
Rebels like to do anything they want to, however, if someone asks or tells them to do something, they’re likely to resist. They can be inspired by the spirt of resistance or an appeal to their identity.
This framework is an excellent tool for thinking through different ways to interact with patients based on their tendencies. Looking at some specific healthcare scenarios, different ways of communicating may be more effective in achieving better results for specific patients.
Healthcare professionals know that medicine works–there are clinical studies to prove it. Yet, people frequently struggle to comply with their physician’s instructions. This often comes down to communicating in a way that doesn’t resonate with a specific patient. In the case of Rebels, taking their diabetes medication is a doctor’s orders. They don’t like being told what to do, so this is unlikely to work. Instead, there are a number of other communication methods that are more effective for Rebels:
Rebels have a strong identity. Appealing to their identity can make taking their medication seem like their choice and thus be more effective. For example, a doctor could say to this patient, “You’re a strong, healthy person. You want to travel the world. You’ve got a million things you want to do. This is going to get in your way. Don’t you want to continue that lifestyle?” The doctor should remind them that taking their medication will help give them the life they want.
The sequence of information, consequences, choice can work well with Rebels, especially in terms of healthcare. First, healthcare professionals should give them the information: “You have diabetes.” Next, they should provide the consequences: “If you don’t treat your diabetes, you increase your risk of many serious health problems most of which are entirely preventable if you keep your blood glucose in a healthy range.” Lastly, the professional lets them choose. “Taking this medication will help keep you healthy.” Although it may seem severe to leave the decision to the patient, caregivers should remember that pushing or reminding Rebel patients to do something ignites the spirit of resistance.
A challenge can work well with some Rebels. They can be inspired by the spirt of resistance. For example, a care manager might say, “The doctor said he likes what he’s seen, but he’s not sure if you can stick with it for a year. I’ve seen you do amazing things when you put your mind to it, so I don’t know?” If it’s in the form of challenge, it just might work.
Knowing someone is an Obliger is a hugely important piece of information to have, because while the Rebel might resist accountability, for the Obliger accountability is essential.
Obligers are very different from Rebels in terms of what accountability looks like. Some of these patients might even be accountable to their future selves. For example, she might say to herself, “Well, Now Gretchen doesn’t feel like doing this, but think about Future Gretchen. A year from now, she’s going to be really upset if she hasn’t stuck with her diet.” Their duty to be a role model for someone else often motivates them follow through on something they think is important. A caregiver might prod, “Sticking with this will show your family that you’ve made health a priority.”
Outer accountability is very effective for most Obligers. There are many technology solutions, apps, or groups they can join to help provide the accountability they need to stick with a healthy habit.
Many corporate wellness programs are designed perfectly for an Obliger. These programs generally provide outer accountability with apps and team-based competitions, but they provide little motivation for Questioners.
Once Questioners have bought into something, they usually execute well. They don’t need accountability the same way that Obligers do. They need reasons and research behind what they’re being asked to do. The best way to get a Questioner to participate in a wellness program is establish credentials of the program and show why it is the most efficient up-to-date solution. They will resist anything that seems arbitrary. For example, many programs encourage the 10,000-steps/day goal, but the Questioner might say, “Why 10,000 steps?”
The Questioner employee needs links, pamphlets, data, etc. that support the reasons behind what they’re being asked to do. And, ideally, the program will be customized for their needs. Once they have the justification and they’ve bought in, they will follow through.
Upholders are very good at executing goals and probably the easiest tendency to keep on track. But, their rigidity may get in the way. Healthcare professionals should not exaggerate expectations as Upholders can easily become stressed or overwhelmed. In the case of a corporate wellness program, Upholders may resist systems they feel are unnecessary measures of accountability. Their ability to fulfill expectations on their own can be great, but can also be rigid. Changes in rules or expectations can demotivate or upset them because of their strict adherence to schedule. Despite these challenges, Upholders tend to be ideal patients in terms of patience compliance.
Knowing that there are more effective ways of communicating with each of the Four Tendencies, how do you know what someone’s tendency is? A more in-depth description of each personality profile is available in The Four Tendencies book, the quiz, or the one-page flash guide. There are also clues to look out for that can reveal someone’s tendency, such as when someone says that something is “arbitrary.” That is a big sign of a Questioner. Any time someone uses words like “self-care.” or “make time for myself,” that person is usually an Obliger.
Rebels will often mention things like spontaneity or doing what they want. If a patient says, “I’ve been to see three doctors and I can’t do what they say. I have to live my own life the way I see fit,” that’s the sign of a Rebel. A sign of an Upholder is not usually specific words, but the way they’re thinking about something. If they seem very enthusiastic about executing something, that’s probably an Upholder.
In healthcare, the idea that there’s a magic one-size-fits-all solution is outdated and ineffective. Instead, healthcare is becoming more personalized and targeted, and the Four Tendencies provides a framework for personalization that can lead to better outcomes.
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