In mid-October, I canoed as part of an annual wilderness trip and was completely off the grid with plenty of time for reflection.
After many years of backpacking, canoeing on flat water adds a new dimension of tranquility. At one point, we had a very long portage and it was quite grueling, particularly because some beavers had altered the trail and turned it into a pond.
After 2 1/2 hours of carrying the canoe and our packs, we collapsed at the edge of a gorgeous lake and had lunch.
For the rest of the trip I kept thinking, “what is it that drives me to maintain this habit that involves strenuous exercise, risk, and occasional discomfort (translation: a body that is cold, wet, tired, sore)?"
My answer: It's a healthy thing. When I am on these adventures, I work hard, exercising in one form or another all day long; eat well; sleep more deeply than I do at home; and mentally relax more than I ever do at home or work. My busy cognitive brain – which constantly juggles to-do lists – is able to quiet.
My emotional brain calms also, soothed by beauty, peacefulness, and rearranged priorities. I can concentrate on what matters most to me: relationships, love, family. Even my work is all about relationships. That’s what health care is, and I connect more deeply with those core values.
In health care, we talk about hardwiring best practices. We derive care bundles based on best practice and then figure out ways of putting the best practice in a workflow so that it's easier to do the right thing than the wrong thing. That is easier said than done.
I've done some reading about this. In his book, The Power of Habit, Charles Duhigg makes interesting observations. He writes about habits from a research standpoint, summarizing neurologic, physiologic, and psychological research into how people establish and change habits.
First, there is a "habit loop" where we experience a cue, follow a routine, and obtain some sort of reward. Astonishingly, Duhigg argues that humans can’t eliminate a bad habit, they can only change it.
So, for me, what created the habit of paddling in cold rain? What’s the cue, what’s the routine, and what’s the reward? And how does this research help us improve healthy habits?
I’m still figuring this out, so indulge me. The cues to engage in this behavior are, I think, a couple:
-Crazy, busy weeks of intense work trigger a desire to power down, so I use the anticipation of the outdoor relaxing experience to unwind. I use the mental ‘videos’ to ease my tension. I crave the calm and the relationship.
-Fall weather and foliage change trigger memories of the prior experiences of endorphins, peace, beauty, and close friendship.
Exploring the Rewards
The rewards are profound, and I think I can now see how they drive the routine. Initially, the wilderness trips were about finding a nice day and ‘bagging a peak.’ My wilderness companion and I were quite spectacular failures at both of these goals as we seemed to find extraordinarily bad weather (massive snowstorms in October, earthquakes in the Adirondacks, and horrendous wind and rain).
Something else was emerging as the reward: companionship, trust, the internal physiology of using your body to do something hard such as endorphins, cannabinoids, and also a ton of fun. Laughing at myself and my partner and planning little surprises has become a reward unto itself.
On one trip, I decided to surprise my partner by bringing a small flask of his favorite before-dinner drink, a very specific sherry with a twist of lime. At the end of a long day of backpacking, while preparing our meal, I asked him what he would like to drink before dinner. Up to that point on our trips, the choices had been water, or water. He effortlessly fell into the surprise, and with a smirk, said “I’ll have a Harvey’s with a twist of lime”. When I handed him the drink, he was truly shocked, and we both laughed about it for the rest of that trip. Now it has become an annual event to see who can surprise the other with something unusual that we enjoy.
So what’s the relationship to healthy habits?
The research on habits suggested that we can change or create habits with practice, mindful of the cue, routine, reward cycle. Health by itself is not enough reward for the cycle. I think that organizations can, and are, introducing people to healthy habits by tying them to something else such as companionship in a community garden.
Duhigg says organizations can focus on what he calls ‘keystone habits.’ In the corporate world, the story of Paul O'Neil's focus on safety at Alcoa changed the company. I believe communities and health care organizations can find keystone habits that have intense rewards tied to new routines. It’s up to health care organizations and the communities they serve to figure them out.