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Dynamic Chiropractic Canada – May 1, 2009, Vol. 02, Issue 03
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Change: A Vision of the Future

Empowering patients to change their health behaviours.

By David J. Brunarski, DC, MSc, FCCS(C)

According to recent studies by Khaw (2008) and Knoops (2004), life expectancy can be increased by 14 years and mortality reduced by 60 percent if you follow a healthy lifestyle. The World Health Organization reports that 90 percent of type II diabetes, 80 percent of cardiovascular disease and 30 percent of all cancers could be prevented in individuals who quit smoking, exercise regularly and adhere to a healthy diet.

The Ottawa Charter for Health Promotion was proclaimed in 1986, but has thus far failed to successfully implement public health policy agenda to reorient health services or strengthen community-based health activities. In fact, Goldstein reported in 2004 that only 9 percent of the adult population ages 18 to 64 follow a daily exercise routine.

The four main unhealthy behaviours that account for the majority of morbidity and mortality statistics in industrialized countries include a sedentary lifestyle, smoking, alcohol abuse and an unhealthy diet. In 2006, Galan found that 50 percent of people engage in at least two of the unhealthy behaviours; 18 percent combine three and 33 percent cluster all four.

The Challenge: Changing Health Behaviours

As clinicians, and health consumers ourselves, we know all too well how difficult it is to change health behaviour. Primary health care providers, most notably doctors of chiropractic, may be the best positioned to make the effort to identify problematic health behaviour(s), outline appropriate goals, and educate, motivate and then continue to provide suitable follow-up as necessary to maintain the revised behaviour.

However, even the contemplation of change typically generates significant fear and apprehension. Change is ever-present in our personal lives and in business. Continuous or incremental change is generally well-tolerated, whereas discontinuous or radical change can be very stressful. A sense of perceived risk disrupts a previously comfortable status quo. When individuals are insecure to begin with, they may resist change quite strongly.

Leading the Way to Change

A man using binoculars. - Copyright – Stock Photo / Register Mark To guide and facilitate change, the doctor of chiropractic must assume a leadership role because individuals, not processes, are the real force behind change.

But what makes a good leader? In a 2000 article in Harvard Business Review, Harvard researcher Daniel Goleman concluded: "Ninety percent of the difference separating the average and the best leaders lies within their grasp of emotional competencies, i.e., self-awareness, self-management, social awareness and social skill." He went on to report that emotional intelligence (EI) appears to be two times more important than IQ.

Hay and McBer studied nearly 4,000 world-class leaders and found they could be classified into six distinct leadership styles. The categories were ultimately derived from important differences in their emotional intelligence, as described below:

  • A coercive leader is seen to be inflexible but demanding. Very achievement oriented but pushing compliance, this leader gets results over the short term, but generates negative impacts that undermine initiative in others.
  • The authoritative style of leadership seems to be the most effective because this leader provides information based on evidence and conveys the clearest vision that motivates and empowers others to follow their advice and direction. This style of leadership builds confidence and long-term success.
  • An affiliative style of leadership demonstrates great empathy and is the most nurturing. This leader establishes solid relationships based on trust and positive feedback. This leadership style is really only successful, however, in the early stages of relationship-building because it establishes dependency and compliance.
  • A democratic leader relies on participatory decision-making through consensus and collaboration. This is a popular style because everyone feels engaged in the process. It takes more time to see results and consolidate commitments. This may lead to missed opportunities and frustration if decisions are delayed or deliberations are contentious.
  • Pace-setting is a leadership style that is usually only successful with people who are highly motivated and intelligent. Standards are set high that results come quickly at first, but compliance drops off just as quickly because the expectations for constant, high performance are rarely sustainable.
  • Coaching is a familiar style of leadership that is positive and well-received because it focuses on personal development and achievable goals. Weaknesses are strengthened and strengths are reinforced. It takes the most time and patience, but is empowering and sustainable.

Although your preferred course of action is to help make positive change toward the desired outcome and a deliberately planned event, there may be unintended consequences that are transformational. Do not hesitate to collaborate with other professionals if you require specialized help. Communication is the number one competency for managing change and is closely supported by building trust and achieving buy-in.

Therefore, try to approach the behavioural change proactively with a style that is authoritative but supportive, empathetic and respectful. Answer all questions clearly, unambiguously and with evidence. Supply enough detailed information so the patient is well-informed and encouraged to participate in the decision-making. Celebrate small successes along the way and provide opportunity to discuss feelings and concerns. This will provide significant separation from the past and build strong emotional bridges to a secure physical and emotional future.

Dr. David Brunarski, former associate editor of DC Canada, graduated from CMCC in 1977 after completing his undergraduate educa-tion at the University of Alberta. He is president of the Ontario Chiropractic Association and practices full time in Simcoe, Ontario. To learn more, visit

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