COLUMN – The author discusses how deeply rooted beliefs and social dynamics impact healthcare change, and what Lean teaches us about turning the tide.

Words: Carlos Frederico Pinto

First published on saudebusiness.com on April 28, 2026

_{"The world is the totality of facts, not of things." — Ludwig Wittgenstein}

One of the greatest challenges in modern medicine is dealing with the bias of deeply entrenched beliefs built over the course of professional careers. The adoption of new protocols, procedures, or even a simple change in routine systematically runs into resistance, even when it is backed by rock-solid scientific evidence.

Why does change trigger so much fear?

THE "ECHO CHAMBER" TRAP

People tend to treat beliefs or practices validated by their past experiences as absolute truths, which is then amplified by what communication scientists call the "echo chamber." This phenomenon deeply impacts complex systems like healthcare, ultimately paralyzing innovation.

An echo chamber occurs when a group—such as a surgical team—is so accustomed to working together that they create an environment of constant mutual validation. This is amplified by homophily, which is our natural tendency to connect with people who think like we do. This reinforces closed loops of beliefs that stubbornly resist any external noise.

Add to this the fear of losing autonomy. Most professionals resist standardization because they view it through this lens, failing to realize that adopting an evidence-based protocol doesn’t mean giving up clinical judgment, but uplifting it.

CUTTING DOWN THE "TALL GRASS": PROCESS BEFORE DECISION

Throughout my journey as a medical leader, I faced this challenge countless times. Most professionals feel threatened by major shifts in their daily routines because they believe the change might worsen clinical outcomes.

The strategy I adopted—and one I always emphasize—is that clinical decisions and procedures should be among the last things we touch in an improvement initiative. This isn't because the clinician or the decision isn’t important, but because they represent only a tiny fraction of the entire care process.

The medical act redirects care, but within the broader value stream, it is just a single intervention exposed to countless upstream and downstream risks and opportunities for improvement. Errors, delays, and waste remain the same regardless of the clinical decision. In many cases, the system is so fragile that the patient is constantly exposed to risks that have absolutely nothing to do with the specific medical intervention itself.

I used to say that the "grass was too tall" for us to immediately intervene in the decision-making process. Cutting down that tall grass—reducing complexity, inefficiency, variation, and process defects—must be the initial goal. Only after we have cleared the field does it make sense to discuss refining clinical decision-making.

COMPLEX CONTAGION: CHANGE FROM THE EDGES

The second practice I adopted was to never push back directly against pushback. Direct confrontation with a deeply rooted belief triggers a rebound effect, only amplifying the resistance. Instead of focusing on the loudest oppositional leaders, I started working from the edges. I focused my energy on the periphery of the system—the highly interconnected teams directly responsible for executing daily tasks. The more redundant this approach was, the more successful the initiative became.

In his book Change: How to Make Big Things Happen (2021), sociologist Damon Centola calls this phenomenon “complex contagion.” Contrary to our intuition, change doesn’t happen because we deeply influence one or two key people, nor because we are incredibly persuasive. It happens because we build a social network of reinforcement that propagates the behavior of a group. It isn’t enough for a boss or a leader to propose a change; your immediate social group must validate it, and a reasonable portion of your peers must adopt it. Only then does the social cost of the new practice become acceptable.

The takeaway: change doesn't happen through the action of a single individual, but through the connections between people and the ecosystem they live in. Relying solely on charismatic leaders is a poor strategy for reaching the periphery of a system. Real transformation happens when we see our actual peers adopting and valuing the new practice, from nurses to technicians, receptionists to transporters and front-desk staff. Nobody changes because of a memo.

COMMITTEES, WIDE BRIDGES, AND THE POWER OF REDUNDANCY

For a long time, I viewed the abundance of committees in healthcare institutions as an administrative headache to be managed. Over time, I came to see them as one of our most powerful tools for driving cultural change.

When aligned with a shared strategic goal, committees create cross-validation and what experts call "narrow bridges"—microcosms where the idea of change receives frequent and repeated interactions.

Suddenly, safety, quality, and tools are being discussed in every department, on every committee. The new idea becomes familiar; people hear about it through multiple channels. This also makes the change highly visible, creating the social perception that "everyone is already doing it." Individual behavior quickly assimilates the new practice to avoid being left out of the group.

For a new practice to be socially accepted, it must travel through multiple routes and communication channels—the "wide bridges" of complex contagion. Cross-functional workgroups then become the primary engine for transformation. This is where the magic of value stream mapping and daily management comes back into play.

THE NEW NORMAL IS CONTAGIOUS

Change usually fails not because of ineffective communication, but because of insufficient communication. The so-called skeptics (those who resist change) are loyal to their convictions, rely on the validation of their peers, and trust their own results. They aren't villains. They are simply the natural product of ecosystems that have never been exposed to the contagion of the new idea.

Real change only happens when we can spread the new idea to the ecosystem as a whole, using wide bridges and highly redundant messaging. When we achieve this, change stops feeling like a threat and simply becomes the new normal.

_THE AUTHOR