The Elephant in the Room

Do you ever find yourself thinking about the elephant in the room? You know?  When you are sitting in that big meeting at work, with your family, or with yourself?  The cliche goes with someone saying, “I don’t think we are addressing the elephant in the room.”  Usually this arises when someone means that a conversation isn't capturing the big picture.  The conversation may be relevant, but there is some uncomfortable topic—that awkward thing that everyone probably knows but doesn’t know how to bring up.  Somehow this thing that is impossible to miss (an elephant in a room…really?) is somehow ignored.    


In the Hub, we recently had Book Clhub on a book called Switch, which is about motivating change when change is hard (sounds like healthcare, right?).  How can we genuinely motivate ourselves, our community, our teams?  In the book, the authors use a three part model—an elephant, a rider riding that elephant, and a path.  The elephant is our emotion that we feel naturally.  The rider is our “rational” mind that uses logic and reason to decide what it wants to do.  The path is what lies ahead and describes the journey that the elephant and rider will theoretically follow.  One might be able to similarly think about these as our emotions (elephant), our thoughts (the rider), and our goals (path).  The strength of this analogy comes when thinking about the interaction between the three.  The rider sits on top and tries to guide the elephant.  But, in all reality, the elephant can go whichever way it wants—do you think you could redirect an elephant?  The rider and elephant can both follow the path, but if the path leads somewhere horrible, they can choose to ignore it.  It is necessary to acknowledge that all three must be addressed to make change most effective, and it is extremely important in my mind to remember that our emotions (elephant) are the most effective drivers of action in the long run.  Although the analogies weren’t originally meant to blend together, that’s one reason to always address “the elephant in the room.”    


One of the things I have been thankful for in the past few years between college, my year at the Hub, and now my first year in medical school has been exposure to many teams and projects—a real variety of styles and missions.  When I think about it, I realize how many new initiatives begin by speaking to the rider.  It starts with something like, “here is our new project, the [insert accreditation/regulatory agency here] requires all places to do XYZ.”  Sometimes the conversation starts by describing the policies addressed by the project or the tactics behind implementation.  Each of our riders listens, knowing the project is the right thing, but the elephants are elsewhere—thinking about other projects we wish to explore.  It’s just like trying to adhere to a new diet or a new year’s resolution—the rider clearly agrees, but the long term success gets defined by whether the elephant does too.  What often amazes me about these meetings is how they commonly finish with a comment like “and it will be good for the patients” or “and it is the right thing to do”.  Somehow, the parts that speak to the elephant get left to the end.    


One of the things I enjoy about design is its way of speaking to the elephant first.  A couple weeks ago, members from the outpatient oncology team came in to work on a project.  It was a half day session that brought in patients, caregivers, articles, and inspiring artifacts.  One patient described to us the loneliness of having a rare disease.  She talked about the struggles she faced while trying to find adequate support groups and the frustration of trying to find health providers that had the right niche of expertise.  She described instances where she would be teaching people in healthcare about her disease and joked about how maybe they should be paying her (as a med student, I have to admit she has a point).  After sharing out to one another about the interviews, the group finished the day by creating a journey map of the experiences—tracking checkpoints and emotions.  

Talk about a day that spoke to the elephant.  Even as the session closed, one idea would spark comments from the entire group.  The conversation could have continued for hours.  The passion in the room sang out loud and clear.  The elephants led the day, pulling the riders forward on the design path.  Work is a lot easier when the goals of the elephant align with the goals of the rider.  So, next time you think about presenting, sharing a story, introducing a new project, or just trying to convince yourself of something, remember that you need the elephant.  Remember that it isn’t just about addressing the elephant in the room, it is really about making it the star of the show.

"If you're walking down the right path and you are willing to keep walking, eventually you will make a path"—Barack Obama

In my own subtext to that quote, I might add that it takes more than a rider to make a path—it takes an elephant.  

Andrew Yin