The Immunity to Change Assessment: Why Knowing Better Isn't Enough
You Know Exactly What You Should Be Doing Differently
You've gotten the feedback. Multiple times. You need to delegate more. Or speak up in leadership meetings. Or stop overcommitting to projects that aren't strategic. You agree with the feedback. You've agreed with it for years.
And yet here you are, doing the same thing.
This isn't a willpower problem. It isn't laziness. You see it clearly. You just can't seem to change it. Robert Kegan and Lisa Lahey, psychologists at the Harvard Graduate School of Education, spent decades studying exactly this phenomenon. They call it an immunity to change -- and their framework for diagnosing it is one of the most useful tools I've encountered in coaching physician leaders.
The Hidden System That Keeps You Stuck
Kegan and Lahey lay out the model in Immunity to Change: How to Overcome It and Unlock the Potential in Yourself and Your Organization. The core idea is simple: when you can't close the gap between what you want to do and what you actually do, there is usually a competing commitment operating beneath the surface. Not a lack of motivation. A hidden commitment that directly contradicts your stated goal.
A department chair says she wants to empower her vice chairs to make decisions independently. She means it. But every time a decision comes up, she inserts herself. Why? Because she's terrified a bad decision will reflect on her leadership. She has a competing commitment -- to protecting her reputation -- that quietly overrides her stated commitment to delegation.
Both commitments are real. And they are working against each other.
The Four-Column Map
The Immunity to Change assessment uses a four-column exercise to surface this hidden architecture:
- Column 1: Commitment. What do you genuinely want to change? (e.g., "I want to say no to projects that aren't aligned with my research priorities.")
- Column 2: Behaviors. What are you doing that works against that commitment? (e.g., "I say yes to every collaborative opportunity.")
- Column 3: Competing commitments. What hidden commitment drives those behaviors? (e.g., "I'm committed to being seen as a good colleague. I'm afraid saying no will make people stop including me.")
- Column 4: Big assumptions. What assumption holds the competing commitment in place? (e.g., "If I turn people down, they'll write me off.")
Column 3 is where the real work happens. Most physicians I coach have never articulated their competing commitments. They experience the gap between intention and behavior as a personal failing. The map reframes it as a system. You aren't failing to change. You're succeeding at two contradictory things at once.
Why This Matters in Academic Medicine
Academic medicine manufactures competing commitments. You're supposed to be a productive researcher and an accessible mentor. A strategic leader and a responsive clinician. Visible enough to advance and humble enough to be trusted. When you can't change a behavior you know you should change, it's rarely because you don't understand the problem. It's because changing the behavior threatens something else you care about deeply.
I've seen this with physicians who want to stop micromanaging but are terrified of being blindsided by a mistake. With researchers who want to narrow their portfolio but fear losing their identity. With leaders who want honest conversations with their dean but can't tolerate the risk of conflict.
The map doesn't judge those commitments. It makes them visible so you can test whether the big assumption in Column 4 is actually true.
Testing the Assumption
This is what separates the framework from most self-reflection exercises. Kegan and Lahey don't ask you to simply think differently. They ask you to design a small, safe test of your big assumption.
If your assumption is "saying no will make me irrelevant," the test isn't to refuse every request. It's to decline one low-stakes invitation and observe what actually happens. Does the relationship collapse? Or does nothing happen at all?
Most of the time, the assumption doesn't survive contact with reality. That lived experience -- not insight alone -- is what loosens the grip of the competing commitment.
Why Knowing Better Was Never the Problem
This framework resonates with physician leaders because they are people who understand things quickly. They read the book. They absorb the feedback. They can articulate exactly what needs to change. And then they don't change it.
The Immunity to Change assessment offers a different explanation: you are running a coherent internal system that produces contradictory results. The system isn't broken. It's doing exactly what it was designed to do. You just haven't seen the full blueprint until now.
The real value comes from doing the four-column map with someone who can push back on your assumptions and help you design tests that matter. That is where coaching comes in.
If you've been stuck on a change you know you should make, the issue probably isn't what you think it is. Check out our individual coaching options to get clarity on your next move.
