Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How to Make New Habits Stick, Part 1


James Clear’s book, “Atomic Habits,” teaches us that the best way to start good habits is to implement small changes. This framework can help clinicians and patients meaningfully improve their daily routine. 

In his bestselling book “Atomic Habits,” James Clear offers a scientifically-informed yet simple framework for making small (“atomic”) changes in our daily lives that, over time, helps build good habits and break bad ones to achieve long-lasting behavior change.  


A foundational and somewhat unorthodox proposition underlying Clear’s philosophy is that in striving to change our habits, we tend to fixate too much on goals. He points out that when we are hyper-focused on goals, we unwittingly neglect the day-to-day processes that underlie the heart of lasting behavior change. Counterintuitively, goals can actually be at odds with long-term progress. He offers the example of someone who sets the goal of running a race—they train hard for months to achieve their goal, but after they cross the finish line, they stop training. They’ve accomplished their goal, and thus the motivation to train deteriorates—leading to reversion into old habits—unless they set a new goal.  


The perpetuity of goal-setting can also restrict our happiness. When we reach our goal, we feel valuable and successful, but when we fall short of our goal or have yet to reach it, we are discontent with our lives. Happiness is repeatedly postponed until we achieve our next goal, and then rapidly declines—along with the “habits” we used to reach that goal—once the transient high wears off.  


This is not to dismiss the value of goal-setting, which is necessary for us to create a vision of where we want to go. The primary utility of goals is simply direction. However—and this is Clear’s main point—radical habit change that leads to permanent self-transformation requires systems.  


Clear writes, “If you’re having trouble changing your habits, the problem isn’t you. The problem is your system. Bad habits repeat themselves again and again not because you don’t want to change, but because you have the wrong system for change. You do not rise to the level of your goals. You fall to the level of your systems.”1 


What is a system? 

It’s a mechanism that naturally fosters our ability to do good things and refrain from bad things on a regular basis. Over time, as long as we follow the system each day, we take on a new identity. Someone who’s smoked for 30 years and follows a system that helps them avoid smoking each day takes on the identity of being a non-smoker. A person who usually doesn’t exercise and follows a system that gets them jogging each day takes on the identity, of being a jogger.  


This is the heart of habit change. We become the type of person who does what our system tells us to do. It becomes much easier to stop smoking if we see ourselves as non-smokers, or to continue jogging if we see ourselves as joggers. 


Clear’s system is predicated on his four laws of habit change. To create a good habit, the system makes the desired action obvious, attractive, easy, and satisfying. To break a bad habit, the system does the reverse, making the undesired action invisible, unattractive, difficult, and unsatisfying.  


Most of Clear’s book explains each law of his system in detail and what it looks like in practice. I have used it personally to build a good habit, and I strongly believe that we can use the system both to improve our own lives and as a powerful way to guide patients towards positive behavior change as well. 


In Part 2 I’ll share a practical example of how I’ve implemented these laws to adopt a good habit and how we might use them to help a patient make a healthy habit change.







This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.