You have an innovative idea that will streamline the work, double the margin, improve quality and eliminate the headaches. You got sponsorship, budget approval, and a project team. Today you are taking the plan out to your organization in a series of meetings.

WAIT. What’s that noise? What are you hearing from colleagues? From those rational and thoughtful human beings who used to be your friends…

It sounds like this:

Who on earth came up with THIS?

We did this once in 1998 and it didn’t work. They did this in Radiology and it didn’t work.

Are you KIDDING me?! We have too many projects already. This is the LAST thing we need right now.

This is not what I signed up for when you recruited me.

Those people in administration must’ve gone to another junket in Hawaii.

This simply doesn’t work with         . (the EMR, ACA, primary care, specialty care, capitation, RVUs, labor environment, cat-lovers, academic medical centers….) This is not in the budget.

We’re going to lose a lot of good people if we do this. NO ONE in my department will buy into this!

 

With reflection, you might recall a time when you said a few of these things yourself. Whether the change is pumping your own gas, adapting to a new piece of hardware, using an EMR, or moving to a new medical complex—we experience resistance.

What is that about?

Resistance is an inevitable response to the threat of change. What is the nature of the threat that people feel when they are faced with significant change? It’s LOSS.

 

Resistance is inevitable. —Don Harrison, IMA

WHY LEADERS MUST EMBRACE RESISTANCE

Adaptive Leadership (Heifetz, et.al.) emphasizes the need to understand the stakeholders’ values, loyalties, and losses. People seek to protect their values and loyalties—and to limit their losses. We don’t fear or resist change per se (otherwise we would never have children!) but we fear the loss associated with a change.

Even simple initiatives with compelling business cases (e.g., making patient pamphlets or surgical supplies consistent) will represent a loss to stakeholders. If it is significant—the leader needs to know as early as possible.

This is not the place for a manager to roll his eyes or disparage those who won’t “get on board.” Emotional intelligence and interpersonal skill are called for. Why? Because:

  • Stakeholders may be right. Stakeholder input is the quickest path to correcting your faulty thinking before you have too much
  • Leaders change things. Managing resistance is the daunting wall you must climb if you hope to accomplish the work of leadership. Especially in
  • Managing emotions is a critical skill of a leader. If you (or stakeholders) are in a threat state creativity and cognitive skills are
  • Building trust and credibility. You will have to disappoint people, tell them NO, at some point on this project or another. Trust and credibility as a leader hinge on listening closely and showing that you’re willing to be influenced.

With significant cultural change you want to be confident in your change-management process. You may have to ask high-performers who won’t accept the change to leave. If you hustled a change through hoping to get it done before resistance mounted then you could find yourself in a career-limiting pickle.

Risks managers face if they don’t understand and manage RESISTANCE:

  • Hoisting an ill-conceived change on the organization which could harm the company and the people who were demonized for “not getting on ”
  • Needing to unwind the change—a career hit for you and morale hit for
  • You may be the one who has to go if you’ve alienated swaths of staff without engaging them and capitalizing on their knowledge in the change.

How well leaders manage their moods and affect everyone else’s moods, then, becomes not just a private matter, but a factor in how well a business will do. –Daniel Goleman, Emotional Intelligence.

THREATS OF CHANGE FOR STAKEHOLDERS AND MANAGERS

The idea that resistance is fear of loss should increase your empathy for those affected by a change initiative. Try to anticipate the losses people could experience and then take your hypotheses on the road to verify or correct them. Find out what the change means to people. Keep the CARB model of interpersonal motivators in mind.

 

THREAT———— CLARITY AUTONOMY RESPECT BELONGING ——————-REWARD

 

Which CARB motivators could be threatened when stakeholders face change?

Clarity: How do they and their roles fit in? Will they have the needed expertise? Will they know how to comply? What about job security, timing, leadership, compensation?

Autonomy: Do they have any say in what the change IS or how the change is implemented in their area? Do they have input to the timing or the messaging?

Respect: Is their value or expertise acknowledged? Are people being treated fairly? Belonging: Are they wanted or needed here? Is this still their tribe? Does this change process reflect any concern for them as a person? Are they a valued part of the team?

Management response to resistance is often not useful. Why?

Sadly–our first instincts in managing change are often wrong-headed. The tendency to squelch resistance may reflect a manager’s own fears of being exposed and failing. As leaders managing a change effort we may experience a variety of THREATS:

Clarity: If we don’t have a clear sponsor agreement.

Autonomy: When an unpopular or ill-advised change initiative is assigned to us.

Respect: If people resist change by discounting our authority or expertise.

Belonging: When our tribe gives our change project the “thumbs down.”

When managers are threatened it is likely they experience some degree of amygdala hijack and impaired prefrontal cortex function. They will see fewer options, become more rigid and self-protective, interpret neutral environmental cues as negative, and be less able to think creatively and analytically.

COMMITMENT vs. COMPLIANCE: PAY NOW OR PAY LATER

Some activities do require compliance (a command and control approach) —but not very many. Here are a few examples:

  • The ORs have an unexplained outbreak of a fatal
  • Shut them down and investigate.
  • Radiology is on fire (and not in an engaged way). Evacuate now.
  • NCQA or Joint Commission is investigating whistleblower. Emergency system-wide leadership meeting now.

Compliance is appropriate in emergencies.

Playing the compliance card in non-emergencies flunks the sniff test, increases resistance, and decreases trust.

Unfortunately, a trend toward tough leadership led many organizations astray. When resistance is not acknowledged or permitted it goes underground. And festers. When people aren’t included and engaged in a transformational change they may comply, but they won’t be committed. The difference is important—compliance requires monitoring or else the behavioral change disappears. Commitment is internally motivated and sustained. It is associated with discretionary effort leading to better business outcomes such as improved productivity, retention, customer satisfaction, and financial results.

Painfully common approaches to squelching resistance:

  • The hurry-up offense: get it done and before anyone notices the whole compensation system has been revamped with brand new
  • Discounting: logically reciting how very wrong the resistors are about the facts of the situation. “Don’t you understand that this is the very best thing…”
  • Denying—stating that nothing significant is happening here and there is nothing to worry about. “Nothing happening here ma’am, just move right ”
  • Sugar-coating—expressing all the simply delightful and wonderful things about the change and heaping it on more when concerns are expressed. “Computers are wonderful. Everyone who has an EMR just loves it. You’ll LOVE having a fast, efficient computer to help you at the ”
  • “Get on board” (a.k.a. culture-killing compliance approach): “This is where we’re going and if you don’t like it I’m sure you can find another job more to your liking”.

Resistance is normal.

EFFECTIVE APPROACHES TO RESISTANCE

Effective approaches resistance

Leaders benefit from a healthy (not fearful or judgmental) relationship with resistance:

1.  Anticipate

  • Anticipate resistance and plan to mine it for all the information you
  • Use a stakeholder map to identify everyone who will be affected by the
  • Guess at the stakeholders’ various values, loyalties and losses (especially losses) and plan your follow up meetings to test and supplement those

2.  Communicate

  • Go to stakeholders and make it safe to surface
  • Remember 10X communication—a threat state makes it difficult to hear and increases likelihood of only attending to the negative cues (and interpreting neutral stimuli as negative). So no, they didn’t hear you the first nine times…
  • Adopt the various stakeholders’ frame of reference (FOR) as you talk with them about the change—one-size-fits-all messaging doesn’t
  • Ask open-ended questions to identify or confirm their values, loyalties, and losses.
  • Take your time (this is COMMITMENT not compliance).
  • Use your sponsors liberally!
  • Use less than 20% of airtime (your power point must not bump the Q&A time).
  • Don’t be defensive. If you’re the one with the microphone remember:
    • Don’t take resistance personally (get CURIOUS not FURIOUS)
    • Don’t make others wrong (the half life of public humiliation is 20 years…)
  • Mop up the past. Acknowledge, take responsibility for, and apologize for past harm.

Get curious, not furious.

3.  Offer healthy doses of CARB:

  • Clarity: Provide as much why, why, why, who, what, where, when, how and why as you can. Say “I don’t know” and tell them what you will do when you DO know.
  • Autonomy: Allow as much autonomy as you can in project design, communication, implementation, etc. Tell them “why” if you limit autonomy. Share the vision and the impact on the
  • Respect: Always consider your stakeholders’ expertise, roles, and honor their contributions to the organization and to the change effort. Be fair. Applaud (don’t demonize) the brave souls who pipe up about the concerns shared by
  • Belonging: A reliable way for leaders to mitigate threat is to build the sense of “tribe” or commitment within the organization. Point to the bigger vision that includes all the various stakeholders. Considering a greater good and participating in achieving something important to the organization may trump the values and loyalties that are threatened by the change

RESISTANCE IS INEVITABLE. And NORMAL. The BORG was wrong. Resistance is not futile. Captain Jean-Luc Picard escaped the BORG, defeated them, and saved humanity. So it is clear: RESISTANCE IS GOOD.

Patty Fahy
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