In the first of a series of blogs about resistance to change, Healthcare Improvement Scotland’s Ruth Glassborow explores the very human nature of resistance. These draw from Ruth’s extensive change management experience and a dissertation she completed back in 2008 entitled ‘Understanding why change is resisted in primary care’.
In a landscape that seems to be continually changing, it is probably not surprising that so much time is spent talking about how we can “overcome resistance”. Yet in my view those two words are both overused and unhelpful.
Because they communicate a belief that those resisting the change are wrong and that we need to find a way to force them to accept the thing we want them to do. Further, all too often this is underpinned by a pressure on those with lesser power to conform to changes thought up by those with greater power.
Over the years I’ve run many training courses on resistance to change. I wish I’d had the foresight to keep and analyse the outputs of those sessions. By now they would have contained a rich source of evidence that even the phrase “resistance to change” is one that immediately conjures up negative words in the participants’ minds such as “stuck in the muds”, “vested interests” and “hard work”.
“We need individuals working in our health and care system who have the courage to challenge changes that they believe will make care worse. That kind of resistance is to be celebrated and responded to by openly exploring and discussing their concerns.”
Yet when I ask individuals in the room to reflect on the emotions they experience when they think about the resistance movement in World War 2 you can literally feel the atmosphere changing. In this scenario “resisting change” was an act of enormous courage and sacrifice and so clearly the right thing to do.
For me this makes the vital point that not all change is good. And, to individualise it for a moment, that includes some of the ideas that I’ve come up with and, dare I say, some of the ideas that you’ve come up with.
This means we need individuals working in our health and care system who have the courage to challenge changes that they believe will make care worse. That kind of resistance is to be celebrated and responded to by openly exploring and discussing their concerns. After all, if the idea is a good one then it has nothing to fear from such questioning.
Sometimes, when we explore the concerns, we find that the person is resisting because they are placing their own individual needs above the greater good of our populations. Yet, in my experience, more often you will find they have a genuine belief that the change will have negative consequences for those using their services.
They may be right or they may be wrong, but surely the onus is on all of us leading change to explore and better understand the concern. If they are right, wouldn’t you want to know and adjust your change?
Another exercise I undertake in the training is to divide the room in half, and without them knowing, get participants to discuss two different questions. One half looks at reasons why they’ve resisted change in the past and the other looks at reasons why people they’ve worked with have resisted change.
In most cases the discussions demonstrate in practice a phenomenon known as the ‘Actor-Observer Bias’. This is a tendency to overestimate the importance of personal/dispositional factors and underestimate the importance of situational/environmental factors as causes of other’s behaviour. And vice versa when it comes to our own behaviour.
This means we tend to see ourselves as resisting change for good reasons attached to the nature of the change, yet we judge others as resisting it because they are in some way “being bad people”.
What fascinates me about this is that, even though I know this and have spent nearly a decade training on it, I still regularly catch myself making the assumption that someone else is behaving in a particular way because of who they are, not because of the circumstances they find themselves in.
So why does all this matter? In my experience, when we make an assumption that resistance is attached to the person’s disposition rather than a genuine concern about the change, we are much less likely to take the time to find out why the person is resisting.
Yet effective responses are often, if not always, dependent on a good understanding of the reason for resistance. This is why I believe the key message is that we should seek to “understand and respond to resistance” rather than “overcome it”.
“In my experience, when we make an assumption that resistance is attached to the person’s disposition rather than a genuine concern about the change, we are much less likely to take the time to find out why the person is resisting.”
My fascination with resistance to change led me to write a Masters dissertation on it. Even though that was eleven years ago, the findings seem as relevant today. My analysis of the literature identified 63 different reasons why change is resisted, with the majority fitting under one of the following three headings:
- lack of dissatisfaction with status quo,
- lack of belief that the change proposed is a better way of doing things, and
- lack of ability to action the change.
There was a residual set of items that didn’t naturally fit any of these three categories but which did have a common theme. They were all about the way the change was led. Indeed it can be argued that poor leadership is a causal factor of all of the other three factors.
When I used the framework to reflect on my own leadership practice I realised that, on more than one occasion, I had focused my action on supporting people to make change when in practice they weren’t actually dissatisfied with the status quo and/or didn’t believe the changes being proposed would make things better.
In other words I was trying to spread solutions to problems people didn’t know they had or solutions they didn’t believe in. No wonder they were resisting.
In my next blog I will pick up further on the analysis of the 63 reasons, before I then go on in my third blog to consider what the research tells us about techniques for responding effectively to resistance.
Ruth Glassborow is Director of Improvement at Healthcare Improvement Scotland.