In part three of this blog series, Ruth Glassborow continues to explore resistance to change by looking at what the research says about how to respond to resistance effectively.

Here goes:

Step One – Check your mental model

This goes back to my first blog.  If you view resistance as something that an individual is doing because they are being awkward or in some other way demonstrating bad behaviour, then you are much less likely to take the time to openly explore their reasons.  Instead you’ll make assumptions, or judge their personal motives. Yet effective responses are often, if not always, dependent on a good understanding of the reason for resistance.

This leads us nicely on to ….

Step Two – Understand the individual’s/group’s reasons for resisting

This goes back to my second blog; if you want people to choose to change they need to be

  • dissatisfied with the status quo and
  • believe the change being proposed is a better way of doing things and
  • have the ability to implement the change and
  • are supported by an effective leadership context.

When trying to understand why people are resistant, don’t make assumptions without actually talking to them. You might think you know what’s happening but nothing can beat sitting down and openly exploring the issues together. However, the research also identifies the risk that the individual may not know themselves why they are resisting because of what is called “hidden competing commitments”. You can read more about the reasons people resist change.

And remember, we often resist change for more than one reason.

For instance I might be happy with the status quo but alongside this I might also lack the ability to implement the change. You could address the former by getting me to listen to the poor experiences my patients are having or showing me data that says my colleagues are doing so much better than me. However, if you want me to implement the change you also need to tackle the issues around my ability to implement it. So the key message here is consider all possible forms of resistance in play, not just the first one you identify.

Step Three – Decide whether to intervene

I remember many years ago a team member saying to me “why are you paying so much attention to x when the vast majority of the team want this change? We can do this without him so please stop spending all your time on the one person who doesn’t want it and focus a bit more on the rest of us who do”. A very good point well made.

D’Herbemont and Cesar in their book ‘Managing Sensitive Projects’ propose that building a critical mass of allies who support the change is key to the success of any change project. It is not necessary to remove every opponent to change; just to build up enough support so that the positive forces for change are more powerful than the negative ones. They warn against a common mistake made by managers that they refer to as the ‘Magpie Syndrome’, an obsessive focus on opponents to the extent of forgetting one’s allies and their interests.

In my experience, it is all too easy to end up focusing too much energy on the opponents and not enough on the allies, so I’ve found the question “do I need to respond”, a useful one to ask.

In practice, ignoring the resistors and working with the willing is a proven strategy for responding to resistance.  It is after all what sits behind concepts such as prototyping with a willing team.

Step Four – If you are intervening, choose an intervention which fits with your diagnosis of the reason/s for resistance

An effective response to resistance will tailor the interventions to the diagnosis. The literature on resistance to change identifies the following key principles which need to underpin this process.

  • Consider the possibility that the correct response is to amend the change proposal due to the validity of the concerns expressed.
  • The focus should be on reducing the resistance to change, rather than increasing the force for change. The risk attached to increasing the force for change is that it will result in an equal increase in the forces resisting change. Have you ever noticed yourself becoming more determined not to do something the harder someone tries to force it on you?
  • Don’t waste time on variables not receptive to change. As an example, trying to change an individual’s deeply held values is unlikely to achieve the desired result.
  • Remember that resistance is often related to more than one issue and hence your response may also need to be multifactorial to address the different issues.
  • Timing is important. For example, change can be resisted because of a lack of time to make the change, or an overload of organisational change, or because it is happening at a time when a key individual has a lot of change going on in their personal life. We are often given timescales to work to, which can feel very real and are usually important to work with. Indeed many change initiatives are strengthened by the “drumbeat of the change”. The complete absence of deadlines can be problematic. However, the point here is that timescales are rarely more important than the change itself. Meeting a deadline without effectively bringing about the desired change is rarely advantageous. A short delay and extension of deadline can prove far more valuable if it enables the change to take place. Those of you who, like me, have on occasion asked for extensions to essay deadlines will know this very well!

Specific Methods for Responding to Resistance

Kotter and Schlesinger (1979) developed a summary of methods for responding to resistance to change, providing a systematic way to select approaches. The original paper identifies when each of the approaches is commonly used and the advantage and disadvantages of it.  Briefly the methods they highlight are:

  • Participation and Involvement
  • Education and Communication
  • Negotiation and Agreement
  • Facilitation and Support (Emotional) – providing support for coming to terms with change
  • Manipulation and co-optation
  • Explicit and implicit coercion.

Personally, I don’t recommend the last two.  Having seen it first hand, whilst they may deliver in the short term, I think they build problems up longer term due to the breakdown in trust that results.

My literature review highlighted a number of other strategies :

  • Facilitation and Support (Practical) – providing  practical support such as advice, coaching, project management resources
  • Training
  • Demonstrating how the change aligns with an individuals or groups values
  • Exposing the need through for instance the use of data, patient experience, process mapping, and/or peer review
  • Using Subject Matter Experts to highlight the need for the change
  • Using Small Scale Tests of Change
  • Making the desired state easier than the status quo
  • Ignoring it.

This led me to develop a revised version of Kotter and Schlesinger’s analysis .

Step Five – Review and Amend

Finally, when you are implementing change in health and social care it is rarely straightforward. Good change management requires leaders to continuously review progress and adjust as they go. In the words of James Yorke: “The most successful people are those who are good at plan B.” Or in my experience those who have a plan C, D, E, F and G!

This third blog in my series has considered what the literature says about responding effectively to resistance. In my next blog I move on to share some of what I found from interviewing GPs and Practice Managers for their views on resistance to change.

Ruth Glassborow is Director of Improvement at Healthcare Improvement Scotland.