Module 3 - Rolling with resistance

The School for Health and Care
Radicals
www.changeday.nhs.uk/healthcareradicals

Module 3:
Rolling with resistance
Supported by
#NHSChangeDay #SHCRchat

Pledge today!
http://changeday.nhs.uk

Joining in today and beyond
• Please use the chat box to contribute continuously during the
web seminar
• Please tweet using hashtags #NHSChangeDay and #SHCRchat

• We will produce summaries of the discussions of today’s module
using Storify.com and Pinterest and put these on the website
• The conversation continues on the live chat forum at
www.changeday.nhs.uk/healthcareradicalsforum


Modules
31st January:

Being a health and care radical:
change starts with me
7th February: Forming communities: building
alliances for change
14th February: Rolling with resistance
21st February: Making change happen
28th February: Moving beyond the edge

School statistics


for
today
• What is meant by resistance to change?
• Different approaches to resistance
• Importance of diversity in leading change and its
implications in terms of resistance
• Impact and intent
• A story: Maxine Craig
• Using the stages of change model to help people through
change
• A panel discussion
• Questions and call to action

Source of image: www.freshnessmag.com

What do we mean by
resistance to change?


Resistance

Any force that stops or
slows movement


Source of image: sport-fitness-advisor.com

Change can either challenge
or threaten us…….
Your beliefs pave your way to
success or block you
Marsha Sinetar


Diagnostic and dialogic
approaches
to resistance to change


Source of image: cultureisconversation.wordpress.com

Resistance: a “diagnostic” approach
• Change is something that happens “out there” in
the organisation or system
• Resistance is a force to overcome
• Resistance prevents change
• Change agents must diagnose, manage and/or
overcome resistance
• Resisters otherwise known as “laggards”,
“blockers”, “in denial”


Resistance to change


Diagnostic: the role of the change agent
“The role of the change agent is to recognise the
causes of resistance and address each one. If this is
not done, then the change will be much harder to
implement successfully and may not succeed at all”
David Stonehouse
The change agent: the manager’s role in change
British Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013,
pp 443 - 445


Resistance: a “dialogic” approach
• People make their own reality
• Change results from transformational
conversations
•
•
•

involving more and different people in change discussions
altering how and which people engage with each other
by stimulating different perspectives to shape how people
think about things

• Resistance is an inevitable consequence of a
complex change process (based on diversity)
• Resistance should be embraced and worked with

Dialogic: the role of the change agent
1. Create the conditions for transformational
conversations by asking questions that are focussed
on future possibilities, by inviting diversity into the
system, and by being welcoming
2. Creat-e opportunities for everyone to express their
views, spot opportunities and build on each other’s
ideas
3. Create ways for people to reflect together to find
meaning, understanding and shared purpose in the
change
Source: Peggy Holman

Diversity is critical to innovation and change
“The most basic not-so-secret formula for building an
innovation culture is pretty simple - embrace diversity
and start to attract, retain and promote a diverse
workforce that looks differently, works differently, dress
differently, speaks differently and is inclusive of the full
spectrum of human sexual orientation and gender
identities. Do this before you start hiring consultants
and rethinking your innovation process, there is no
process that works without true diversity.”
Idris Moore


Source of image: idsgn.org

Health and care radicals should be champions
of diversity for change
“Leaders and organisations must let go of the idea
that there is “one right way” and instead focus on
creating a learning culture where people feel
accepted, are comfortable contributing ideas, and
actively seek to learn from each other”
Diaz_Uda, Medina and Schill (2013)


Source of image:fineartamerica.com

Discussion
In the context of “rolling with resistance”
• What are the implications of embracing diversity
of thought, experience and background in our
change efforts?
• What skills and perspectives do health and care
radicals need to work effectively with diverse
teams for change?


Source of image:fineartamerica.com

The effectiveness of change agents is not a
matter of intention; it’s a matter of impact


• Helen’s intent was to give people quick
solutions, help them do their work faster
and get on to the next problem at hand
• However, her impact was that people did
not know how to solve their own
problems so that Helen’s style was
impeding their development

Source: adapted from Intent vs. Impact: A Leadership Lesson by Claudia Busch Lee
Source of image: thedigitalawards.com

Stop talking
AT ME
Start talking
TO ME

Source of image: prepbeijing.com

What should I do?

• Build a trusting and supportive work
environment
• Listen with an open heart and open mind
• Fully commit to the change
• Seek common purpose and common
interests
• Take time to build relationships
• Be open with my intent
• Take responsibility for my own actions

If your horse
dies, get off it
Cherokee proverb


Source of image: fenwickgallery.co.uk

Maxine’s story

A tale of resistance and cream paint


I’m right….


It all depends…


So why don’t we change?
Every behaviour serves a purpose
it makes us feel better and / or
keep us safe and secure

Even if in the long run that behaviour harms us

Even if we don’t recognise it in that way

(Kegan and Lahey , 2009, Immunity to Change)


The certainty of youth


“Stages of change”
Transtheoretical model of behaviour change


Prochaska, DiClemente & Norcross (1992)

The model is mostly used around
health-related behaviours
•
•
•
•
•
•
•
•
•
•

smoking cessation
exercise adoption
alcohol and drug use
weight control
fruit and vegetable intake
domestic violence
HIV prevention
use of sunscreens to prevent skin cancer
medication compliance
mammography screening


The model is mostly used around
health-related behaviours
•
•
•
•
•
•
•
•
•
•

smoking cessation
exercise adoption
alcohol and drug use
weight control
fruit and vegetable intake It works for
organisational and
domestic violence
HIV prevention
service change too!
use of sunscreens to prevent skin cancer
medication compliance
mammography screening


Smoking


I am not aware my
smoking is a
problem – I have no
intention to quit


Smoking

I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet



Smoking

I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet

I am making plans
& changing things
I do in
preparation.



Smoking

I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet

I have
stopped
smoking!


I am making plans
& changing things
I do in
preparation.


Smoking
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking

I have
stopped
smoking!


I am not aware my
smoking is a
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet

I am making plans
& changing things
I do in
preparation.


Transtheoretical model of behaviour change


Some questions
• Which stage do most change activities in health and
care focus on?
• Which stage are most people actually at?


90% of the tools available for health and care change
agents are designed for the “action” stage
The reality of our change situation
• Our tools are often not effective at the stage of change
that most people we work with are at
• It’s hard to engage people in change
• It’s hard to get people to make the changes we want
them to make
• People get irritated, defensive, irrational
• We feel powerless in our ability to lead or facilitate the
change


Example - Surgical Checklist
• Designed for Stage 4
– ACTION!
• Mandated it through
targets
• Despite compelling
case for change –
people resisted it –
no values connection
• People did the task
and missed the point

So what do we TEND to do?
• Lower our ambitions for improvement
• Focus our energies on those who are
already in the “action” stage
• Put negative labels on those who are
not yet at the action stage such as
“blocker” or “resister” or “laggard”
• Blame “the management” for not
enforcing change


The single biggest problem
in communication is the
illusion that it has taken
place
George Bernard Shaw


So what SHOULD we do?
• Listen and understand
•
•

appreciate the starting point
elaborate interests

• Build meaning and conviction in the change
• Roll with resistance (Singh)
•
•

Don’t argue against it
Encourage elaboration of resistance

• What makes it so hard?
• What would help?

• Build shared purpose


• I am not thinking about
changing my behaviours,
actions or work processes
• The problem or issue is
outside my frame of
awareness or my perceived
need


• The focus should be on
creating awareness for me of
the need to change
• Remember the goal is not to
make me (as a
precontemplator) change
immediately, but to help me
move to contemplation

Our panel
Focussing on Prochaska, DiClemente and Norcross’s
Stages of Change model:
• What stage of change are some of the key people
that you need to influence for your change initiative
at?
• What actions can you take to help them move to
the next stage?


Calls to action campaigns for this week
Post these or similar actions as a pledge on the NHS
Change Day pledge wall
http://changeday.nhs.uk/campaign
• I will reflect deeply on how I operate as an agent
for change
• I will consider the impact of my communication
and behaviour beyond my intent
• I will listen to others’ views, engage others in
change and help others through the stages of
change

Next opportunities for learning

• Wednesday 19th February
16:00-17:00 Tweet chat #SHCRchat
• Next Friday morning 21st February
module 4: Making change happen


Questions for reflection
1. What does resistance means to you?


think about the things you resist as well as your
responses to others’ resistance

2. How do you work with resistance as a change leader?
3. How can you make sure that the changes you make
achieve the impact you desire and also
 are sustainable?
 do not create dependency?
 generate self-efficacy in others?
4. Who you are interacting with and where they are on
the Stages of Change model?

Module 3 - Rolling with resistance

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