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#S4CA @sch4change
theedge.nhsiq.nhs.uk/school/
Module 3:
Rolling with resistance
@Sch4Change #S4CA
team
Brought to you by the

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#S4CA @sch4change
School Lead:
Helen Bevan
@HelenBevan
Olly Benson
@OllyBenson
Kate Pound
@KateSlater2
Lead
facilitator:
Pip Hardy
@PilgrimPip
Chat Room Monitors Twitter Monitors
Louis Warner
@LouisWHorizons
Technical Support
Joanna Hemming
@JoannaHemming
Paul Woodley
@PaulWoodley4
Kathryn Perera
@Kathrynperera
The team today

3.
#S4CA @sch4change
Joining in today…and beyond
• Please use the chat box to contribute continuously during the
talk
• Please tweet using hashtag #S4CA and the handle
@Sch4Change
• Send a request to join our Facebook group School for Change
Agents https://www.facebook.com/sch4change/
• We will produce summaries of each module discussion using
Steller and put on the website

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#S4CA @sch4change
Each week we’ll cover different
change agent capabilities
16th February: Being a change agent: change begins
with me
23rd February: From me to we: making connections
and building communities
2nd March: Rolling with resistance
9th March: Making change happen
16th March: Moving beyond the edge
Source of image: thenounproject.com

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#S4CA @sch4change
Nurses, Midwives and Allied Health Professionals
Use the school experience as part of your CPD reflective account
for revalidation
Doctors
We have applied for CPD credits for the school
Everyone
If you watch all five of the talks and
demonstrate you have applied the
learning, you can apply to become a
certificated change agent (and it’s free)
Certification and Continuing
Professional Development

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#S4CA @sch4change
Randomised Coffee Trial

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#S4CA @sch4change
• Email to join the RCT
england.si-horizons@nhs.net
• We will randomly match
you with another
participant in the School
for Change Agents from
anywhere in the world
• At some time in the next
four weeks, arrange to
have a conversation over
Skype (or other
communication system)
with a cup of coffee! Image source: Pinterest

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#S4CA @sch4change
When I meet with resistance at work, I…
… initiate a
conversation in the
hope of understanding
the other point(s) of
view
… know I’m right – I
just have to persuade
the resisters!
… bring together
people with different
ideas and encourage
the diversity of ideas

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#S4CA @sch4change
The role I identify with most closely:
User of care system Campaigner
Change agentEnquirer Chief listener
Giver of care

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#S4CA @sch4change
Change agent capabilities
in module 3
• Ability to look at “resistance” from
multiple perspectives
• Understanding of the relationship
between intent and impact
• Building resilience by mobilising and
organising
• Using the Stages of Change model to
understand resistance and help people
through change
Source of image: thenounproject.com

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#S4CA @sch4change Source of image: sport-fitness-advisor.com
Any force that stops or
slows movement
Resistance

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#S4CA @sch4change
Why do organisational change programmes
fail to achieve their objectives?
The majority of
reported
reasons are
related to
resistance to
change
Source:
McKinsey & Co

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#S4CA @sch4changeImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

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#S4CA @sch4change

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#S4CA @sch4change
‘En este muno traidor
No hay verdad ni mentira,
Que todo esta en el color
Del cristal con que se mira.’
‘In this world of many mazes
There is nothing false or true:
All depends upon the hue
Of the glass through which one gazes’.
Sixteenth-century Spanish quatrain

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#S4CA @sch4change
In module 1, we talked about:
Jeremy Heimens, Henry Timms
This is New Power

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#S4CA @sch4change
Let’s think about “resistance” in
old/new power terms

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#S4CA @sch4change
Let’s think about “resistance” in
old/new power terms
• Change can be planned and
managed through a rigorous
process
• Resistance is a force to
overcome
• Resistance prevents change
• Change agents must
diagnose, manage and/or
overcome resistance
• Resisters can otherwise be
known as “laggards”,
“blockers”, “in denial”

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#S4CA @sch4change
Resistance to change:
the old power mindset

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#S4CA @sch4change
A transformation programme
Source: Sewell (2015) : Stop training our project managers to be
process junkies

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#S4CA @sch4change
Old power mindset:
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
Source of image: Health IT Outcomes

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#S4CA @sch4change
• Change can be planned and
managed through a
rigorous process
• Resistance is a force to
overcome
• Resistance prevents change
• Change agents must
diagnose, manage and/or
overcome resistance
• Resisters can otherwise be
known as “laggards”,
“blockers”, “in denial”
• Change in human systems is
often emergent and hard to
predict
• Change results from
connections and interactions
stimulating different
viewpoints, shaping how
people think about things
• Resistance is an inevitable
consequence of a complex
change process
• Resistance should be
embraced and rolled with
Let’s think about “resistance” in old/new
power terms

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#S4CA @sch4change
Is your change programme
a cathedral or a bazaar?
http://www.unterstein.net/su/docs/CathBaz.pdf

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#S4CA @sch4change
Resistant behaviour is a good
indicator of missing relevance
Harald Schirmer
http://de.slideshare.net/haraldschirmer/strategies-for-corporate-change-the-new-
role-of-hr-driving-social-adoption-and-change-in-the-enterprise
Source of image: driverlayer.com
‘‘

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#S4CA @sch4change
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. Create 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
New power mindset:
the role of the change agent
Source of image: rachtalks.pressprestige.com

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#S4CA @sch4change

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#S4CA @sch4change
Recommended: Mark Jaben on the
science behind resistance
What NOT to do What TO do
But what we do do Instead of buyers (who
“buy-in”), we need investors

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#S4CA @sch4change
Data and facts don’t change our minds
http://www.newyorker.com/magazine/2017/02/27/why-facts-dont-change-our-minds

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#S4CA @sch4change
Our effectiveness as change agents is not a
matter of intention; it’s a matter of impact

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#S4CA @sch4change
• 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

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#S4CA @sch4change
Stop talking
AT ME
Start talking
TO ME
Source of image: prepbeijing.com

32.
#S4CA @sch4change
Which kind of activists are most successful
at delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

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#S4CA @sch4change
Patient leaders as “lone wolves”
“What I am ranting about is the way in which patients are
being streamed into advisory sub committees, the way we are
being used as tokens and to help tick off the right box…..
Where is the attitude that patients are part of the team in
healthcare, that we are partners? Why are we always asked
to participate inside a pre-determined frame? When will we
see co-design of new policies, and ultimately co-production?”
Annette McKinnon

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#S4CA @sch4change
Which kind of activists are most successful
at delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

35.
#S4CA @sch4change
Which kind of activists are most successful
at delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

36.
#S4CA @sch4change
Which kind of activists are most successful
at delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

37.
#S4CA @sch4change
Which kind of activists are most successful
at delivering change?
Lone wolves
Build power by expertise and information — through
advocacy, oversight, contributing to committees, public
comments and other forms of consultation
Mobilisers
Build power by mobilising people – being able to call
on large numbers of people to contribute, engage in
change and take action
Organisers
Build power by growing leaders – identifying, recruiting
and training future leaders in a distributed network:
building a community and protecting its strength
Source: Hahrie Han How Organizations Develop Activists: Civic Associations and Leadership in the 21st Century

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#S4CA @sch4change
Health communication and
coaches
Building leaders
Source:
Jönköping

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#S4CA @sch4change
Focus on the “We”
“Great social movements get their
energy by growing a distributed
leadership”
Joe Simpson

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#S4CA @sch4change

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#S4CA @sch4change
“Stages of change”
Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)

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#S4CA @sch4change
• 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

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#S4CA @sch4change
• 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
It works for
organisational and
service change too!
The model is mostly used around
health-related behaviours

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#S4CA @sch4change
“Stages of change”
Smoking
I am not aware my
smoking is a
problem – I have no
intention to quit
Prochaska, DiClemente & Norcross (1992)

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#S4CA @sch4change
“Stages of change”
Smoking
I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
Prochaska, DiClemente & Norcross (1992)

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#S4CA @sch4change
I am not aware my
smoking is a
problem – I have no
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.
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)

47.
#S4CA @sch4change
I am not aware my
smoking is a
problem – I have no
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.
I have
stopped
smoking!
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)

48.
#S4CA @sch4change
I am not aware my
smoking is a
problem – I have no
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.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)

49.
#S4CA @sch4change
I am not aware my
smoking is a
problem – I have no
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.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)

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#S4CA @sch4change
Prochaska, DiClemente & Norcross (1992)
“Stages of change”
Transtheoretical model of behaviour change

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#S4CA @sch4change
• Which stage do most change activities in
health and care focus on?
• Which stage are most people actually at?
Some questions

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#S4CA @sch4change
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
90% of the tools available for health and
care change agents are designed for the
“action” stage

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#S4CA @sch4change
• Designed for Stage
4 – ACTION!
• Mandated it
through targets
• Despite compelling
case for change –
people often
resisted it
• People did the task
and missed the
point
Example – WHO Surgical Safety Checklist

54.
#S4CA @sch4change
Source: Russ et al (2015) A
Qualitative Evaluation of the
Barriers and Facilitators
Toward Implementation of the
WHO Surgical Safety Checklist
Across Hospitals in England:
Lessons From the “Surgical
Checklist Implementation
Project” Ann Surg
Source of infographic here

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#S4CA @sch4change
“In hospitals without adequate resources and efficient systems, simply
requiring the checklist to be used might not only fail to improve
patient safety but might also introduce new risks for staff and
patients. This is the exact opposite of what the checklist was designed
to achieve”.

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#S4CA @sch4change
• 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
So what do we TEND to do when people
resist?

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#S4CA @sch4change
The single biggest problem
in communication is the
illusion that it has taken
place
George Bernard Shaw
‘‘

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#S4CA @sch4change
• Listen and understand
• appreciate the starting point
• elaborate interests
• Roll with resistance
• Don’t argue against it
• Be curious and accepting
• Encourage elaboration of resistance
• What makes it so hard?
• What would help?
• Build meaning and conviction in the change
So what SHOULD we do?
See Motivational interviewing as a change management strategy

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#S4CA @sch4change
• 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
• 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

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#S4CA @sch4change
If your horse dies,
get off it
Cherokee proverb
Source of image: fenwickgallery.co.uk
‘‘

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#S4CA @sch4change
What happens next
• If you pre-registered with your Break out room
number, you will be transferred there
• If you haven’t registered with a room, we are offering
a separate phone conference that you can join:
0800 917 1950
33136606#

62.
#S4CA @sch4change
In the breakout room
• If you get stuck, ask for help here
• Your facilitator will be in the room. They
can be identified with the presenter ball
next to them.
• You can mute and unmute yourself
using the Mute button
• We’ve occasionally seen instances
where screenshare appears. We
therefore strongly recommend you close
other windows you have open on your
computer.