Module 3 - Rolling with resistance

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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

#NHSChangeDay #SHCRchat

#NHSChangeDay #SHCRchat

• 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

Joining in today and beyond

#NHSChangeDay #SHCRchat

31st January: Being a health and care radical: change starts with me7th February: Forming communities: building alliances for change14th February: Rolling with resistance21st February: Making change happen28th February: Moving beyond the edge

Modules

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School statistics

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• 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 actionSource of image: www.freshnessmag.com

for today

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What do we mean by resistance to change?

#NHSChangeDay #SHCRchat Source of image: sport-fitness-advisor.com

Any force that stops or slows movement

Resistance

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Change can either challenge or threaten us…….

Your beliefs pave your way to success or block you

Marsha Sinetar

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Diagnostic and dialogic approaches

to resistance to change

Source of image: cultureisconversation.wordpress.com

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• 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: a “diagnostic” approach

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Resistance to change

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“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 changeBritish Journal of Healthcare Management, Vol. 19, Iss. 9, 09 Sep 2013, pp 443 - 445

Diagnostic: the role of the change agent

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• 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

Resistance: a “dialogic” approach

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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

Dialogic: the role of the change agent

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“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

Diversity is critical to innovation and change

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“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

Health and care radicals should be champions of diversity for change

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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

Discussion

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

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• 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 LeeSource of image: thedigitalawards.com

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Stop talkingAT ME

Start talkingTO ME

Source of image: prepbeijing.com

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• 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

What should I do?

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If your horse dies, get off itCherokee proverb

Source of image: fenwickgallery.co.uk

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Maxine’s story

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A tale of resistance and cream paint

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I’m right….

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It all depends…

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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)

So why don’t we change?

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The certainty of youth

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“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

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• 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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• 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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“Stages of change” Smoking

I am not aware my smoking is a

problem – I have no intention to quit

Prochaska, DiClemente & Norcross (1992)

#NHSChangeDay #SHCRchat

“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)

#NHSChangeDay #SHCRchat

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)

#NHSChangeDay #SHCRchat

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)

#NHSChangeDay #SHCRchat

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)

#NHSChangeDay #SHCRchat

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)

#NHSChangeDay #SHCRchat

Prochaska, DiClemente & Norcross (1992)

“Stages of change” Transtheoretical model of behaviour change

#NHSChangeDay #SHCRchat

• 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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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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• 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

Example - Surgical Checklist

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• 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?

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The single biggest problem in communication is the illusion that it has taken

place

George Bernard Shaw

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• 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

So what SHOULD we do?

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• 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

Example from the worksheet

• 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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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?

Our panel

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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

Calls to action campaigns for this week

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• Wednesday 19th February 16:00-17:00 Tweet chat #SHCRchat

• Next Friday morning 21st February module 4: Making change happen

Next opportunities for learning

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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?

Questions for reflection