The Change Agent's Secret: Three Questions That Dissolve Resistance

How the best leaders turn opposition into collaboration with simple inquiry

"We can't implement that new scheduling system. It won't work with our patient flow."

I watched a practice administrator's face harden as her team resisted another improvement initiative. The tension in the room was palpable. Staff members crossed their arms. The meeting was heading toward another unproductive standoff between leadership vision and team resistance.

Then the administrator did something unexpected. Instead of defending the change or explaining why they were wrong, she asked a simple question:

"Tell me more about your concerns with patient flow."

What happened next transformed the entire conversation.

The resistance melted as team members explained their real concerns: they were worried about elderly patients struggling with new technology, afraid that complex scheduling might increase wait times, and concerned that rushing implementation could create chaos during their busy season.

Suddenly, everyone was on the same team, working toward the same goal: excellent patient care.

I would be lying if I didn't admit that witnessing this transformation completely changed how I understand change leadership. The secret skill of successful change agents isn't persuasion, pressure, or persistence—it's the ability to uncover shared intentions through strategic questioning.

The Resistance Misunderstanding

Most healthcare leaders approach resistance to change as an obstacle to overcome rather than information to understand. They see opposition as stubbornness, fear, or lack of vision when it's usually something much simpler: people are trying to protect something they value.

The fundamental misunderstanding: We assume resistance means people don't want improvement when they usually want the same outcomes we do—they just fear our approach might threaten what's already working.

Common Resistance Patterns:

• "This new system is too complicated" (Translation: "I'm worried about making mistakes")
• "We don't have time for training" (Translation: "I'm concerned about patient care during transition")
• "Our current process works fine" (Translation: "I've worked hard to master this, and I'm afraid of starting over")
• "Patients won't like this change" (Translation: "I care deeply about patient experience")

Every resistance statement contains a positive intention. The key is discovering what people are trying to protect or achieve.

The Three Questions That Change Everything

Drawing from the principles in "Crucial Conversations" by Kerry Patterson and colleagues, successful change agents use strategic questions to transform opposition into collaboration:

Question 1: "Tell me more about X."

This question does something powerful: it shifts the conversation from position-taking to information-sharing.

Instead of: "Why are you resisting this?" Ask: "Tell me more about your concerns with [specific aspect]."

The Psychology: When people feel heard, they stop defending and start explaining. Explanation reveals the underlying values and concerns that drive resistance.

Real Example:

• Staff: "The new patient portal won't work for our demographics."
• Leader: "Tell me more about our patient demographics and how you see them interacting with technology."
• Result: Discovery that 40% of patients are over 70 and prefer phone communication, leading to a hybrid implementation plan.

Question 2: "What outcome are you hoping for?"

This question uncovers positive intentions and shared goals.

Instead of: "What's your solution?" Ask: "What outcome are you hoping for in this situation?"

The Psychology: People resist changes that seem to threaten desired outcomes. When you understand what they're trying to achieve, you can address their concerns while moving toward the same goal.

Real Example:

• Staff: "We shouldn't change our appointment confirmation process."
• Leader: "What outcome are you hoping for with our current confirmation process?"
• Staff: "I want to make sure patients feel personally cared for, not like they're just numbers."
• Result: Implementation included personal touches that maintained relationship feeling while improving efficiency.

Question 3: "What are you trying to avoid?"

This question reveals the fears and potential negative consequences that drive resistance.

Instead of: "What's the worst that could happen?" Ask: "What are you trying to avoid as we consider this change?"

The Psychology: Most resistance is fear-based. When fears are named and addressed, resistance dissolves.

Real Example:

• Staff: "We can't move to electronic charting."
• Leader: "What are you trying to avoid with electronic charting?"
• Staff: "I'm worried about spending so much time on the computer that I can't connect with patients."
• Result: Implementation included training on efficient documentation and protection of patient interaction time.

The Crucial Conversations Framework

The book "Crucial Conversations" provides a framework for navigating high-stakes discussions where emotions run strong and opinions differ. For change agents, this framework is essential:

1. Start with Heart: Examine Your Motives

Before addressing resistance, examine your own intentions:

• Are you trying to be right or achieve the best outcome?
• Do you want to win the argument or solve the problem?
• Are you focused on your agenda or shared success?

Change Agent Mindset Shift:

• From: "How do I convince them to accept this change?"
• To: "How do we find the best path forward together?"

2. Learn to Look: Notice Safety Problems

When people feel unsafe, they either withdraw (silence) or attack (violence). Resistance is often a safety problem, not a content problem.

Safety Threats in Change Conversations:

• People feel their expertise is being dismissed
• They worry about job security or role changes
• They fear being blamed for implementation problems
• They feel excluded from decision-making

Creating Safety:

• Acknowledge their expertise and experience
• Clarify that the goal is improvement, not replacement
• Share decision-making authority where appropriate
• Create psychological safety for expressing concerns

3. Make It Safe: Restore Safety When Needed

When conversations become defensive or resistant, restore safety before continuing:

Apologize: "I may have given the impression that I don't value your input. That wasn't my intention."

Contrast: "I don't want you to think I'm criticizing our current process. I'm hoping we can build on what's working while addressing some new challenges."

Create Mutual Purpose: "I think we both want what's best for patient care and staff efficiency. Let's figure out how to achieve both."

4. STATE Your Path: Share Facts and Stories

When presenting change initiatives, separate facts from interpretations:

• Share Facts: "Patient wait times have increased 15% over six months."
• Tell Your Story: "I'm concerned this might affect patient satisfaction."
• Ask for Others' Paths: "What's your take on what's causing this trend?"
• Talk Tentatively: "I'm wondering if a new scheduling approach might help."
• Encourage Testing: "What do you think? What am I missing?"

The Reactive vs. Proactive Pattern

One of the most powerful insights from change conversations is recognizing when current approaches are born from reaction rather than proactive design.

Identifying Reactive Patterns

Reactive Language Clues:

• "We had to implement this because..."
• "This prevents us from..."
• "We can't afford another..."
• "This protects us from..."

Proactive Language Clues:

• "This enables us to..."
• "We're moving toward..."
• "This creates opportunities for..."
• "We're building capacity for..."

The Reframing Conversation

• Leader: "Help me understand our current patient scheduling approach."
• Staff: "We block schedule to prevent overbooking disasters like we had two years ago."
• Leader: "What outcome are you hoping for with our scheduling?"
• Staff: "Smooth patient flow and no waiting room chaos."
• Leader: "What if we could design a system that creates smooth flow proactively rather than just preventing chaos?"

This conversation reveals that the current system is reactive (preventing disasters) rather than proactive (creating optimal flow). The change conversation can then focus on designing for the desired outcome rather than just avoiding the feared outcome.

Real-World Change Agent Examples

Case Study 1: The Electronic Health Records Resistance

Situation: Surgical practice team strongly resisted EHR implementation.

Traditional Approach: "This is required by regulations. We have no choice."

Change Agent Approach:

• "Tell me more about your concerns with electronic records."
• "What outcome are you hoping for in patient documentation?"
• "What are you trying to avoid as we consider this transition?"

Discoveries:

• Staff valued comprehensive patient care notes
• They feared technology would slow down patient interactions
• They worried about learning curves affecting patient care quality

Result: Implementation plan included extensive training, gradual rollout, and protection of patient interaction time. Resistance became collaboration.

Case Study 2: The Treatment Protocol Standardization

Situation: Surgeons resisted standardized treatment protocols.

Traditional Approach: "Standardization improves outcomes and reduces errors."

Change Agent Approach:

• "Tell me more about your approach to treatment planning."
• "What outcome are you hoping for with your current methods?"
• "What are you trying to avoid with standardization?"

Discoveries:

• Surgeons valued personalized patient care
• They feared protocols would limit clinical judgment
• They worried about reduced autonomy and professional satisfaction

Result: Protocols were designed as frameworks that enhanced rather than replaced clinical judgment. Surgeons became co-creators rather than resistors.

Case Study 3: The Patient Flow Redesign

Situation: Front office staff resisted new patient flow procedures.

Traditional Approach: "This will improve efficiency and reduce wait times."

Change Agent Approach:

• "Tell me more about how you currently manage patient flow."
• "What outcome are you hoping for in patient experience?"
• "What are you trying to avoid as we consider changes?"

Discoveries:

• Staff valued personal relationships with regular patients
• They feared efficiency changes would make interactions feel rushed
• They worried about losing the personal touch that patients appreciated

Result: New procedures included protected time for relationship building and maintained personalization within efficient systems.

The Five-Step Change Agent Process

Step 1: Curiosity Before Conviction

Approach resistance with genuine curiosity rather than defensive conviction. The goal is understanding, not winning.

Mindset Shift: "I wonder what they're seeing that I'm not" instead of "They just don't understand the benefits."

Step 2: Safety Before Solutions

Create psychological safety before discussing solutions. People need to feel safe to share real concerns.

Safety Indicators:

• People ask questions rather than making statements
• They share concerns rather than just objections
• They engage in problem-solving rather than position-defending

Step 3: Shared Purpose Before Specific Plans

Establish shared goals before discussing specific implementation approaches.

Alignment Questions:

• "What do we all want for our patients?"
• "What would success look like for everyone?"
• "What values should guide our approach?"

Step 4: Co-Creation Before Implementation

Involve resistors in solution design rather than trying to convince them to accept predetermined solutions.

Co-Creation Approaches:

• "How might we address these concerns while achieving our goals?"
• "What would need to be true for this to work well?"
• "What modifications would make this approach better?"

Step 5: Pilot Before Permanent

Test changes with willing early adopters before full implementation, allowing skeptics to see results rather than just promises.

Pilot Benefits:

• Reduces risk for skeptics
• Provides real-world data
• Allows refinement based on actual experience
• Creates success stories and champions

Common Change Agent Mistakes

Mistake 1: Explaining Instead of Exploring

• Problem: Rushing to explain benefits instead of exploring concerns.
• Solution: Ask questions before making statements.

Mistake 2: Defending Instead of Designing

• Problem: Defending the proposed change instead of designing solutions together.
• Solution: Treat resistance as design input, not opposition.

Mistake 3: Convincing Instead of Collaborating

• Problem: Trying to convince people to accept your solution instead of collaborating on shared solutions.
• Solution: Make resistors co-creators of the solution.

Mistake 4: Timeline Pressure

• Problem: Rushing implementation because of artificial deadlines.
• Solution: Invest time in alignment to accelerate overall success.

Your Change Agent Assessment

To evaluate your current change leadership effectiveness:

1. Resistance Pattern Analysis: What types of resistance do you encounter most frequently?
2. Question Usage: How often do you ask the three key questions when facing resistance?
3. Safety Creation: How do you create psychological safety for people to express concerns?
4. Co-Creation Approach: How often do resistors become co-creators of solutions?
5. Outcome Alignment: How well do you establish shared goals before discussing specific changes?

The Change Agent Mindset

The most effective change agents understand that resistance is information, not opposition. Every objection contains valuable data about how to implement change successfully.

This mindset shift transforms change leadership from a persuasion activity to a collaboration process. Instead of trying to overcome resistance, change agents learn to harness it as a design input that makes solutions better.

Your Change Challenge

Identify one change initiative in your organization that's facing resistance. Instead of pushing harder for acceptance, try the three-question approach:

1. "Tell me more about [specific concern]."
2. "What outcome are you hoping for?"
3. "What are you trying to avoid?"

The insights you discover will likely transform both your approach and their response.

Remember: People don't resist change—they resist being changed. When you make them partners in creating change, resistance becomes collaboration.

Dr. Josh Everts is the Chief Clinical Officer of OMS360, an oral surgery management organization partnered with practices across the United States. With over 20 years of experience as a practicing oral surgeon and healthcare leader, he helps practices transform their operations while maintaining clinical excellence.