Module 3 rolling with resistence final

#SHCR @School4Radicals
http://www.theedge.nhsiq.nhs.uk/school/
Module 3:
Rolling with resistance
Supported by

Joining in today and beyond
• Please use the chat box to contribute continuously during the
web seminar
• Please tweet using hashtag #SHCR and the handle
@School4Radicals
• Join our Facebook group School for Health and Care Radicals
• We will produce summaries of the discussions on each module
using Storify and Pinterest and put on the website
• Join in the Tweetchat each Wednesday at 4-5pm (GMT) using
the hashtag #SHCR

The team today
Session lead:
Helen Bevan
@HelenBevan
Learning lead
and case study:
Pip Hardy
@PilgrimPip
Chat monitor:
Dominic Cushman
@domcushnan
Case study alumna:
Vanessa Garrity
@VanessaLGarrity
Icebreaker & twitter
monitor:
Kate Pound
@kateslater2

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
them to use their
energy for change.

With which role do you most closely identify?
Receiver of care Campaigner
Change agentAwesome Chief listener
Giver of care

Best role: Director of Possibilities!

Who are the students of the School for
Health and Care Radicals?
• 77% - healthcare workforce (all sectors)
• 6% - local government which include social
workers, public health
• 6% - education (research and universities)
• 11% - “others” which includes patients and
carers, voluntary sector, consultant /private
sector and police

The biggest learning groups in the
School for Health and Care Radicals
• Nottingham University Hospitals, England – 65
people
• NHS England – 36 people
• Kingston General Hospital, England – 29 people
• Nelson Marlborough District Health Board, New
Zealand – 23 people
The #WARuralHealth learning group

• What do we mean by resistance to change?
• Some different ways to look at resistance
• Importance of diversity in leading change and its
implications in terms of resistance
• Impact and intent
• Using the Stages of Change model to understand
“resistance” and help people through change
• What we tend to do when dealing with resistance and
what we should do?
• Call to action and reflection Source of image: www.freshnessmag.com
for
today

Employee resistance is the
most common reason
executives cite for the
failure of big
organizational-change
efforts
Scott Keller and Colin Price
(2011), Beyond Performance: How
Great Organizations Build Ultimate
Competitive Advantage
Source of image:
Businessconjunctions.com

“
Thousands of patients have died
needlessly because of a
damaging reluctance amongst
doctors and the public to accept
changes in the NHS, according to
the country’s top emergency
doctor
“

What do we mean by
?

#SHCR @School4Radicals Source of image: sport-fitness-advisor.com
Any force that stops or
slows movement
Resistance

In module 1, we talked about:

Let’s think about this in the context of “resistance”

Leading change in a new era
Dominant approach Emerging direction
• 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”

Resistance to change: the dominant approach

An example “dominant approach”
transformation programme

“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
Dominant approach:
the role of the change agent

Leading change in a new era
• Change in human systems is
often emergent and hard to
predict
• Change results from
connections/interactions
stimulating different
perspectives, shaping how
people think about things
• Resistance is an inevitable
consequence of a complex
change process
• Resistance should be embraced
and rolled with
Dominant approach Emerging direction
• 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 doesn’t rain down on us from on high. Rather, its stories are co-
created and co-owned by the community. Or, at least they are if you want
the change to stick”
Julian Stodd
https://julianstodd.wordpress.com/2013/11/29/the-co-creation-and-co-ownership-of-organisational-change/

Leaders ask their staff to be ready for change,
but do not engage enough in
sensemaking........
Sensemaking is not done via marketing...or
slogans but by emotional connection with
employees
Ron Weil

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
‘‘

Cultural change
is a million
subversive acts
of resistance.”
Brene Brown
Source of image: zazzle.com
‘‘

Language constructs our world(s) rather than
reports the objective facts about the world.
Therefore changing when, where, how and
which people talk about things – changing the
conversation – will lead to organisational
change.”
Robert J Marshak
Source of image: createbusiness.net.au
‘‘

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
Emerging direction:
the role of the change agent
Source of image: rachtalks.pressprestige.com

“Having care wrapped around the person rather
than the person pushed through the system.”
Lesley Young-Murphy
North Tyneside Clinical Care Group

Case study: A story of resistance
Pip Hardy

‘I have a dream…’
www.patientvoices.org.uk

The evidence of experience
‘Statistics tell us the
system’s experience
of the individual,
whereas stories tell
us the individual’s
experience of the
system…’
Tony Sumner, 2009

The Patient Voices mandala
‘The stories go out, like
flashes of light over the
waves, as markers and
guides, comfort and
warning.’
Winterson 2004

“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

“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
As health and care radicals, we should be
champions of diversity for change

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

Our effectiveness as 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

• Build a trusting and supportive work
environment
• Listen like an ally
• Be open with my intent
• Fully commit to the change
• Seek common purpose and common
interests
• Take time to build relationships
• Take responsibility for my own actions
What can I do?

If your horse dies,
get off it.”
Cherokee proverb
Source of image: fenwickgallery.co.uk
‘‘

#SHCR @School4RadicalsImage copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/

C http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively

#SHCR @School4RadicalsSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal
PERFORMANCE target.

Research from the sales industry:
How many NOs should we be seeking to get?
• 2% of sales are made on the first contact
• 3% of sales are made on the second contact
• 5% of sales are made on the third contact
• 10% of sales are made on the fourth contact
• 80% of sales are made on the fifth to twelfth
contact
Source: http://www.slideshare.net/bryandaly/go-for-no

“Papers that are more likely to contend against
the status quo are more likely to find an
opponent in the review system—and thus be
rejected —but those papers are also more
likely to have an impact on people across the
system, earning them more citations when
finally published.”
V. Calcagno et al., “Flows of research manuscripts among
scientific journals reveal hidden submission patterns,”
Science, doi:10.1126/science.1227833, 2012.
—

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

• 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
• 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

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

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 am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
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.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
Smoking

Transtheoretical model of behaviour change

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

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

• 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 – WHO Surgical Safety Checklist

IN A NUTSHELL
• Evidence from observational studies that the use of surgical safety
checklists results in striking improvements in outcomes
• Led to rapid adoption of such checklists worldwide
• Researchers studied effect of mandatory adoption of checklists in
Ontario, Canada
• Use of checklists not associated with significant reductions in
operative mortality or complications

• 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?

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

• Listen and understand
• appreciate the starting point
• elaborate interests
• Roll with resistance (Singh)
• Don’t argue against it
• Encourage elaboration of resistance
•What makes it so hard?
•What would help?
• Build meaning and conviction in the
change
So what SHOULD we do?

• 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

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?
Thinking about your own situation

Case study: Stages of Change
Vanessa Garrity

“Tomorrow’s
management systems
will need to value
diversity, dissent and
divergence as highly
as conformance,
consensus and
cohesion.”
Gary HamelSource of image: www.fastcompany.com

Call to action for this week
• Reflect deeply on how you operate as
an agent for change
• Consider the impact of your
communication and behaviour beyond
your intent
• Listen to others’ views, engage others in
change and help others through the
stages of change

• Wednesday 18th February
16:00-17:00 Tweet chat #SHCR
• Next Friday morning 20th February
module 4: Making change happen
Next opportunities for learning

1. What does resistance mean 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

Module 3 rolling with resistence final

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Module 3 rolling with resistence final