Here is an article that caught my eye recently, from HBR:
Seeing the word “resistance” always makes me wonder if the health system in the article was blaming surgeons (or others) for being “resistant.” As I've written about before, blaming others is a really poor strategy for getting others to embrace change.
The authors of the HBR article seem to agree:
“The natural reaction by leaders at all levels charged with implementing change is to fight the resisters. But research and the experiences of some organizations suggest that embracing those who resist
changethe most — empathizing with them, identifying the sources of their resistance, and helping them see change as positive — is far more effective.”
Those thoughts remind me, in a way, of the “motivational interviewing” style of counseling and managing. Of course, helping people accept change is more complicated than knocking down sources of resistance. We have to also help people strengthen their commitment to change, evoking and strengthening intrinsic motivation.
The article discusses how they increased acceptance, and they report:
“[McLeod Regional Health System] now use the checklist for 100% of surgical cases.”
Is that a real “100%” — or a “reported 100%” or an “observed 100%”? Those might not be the same thing.
This has been done to what benefit?
“Since implementing the checklist, McLeod's 30-day surgical mortality rate has dropped by nearly one-third; surgical teams' productivity has increased (by 7.5 hours per case), saving more than $4 million annually; and a greater volume of surgical cases, combined with the higher operating room throughput, has generated more than $3 million in additional revenue annually. Surgical team members also report that their job satisfaction has risen and there's a stronger culture of safety in which everyone, regardless of their position, feels they can speak up to call attention to and take action as safety issues arise.”
The article talks about how surgical checklists are logical and evidence based… but people still “resist.” People are complicated. That's why we have to help them and work with them instead of just labeling or blaming them.
For the first 18 months, acceptance rates hovered at about 30% at McLeod.
Then, they tried three approaches that are elaborated on in the piece:
- Don't fight the resistors
- Stop telling people what changes to make
- Focus on the people who already are committed to change
All of those three approaches require conversations about change. Again, that reminds me of the M.I. approach.
Communication can't just be a one-way mandate. Leaders need to invite people to share their motivations and challenges. Hopefully, the discussion goes in a direction that allows people to strengthen their motivation. TELLING is tempting, but it might result only in superficial compliance (with people reporting that checklists are being used, even if they are really not).
What do you think of the article? How does this line up with your experiences?
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