Why “Hesitant” is a Better Word Than “Resistant” for Vaccines or Workplace Change

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Words matter, as do our approaches to leading change and influencing others.

The word “hesitant” has been in the news a lot recently, in the form of the phrase “vaccine hesitancy.”

The word “resistant” gets used quite often in organizations, in the context of the phrase “resistance to change.”

In this post, I'll make the case that hesitant is the right word in both contexts. Your employees aren't “resistant to change” — they are “hesitant about change.” Recognizing and respecting that means we'll be more effective in leading change.

What's the dictionary definition of “resistance” (with a “resistant” person exhibiting resistance)? One definition is:

“The refusal to accept or comply with something; the attempt to prevent something by action or argument.”

Resistance can also be the choice of inaction. “Refusal,” in that definition, sounds pretty definitive, as in the definition of “refuse”:

“Indicate or show that one is not willing to do something”

That definitive language of “not willing” is often an oversimplification of a situation. Leaders often suggest (or assume) that “not willing” means “not at all willing” (or “I'll never do that”) and that might not be the case. Leaders too often label those who are “resistant to change” as bad people — and that's certainly not the case. They're not bad people. They're people.

One very powerful thing I've learned (and tried to practice) from my study of the “motivational interviewing” (MI) methodology is that “resistance” is the wrong word to use. MI teaches us that “ambivalence” is a better, more accurate, and more constructive word to use. That word can be defined as:

“Having mixed feelings or contradictory ideas about something or someone.”

MIXED feelings. That's not the same as being 100% OPPOSED. Somebody who is ambivalent (or hesitant) can come around. Don't give up on them.

What's the dictionary definition of “hesitant”?

“Tentative, unsure, or slow in acting or speaking.”

Motivational Interviewing also teaches us that ambivalence is a normal part of the change process for every person. Change is not like flipping a light switch — it takes time and it can be a process. Some people move through that process faster than others. It can be slow (hesitancy) and MI can help people convince themselves to take action (which is not telling them to take action and it's not manipulative, because you're helping reinforce a motivation that they already have to some level).

Maybe that employee (or that CEO) isn't “resistant to Lean” — maybe they are “Lean hesitant,” which could just mean they are slowly coming around to the idea.

Accepting the Change of Wearing Masks

When I chose to start wearing masks last year, I went through stages of ambivalence where, as MI teaches, I had reasons to change and reasons not to change… this would have been my thinking in late March 2020:

My Reasons to Wear MasksMy Reasons Not to Wear Masks
Scientists say they'll likely protect meThey aren't always comfortable
Scientists say they'll likely protect othersIt's hard to tie that mask around my head without help
I want to avoid getting CovidMy glasses sometimes fog up
It's important to me to help others

The science is more definitive now — that masks do block droplets that carry the virus and masks do prevent the spread to others. This journal article reviews the data. BTW, if you see somebody say online that “masks don't work” or “the virus is too small to be blocked,” that's misinformation. I was really troubled to see a self-labeled “Lean pioneer” spreading misinformation about masks recently on LinkedIn.

BTW, thanks to my friend Karyn Ross for sending me a mask that she made… as seen in a photo from last April.

The mask that Karyn sent me required tying around the head. The masks I bought (and then wore) are ear loop masks, so that addressed the one reason why adopting that change was hard. I have found masks that don't fog my glasses as much.

I wasn't that ambivalent… or I should say I worked through the ambivalence pretty quickly. The woman who cut my hair recently said that, in her experience, wearing a mask all day was uncomfortable at first — but, like me, she got used to it (and I don't have to wear one all day).

When I voted in local elections (Colleyville, Texas) the other day, I was saddened to see about HALF of the voters (out of about 25) inside City Hall were NOT wearing masks. There wasn't even a sign at the door requesting that people choose to wear them or please wear them. I think that's awful.

As I'm demonstrating, it's a human tendency to be judgmental — I was certainly being judgmental of those who were not wearing masks at the polling place. Or I should say they were choosing to not wear them.

Motivational Interviewing teaches us that the “righting reflex” is a naturally-occurring tendency. MI also teaches us that TELLING people to change only breeds stronger resistance.

Had I accosted one of the maskless, would I have done anything to sway their views or change their behavior? Probably not. Are they being “ambivalent” or “resistant”? At this point, they've probably fully made up their minds, but their balance in the change equation might be different:

Their Reasons to Wear MasksTheir Reasons Not to Wear Masks
“Experts” are telling me toI don't like wearing them
I heard they don't work (again, this is false)
I'm brave and I'm not scared of a virus
You can't tell me what to do
I don't trust experts / media / government

The balance, for me, did tilt toward wearing a mask. The balance, for them, tilts in the other direction. Are they bad people? Probably not. Have they received bad information? That's more likely. Are they refusing to “do their research” or look for more information that might change their mind? Maybe.

Covid Vaccines

Now, coming back to vaccines, there might be many reasons why somebody is hesitant or ambivalent about a vaccine. Again, I got through the change process pretty quickly and I got vaccinated at the first opportunity I had.

I also have family members who were understandably hesitant — and I would have never thought to label them “resistant.” They weren't just being argumentative or oppositional, as in “You can't tell me what to do.” They were likely to come around, so I made sure I didn't push them.

As we learn in the Motivational Interviewing approach, they had reasons TO change and they also had reasons NOT to change. MI would teach us that being more strident and trying to tell them they HAVE to get vaccinated (the “righting reflex”) might be well intended, but would likely be ineffective.

Two family members had legitimate concerns about possible allergic reactions, given their own medical histories and the early reports about allergy risks with the Pfizer and Moderna vaccines. They were holding out for the J&J vaccine because it works differently and didn't have that same risk.

One of them got vaccinated with the J&J shot (that's the “jab” I also got) and this was before the concerns about rare blood clots came to light. The one family member who got it is a woman over 50, so she's not in the high-risk category and she didn't regret that choice.

The other family member didn't have access to the J&J vaccine, but she came around to accepting the Pfizer or Moderna vaccines, given that the allergic reaction rate is EXTREMELY low and it's readily treatable at the vaccination location or with her EpiPen. In weighing the reasons TO get vaccinated and the reasons to WAIT… she decided that it was better to take the Moderna vaccine (and she had no reaction to that first shot).

I supported her decision. Again, I think if I had tried to push, she might have pushed back… but she would have eventually come around to that decision (or she would have said yes to the J&J).

When we hope others take the actions we'd chose (or would want them to choose) — wearing a mask, getting a Covid vaccination, or doing something in the workplace, telling others to change might feel good, but it's ineffective.

Being Effective or Being Right?

Some then say, “So you have to TELL them the reasons why.” That's often not very effective either. The practice of Motivational Interviewing helps evoke or draw out their inner motivations so they can be built upon and strengthened. These reasons and motivations might be different for different people, including:

  • I want to see my grandkids again
  • I want to be safer at work (or wherever outside the house)
  • I want to help end the pandemic

As the government works to reduce “vaccine hesitancy” (and, again, I'm really glad that most people aren't calling this “vaccine resistance”), there's some amount of education and information that will be shared. But, will that be enough?

Some people have already fallen victim to hearing (and believing) misinformation about the vaccines. I'm often reminded of this alleged Mark Twain quote (and hopefully I wasn't fooled about this):

“It's easier to fool people than to convince them that they have been fooled.”

Even if he didn't say it, there's truth there. People get anchored on something they have learned, and then we tend to look for (or more readily accept) information that reinforces what we were already taught.

This happens in the realm of Lean Six Sigma:

So, back to vaccine hesitancy… methods that would likely not work include:

  • Just giving information and education (what's to say people will be open to that info?)
  • Telling people they have to get vaccinated (and that includes offering incentives)
  • Telling them that they're bad for not getting vaccinated (that will trigger even more defensiveness)

Motivational Interviewing would teach us to have open-ended conversations. A gentle way to bring up this topic with a loved one might be:

“Can you tell me what you know about Covid vaccination? Can we have a conversation about this?”

We could ask “on a scale of zero to ten, with ten being most likely, how important is it to you to get vaccinated?”

If they say “ZERO” or “Hell no, I'm not ever doing that,” then they probably aren't open to a discussion (and your time and effort not lead anywhere).

If they say “four,” then you can ask, “Why did you say four instead of two?” and their answers will start evoking “change talk” and “reasons why” — they've said they have SOME motivation to do it… so that's a good basis for using the MI approach.

MI would teach us to ask open ended questions, like:

“What are your top three reasons for getting vaccinated?”

If they are ambivalent (with reasons to get vaccinated and with reasons not to), you want to ask questions that evoke reasons why (or what MI calls “change talk”). The other person articulating these out loud strengthens their commitment to change. We don't want to ask questions that evoke the “why not” reasons (or “sustain talk” in the MI framework). Motivational interviewing: A powerful tool to address vaccine hesitancy

Questions about concerns or reasons to be hesitant will likely come up anyway, I don't think you have to prompt for that (but you can be ready to address them by offering to share information if it's welcome).

Those are some of my thoughts, ideas, suggestions, and cautions that might be helpful if you're hoping more people will get vaccinated in your family, workplace, community, etc.

Workplace Considerations

If there's somebody at work that you have considered to be “resistant to change,” how would your approach change if you viewed them as “change hesitant” or “ambivalent about change”? We need to do more than change our words — what happens if we also change our approach in helping others through the change process.

Here are some other articles that might articulate all of this better or more authoritatively:

Communication Skills for Talking About COVID-19 Vaccines

“…these skills are designed to address people who are indeterminate, or not sure, or deciding–for this group, openness, empathy, and offering information after they give permission or show interest can build trust and your credibility as a messenger.”

Their approach at a high level:

  1. Start with Open-Ended Questions that Do Not Assume Vaccine Acceptance
  2. Acknowledge Patient Concerns Without Judging
  3. Avoid Criticizing the Patient's Information Sources; Cite Your Experience and/or Point Them to High Quality Sources.
  4. Show Awareness of Your Status as a Messenger, Especially for People of Color and Members of Other Underserved Groups
  5. Link Vaccine Acceptance to the Patient's Hopes and Goals

Note that I admit to not always being good about Point 2 — the thoughts I have or some of the things I tweet. I am working to be better.

Vaccine Hesitancy in the Era of COVID

Motivational interviewing: A powerful tool to address vaccine hesitancy

CDC's Strategy to Reinforce Confidence in COVID-19 Vaccines

How to Tackle COVID-19 Vaccine Hesitancy

Vaccinations are plateauing. Don't blame it on ‘resistance'

“Individuals who aren't seeking a Covid-19 vaccine right now are not necessarily the same people as those who are truly anti-vaccine. Instead of talking up hesitancy, it's time to talk about what motivates people to get vaccinated and identify the ongoing barriers to vaccination.” 

“First, retire the term “vaccine hesitancy.” As any crisis communications expert will point out, it's not a good idea to say things you don't want people to be thinking. Repeating the term over and over again unwittingly communicates that there may be something to be hesitant about. The more people talk about it, the more it becomes a self-fulfilling prophecy.”

More on Motivational Interviewing

You can view all blog posts (including podcasts) on the topic):

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Mark Graban is an internationally-recognized consultant, author, and professional speaker who has worked in healthcare, manufacturing, and startups. His latest book is Measures of Success: React Less, Lead Better, Improve More. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. He also published the anthology Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also a Senior Advisor to the technology company KaiNexus.

10 Comments
  1. Mark Graban says

    Good thread… click on the date in the tweet to read the entire thread. Or click here.

  2. Mark Graban says

    This is a good listen on reaching people who are hesitant:

  3. Mark Graban says

    Somebody I talked to from a health system today used the phrase “vaccine apathy.” It’s more a matter of “indifference” she said.

    They aren’t saying “hell no,” but they also aren’t taking action to get it.

  4. Mark Graban says

    I think headlines like this are inaccurate. People aren’t always “skipping” as much as they “aren’t getting the second dose yet” — and some of the reasons why are not the fault of the people who’ve gotten their first doses.

    Vaccine hesitancy; are people skipping their second COVID-19 vaccine doses?

    1. Mark Graban says

      Similar news in the NY Times:

      Millions Are Skipping Their Second Doses of Covid Vaccines

      I’m afraid that headlines like this will make people wonder “should I be skipping my second dose?”

  5. Mark Graban says

    I love this public health campaign that says it’s OK to have questions… that’s the way to not drive people away.

    “It’s okay to have questions.
    Everyone deserves answers.”

    https://www.vaccinateall58.com/

  6. Mark Graban says

  7. Mark Graban says
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