Paul Plsek is the senior visiting fellow on innovation and complexity at Ko Awatea. He is also the chair of innovation at Virginia Mason Medical Centre in Seattle, innovator-in-residence at the MedStar Health Institute for Innovation in Washington DC, and is an internationally recognised independent consultant on creativity, innovation, leadership and the management of change in complex systems. He has an extensive list of healthcare clients in the US, UK, Norway, Sweden and Canada, and has authored or co-authored eight books and numerous journal articles.
Resistance to change is a myth. It’s a label we use to describe difficulty engaging people in the changes we want to make, but it’s not an accurate description of what’s really happening.
Change has both technical and social aspects, and technically rational changes can fail if the social aspects are not handled well.
The social aspect to change is part of a complex adaptive system, and every group of human beings – a family, a team or an organisation – is a complex adaptive system. The behaviour we label resistance is a natural phenomenon that occurs in such a system.
Change in complex adaptive systems
The difference between throwing a rock and releasing a bird is a helpful metaphor to illustrate how change, or resistance to change, happens in a non-complex system versus a complex system. When we throw a rock, it will follow a predictable path. A released bird will not, but we can increase our chances of getting it to go where we want it to by understanding what attracts birds and the resulting patterns in their behaviour.
Releasing a bird is akin to launching change in a complex system. To make change work, we need to understand the attractor patterns. The patterns of behaviour people exhibit when faced with change are rooted in their values. People have different values, so their behaviour patterns also differ.
The importance of framing
The key to making change resonate with people is framing the case for change to fit with their values, needs and sense of urgency. There is no such thing as resistance to change – but there is poor framing. Many people present a case for change that resonates with their own values, but which fails to connect with the values of their audience.
Framing change to resonate with stakeholders unlocks their discretionary effort – the time and energy they are willing to put in. Change occurs when stakeholders are motivated to unlock their discretionary effort and the resources to enable change are provided. Therefore, understanding people’s key values is essential to implement change successfully.
Key values for healthcare professionals
For health and social care professionals, common values that underpin attractor patterns are:
- altruism – doing good for others and for society
- service and quality – meeting the needs of, and avoiding risk or harm to, service users
- mastery – professional knowledge, achievement, challenge, lifelong learning and demonstrating advanced practice
- autonomy – having a say in how things are done
- comfort/control – feeling competent and in control
- affiliation – identifying with peers
- recognition – valuing praise and respect from peers, the organisation and wider society
- survive/thrive – sustaining the group or organisation, and a good life for themselves and their family.
While we may identify with all of these, most of us are motivated by two or three key values.
Recognising the values
People may espouse values that do not accurately reflect their actual behaviour, so the best way to recognise the key values of others is to reflect on how they have behaved when faced with change in the past. What kinds of change have they supported, and what kinds have they actively or passively resisted? What types of questions or issues do they raise when they resist a change?
For example, people who strongly value altruism often make exceptional efforts to serve the underserved, and may express concern about inequalities and disparities. They are likely to oppose dictates and targets from those in power which they feel might create inequalities or fail to serve all situations.
Using values to activate intrinsic motivation
Activating intrinsic motivation requires those driving change to be authentic, not manipulative, in trying to frame change to resonate with people’s values. Change makers should look at the issue from the perspective of people motivated by each of the core values and adapt how they present the change to what is important to each person they need to engage.
A genuine understanding of core values informs ideas for activating intrinsic motivation and for what to avoid or minimise when presenting change. For example, the presentation of a change to a person who values altruism should focus on service users and the public, and should use a combination of narrative and data to paint a positive picture of what could be. It should, however, avoid over-emphasis on policy, legislation, targets, hierarchy, costs or the needs of internal groups.
A mindset shift for change leaders
Change leaders need to accept that labelling people as ‘change resistant’ is simply a way to justify their own failure to connect with the values of others; what is required is a mindset shift. Instead of becoming frustrated with others because you’ve made your best case for change and “They just don’t get it!”, ask yourself “What is it that perhaps I don’t get about them?”