What We're Reading Now

Change is Hard

26 September 2017

Barbara read 6 Steps for Successfully Bringing Change to your Company and learned if you attempt to change a process quickly without providing enough of the right kind of information, people may dig in their heels and sabotage it.

Tags: barbara read, change, communication, healthcare

You’ve probably heard that the only person who is excited about change is a wet baby. I've worked with physician leaders for almost 30 years, and they'll tell you hospitals are one of the hardest places to enact change. Even when the change will improve outcomes or increase safety, a small number of people can sabotage the initiative. They can do things slower than you wish. They can refuse to use hand sanitizer each time they walk in and out of a patient room even though the research shows that this dramatically reduces infections. They can fail to give enough information about the patient to the next group of caregivers when the shift changes. These are subtle, hard to detect behaviors, but they can be deadly.

So just telling people why the change is important doesn’t always get you the new behavior you want. You need to persuade. And there's a good chance you aren't persuading people the right way. The first three steps listed in 6 Steps for Successfully Bringing Change to your Company by Ken Blanchard and Scott Blanchard are especially helpful: “Beat communication breakdown, get personal, and plan your action.”

Beat communication breakdown

Leaders who have been planning the change are often excited and first want to communicate why the new way will be great—how it will bring in more money, make customers happier, make processes more efficient, make workers more competent, make our group seem friendlier, or improve health outcomes. But the Blanchards say that is not what people want to hear first especially if they haven’t been part of planning the change. They want to understand exactly what the change is before they begin to hear why it is a good idea.

Here's how I'd tell a hospital to use the Blanchards' recommendations to enact a common safety change many hospitals are trying to implement—We are going to try a new process. When a nurse is dispensing medications, no one will go up and talk to him about anything. We’ll have other nurses who can be ready to deal with unexpected emergencies. There will be no casual side conversations. Once people have absorbed the explanation, then tell them the reason why you are going to try the change—It’s hard to talk and concentrate at the same time. We have verified instances where a nurse was distracted and made a mistake. Paying attention without being interrupted will make this less likely.

Get personal

After the what and why, the next step of serious listening begins. People need to absorb the shock and then tell you why it won’t work, why the old way is better, why they don’t want to do it. The Blanchards quote the author, Werner Erhard, “If you don’t permit people to deal with their feelings about what’s happening, those feelings stay around. Have you ever said to yourself, ‘I’m glad I got that off my chest?’ If so, you know the relief that comes from sharing your concerns openly. The good news is that when people share them openly, their concerns often dissipate.’”

My hospital clients share these common complaints about the medicine dispensing example—Mary is the nurse who knows the answer to everything. You can’t tie her up. Sometimes I have to talk to her. You don’t understand how chaotic it can be on this surgical floor when all the patients have trouble at once.

Going forward, I'll tell the leaders (or those asking for change) to listen as long as they can and then say—I understand you are not for this and are concerned it will create other problems, but we are going to try if for two months and then evaluate our experiment.

Plan your action

Once people know what and why changed is desired, and they’ve had a chance to complain, they are more prepared for the how. Be ready to answer these questions: “What do I do first, second, third? How do I manage all the details? What happens if it doesn’t work as planned?”

In my example, leaders could respond with this plan—Each day we’ll remind everyone on the shift about this new process. The nurse dispensing medications will put on a red tunic that says, “Please Don't Talk to Me” as a reminder to people. If someone approaches you when you’re doing the task, raise your hand in the motion of a stop sign and smile, but do not engage in conversation, just keep doing what you are doing.

The Blanchards said, “Be prepared to share early wins and proof that the change is making a positive difference.” Let everyone know that medication errors have stopped or reduced since the change was made. It will keep the momentum going and may make the next change easier to take. Also, allow people to share what didn't work about the new plan and provide ideas on how to make continued improvements.

Change can be hard, but perhaps changing our persuasion tactics can reduce some of the pain. How could you use this approach in your organization?

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