Change Resistance in Healthcare

QUINN's MODEL OF CHANGE

Changes in nursing procedures:

Applying Quinn's theory of change

Change resistance can often be extremely difficult to overcome in a healthcare environment. Given that nurses operate with a great deal of autonomy, they are often suspicious when new initiatives interfere with standard operating procedures that have worked in the past. To change the locality of shift to shift reporting from the break room to the bedroom, a nurse manager must generate staff buy-in so that employees genuinely believe that the change is needed and will make substantive improvements for patients, enough so that any of the inconveniences generated by the change seem warranted. Rather than demanding immediate and radical changes, James Brien Quinn "suggests that the most effective strategies of major enterprises tend to emerge step-by-step from an iterative process in which the organization probes the future, experiments, and learns from a series of partial (incremental) commitments rather than through global formulations of total strategies" (Barnat 2014). Quinn argues that incremental change is preferred because this results in improved quality of information dissemination, better organizational awareness, decreased uncertainty and thus improved psychological commitment.

The model of change theory embraced by the organization must be founded in the principles of ACT (Advanced Change Theory) and depart from traditional theories of change. In contrast, the old empirical-rational strategy stresses that if people are presented with the logical benefits of change, they will alter their behaviors (Pochron 2008: 125). While this is an important component of change, unfortunately rationalism alone will not generate buy-in. People can become very emotionally attached to old ways. Also, there may be personal dynamics within an institution to the leader that cause resistance. The power-coercive strategy suggests that a series of carrots and sticks created by the leadership will generate needed changes (Pochron 2008: 126). Unfortunately, in a healthcare environment, this is often the worst method of generating change, given that nurses will feel dictated to in a negative fashion and as if their expertise is being ignored. Even the normative-reeducative strategy which "assumes people are rationally minded and need to be engaged in the process of change" and depends upon consensus-building is problematic according to the ACT model because it does not focus on the leader as well as the follower (Pochron 2008: 125). The leader must be engaged in an intensely self-reflective process about how he or she brings about the change process and be willing to learn from the needs of his or her followers.

Some of the ten principles of ACT can seem extremely idealistic, such as the need to "create an emergent system" (principle one) or to "develop a vision for the common good" (Pochron 2008:127). This stress upon inspiring and visionary leadership is transformational in nature and may initially seem to be difficult for a nurse-manager to grasp, given the bureaucratic model of leadership required in most organizational contexts in healthcare. Nurse managers often have little leeway in terms of how they present change to followers. Their immediate power derives from their position in a hierarchy of authority rather than the personal charisma they generate. "A bureaucratic leader is subject to a system of behavioral rules and technical rules. Behavioral rules define the scope of a manager's behavior and constrain his conduct, while technical rules control how work is to be performed and how decisions are to be made" ("What is bureaucratic leadership," 2015). The change they must enforce (in this case, the change in shift reporting) is not generated from personal conviction but rather is generated from upper-level management and must be filtered through the leader.

However, what is so useful about the ACT's conception of leadership is that it even allows a bureaucratically-oriented leader to infuse a sense of purpose into the change process. "The authors note that failure to change is often due to the lack of appreciation for the complexity of human systems" (Pochron 2008: 128). Quinn's belief in incremental change also embraces a greater appreciation for the "painful adjustments to one's behavior" required by change and the fact that for all workers "change requires placing oneself in jeopardy -- taking risks that put the common good above self-preservation" (Pochron 2008: 125). In a highly negative workplace where management has often ignored nurses' input, any change can be symbolic of the extent to which nurses' input is unappreciated by managers. The nurse manager should acknowledge this: one of the second principles of the ACT model is that a good leader "recognizes hypocrisy and patterns of self-deception" and thus "continuously seeks to improve integrity; honest self-assessment, open to feedback; personal discipline to change behaviors that are not aligned" (Pochron 2008: 127). Change of any kind must be perceived as coming from a place of organizational need, not simply change for change's sake or as simply a need for management to impose its worldview upon nurses.