Combat ‘resisting forces’ in the ED

Every change effort has its "resisting forces"—individuals or groups which actively resist change. "Resistance is going to be there, so thinking creatively about how to deal with that is important," emphasizes Thom Mayer, MD, FACEP, FAAP, chairman of the department of emergency medicine at Fairfax Hospital in Falls Church, VA.. Here are some commonly heard comments from "resisting forces" of change and how to counter them:

"This is as good as we can do." It’s common for staff to insist it’s simply impossible to do any better. "If there is a certain complacency about the status quo, leaders need to figure out how to attack that by finding examples of where people do it better," says Mayer. Once you find evidence that your ED isn’t measuring up, make that information as public as possible.

When the ED staff at Harris Methodist Medical Center in Fort Worth, TX, were told they had to dramatically reduce their waiting times, the initial reaction was disbelief. "In the beginning, we didn’t see how we, as an inner city trauma center could make such significant changes in our times, and it wasn’t just the staff who had that attitude—the leadership also felt we were being held to too high an expectation," recalls Lindy Rose, RN, BSN, the ED’s director.

The ED’s staff had to do a complete about-face to make the change occur. "We had to totally change our philosophy," Rose says. "We had to realize it wasn’t just important for us to satisfy the critical patients, we needed to make everybody happy." Focus groups with the ED’s former patients helped the staff to get on the same wavelength as the patients, which facilitated the change process.

"But, we’ve always done it that way." Major changes may seem too disruptive to some staff members. Take the opportunity to get them back on track. "Don’t tell them to take a hike; instead, ask them to tell you what fears and concerns [they have] about the change process," advises John Kotter, author of the business textbook, Leading Change, and the Konosuke Matsushita Professor of Leadership at Harvard Business School.

"It’s against regulations." If a staff member creates an obstacle by claiming a process change is against regulations, have a healthy skepticism. "Regulatory issues are usually smoke screens in my experience," says Mayer. " When you unpack regulations, they don’t always say what people claim."

"It’s the administration’s fault." People who won’t take responsibility for making positive change can blame others if things go awry. "They claim innocence and blame financial people or techs, telling others, ‘We’re okay but administrators are skunks and lying thieves,’" says Mayer. "Be careful of this victim mentality, because what they really want is power."

"I’m not going to get involved with this unless you can prove it’s going to work." Although bystanders who avoid committing may not be numerous, they can have a big influence on others. "React not so much to them, but to people who will see you interact with them publicly," Mayer recommends. "If people see you being reasonable and fair, an opponent may become affirmatory."

"I’m going to wait and see." "Fence sitters are smoothly polished people who know how to tell which way the wind is blowing, and they’ll get there as soon as the decision has been made," says Mayer. While they claim to be realists, these staff members may actually be cynics in disguise. "They usually will want some sort of guarantee that the change isn’t going to affect their pay or their jobs," he says. "Tell them, there isn’t any promise, just an invitation that there could be a better way."

"Gee, I guess you haven’t been here very long—we tried that already." "Maybe they have and maybe they haven’t, but there’s such a thing as timing for a good idea," says Mayer. "Sometimes things have been tried, but the chemistry may be different now."