Resistance to Change literature review

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ABOUT MANAGEMENT TECHNIQUES B Y M A R J O R I E B E Y E R S , P H D , R N , F A A N

E X E C U T I V E D I R E C T O R

T H E A M E R I C A N O R G A N I Z A T I O N O F N U R S E E X E C U T I V E S

management posi-

tion, especially when

everyone works to-

what is expected. But

• I have been troubk

lately about how to handle

the behavior of one of the

staff members. When the staff

discusses improvements, this

person finds reasons why we

cannot change. She always

has some reason for not

quite completing care respon-

sibilities and often upsets

other staff members with

comments and innuendos.

How can I turn this situation

around?

Pat Peverly, M S N , RN, Ad-

ministrative Director, Patient

Care Sen/ices, Anderson i-ios-

pitai Mar/vilie, iiiinois responds:

Managing in an environment

of change requires a culture

that accepts "change" as both

constant and positive. Em-

ployee feedback is necessary

for accurately assessing all as-

pects of care delivery, but the

managerial challenge is to

channel the feedback to pro-

ductive work groups where pro-

cess improvement will result.

I will make two assumptions.

The first is that you have pro-

vided an environment where

employee communication and

participation is encouraged.

Second, I will assume that the

problem employee is just a

"barrier to change" and that her

negative focus can be redi-

rected.

Often employees react neg-

atively due to lack of under-

standing. I would start with fre-

quent staff meetings where

you provide a good orientation

regarding the current status of

health care, how your hospital

has aligned its mission and ob-

jectives to be successful with

the changes, and specifically

on how your unit/department

must contribute. Provide time

for discussion with the staff to

solicit their feedback and to

evaluate their commitment.

Next, I would focus on "team

building" exercises to promote

the skills and cohesiveness of

group interaction. Train team

leaders and facilitators, then as-

sign work groups to study

some of the unit activities or

problems. When you deter-

mine adequate "readiness" ex-

ists for some formal activities,

target those "barriers" for spe-

cial assignments and roles. Your

goal is to make that "vocal" em-

ployee work toward problem

resolution and take some own-

ership for unit outcomes.

If these activities are not suc-

cessful, realize that in any work-

force you will have that small

percentage of employees who

are never going to be "shining

stars" regardless of our man-

agerial abilities. Concentrate on

the majority of employees

and celebrate the successes.

Sharon Denning, BSN, RN,

Nurse Manager, iCU/ACMS,

Nortii i\/lemoriai i\/ledicai Cen-

ter, Minneapoiis, Minnesota, re-

sponds: This employee demon-

strates several challenges: resis-

tance to change, less than

optimal performance in patient

care and poor interpersonal

skills. In this time of unprece-

dented change, it is not unusual

to experience resistance to new

ideas. To reduce resistance to

change, involve employees in

the change process, and com-

municate regularly about ex-

pected changes. In this in-

stance, however, all of these is-

sues should be addressed by

coaching the problem e m -

ployee.

Coaching should be con-

ducted in privacy so that her

dignity is preserved. Begin by

describing the undesirable be-

haviors and the impact of those

behaviors, such as, "When you

do not complete your work, pa-

tients do not receive the best

possible care and your cowork-

ers have to do extra work to

compensate." Be as specific as

possible. Discuss your expecta-

tions in regard to each of the

performance issues. Follow the

coaching session by giving

feedback on a regular basis.

When you see improvement,

provide immediate positive

feedback. If performance is-

sues continue, additional

coaching may be required. If

necessary, formal disciplinary

processes may need to be im-

plemented so that there are

consequences for not demon-

strating improvement.

Denise Ringer, MS, RN,

Vice-President, Patient Care

Services, Aibany Memoriai

Hospitai, Aibany, New Yoric, re-

sponds: Sounds as if it is time

to have a serious talk with this

employee. I would point out

the patterns of incomplete care

responsibilities and the upset-

ting comments using specific,

objective examples. The impact

of the actions, such as patient

complaints or other staff mem-

bers completing the tasks,

should be explained. Give her

an opportunity to identify what

barriers may exist and develop

an action plan for improve-

ment. It is essential that she

perceive your desire to be sup-

portive but also understand the

consequences of not complet-

ing care responsibilities or re-

sisting change in a destructive

manner.

If the other stafi' members

have complained to you, help

them set appropriate bound-

aries in dealing with her. In my

experience, these behaviors

usually have come from em-

ployees who were unhappy in

their present situation and

eventually switched to another

nursing career. Although nega-

tive at first, several later thanked

me for helping them face a dif-

ficult decision. Good luck! •

Abstract: An employee's negative focus can be redirected. Three nurse executives discuss management techniques to use in an environment of change. [Nurs Manage 1998:29(5):56]

56 Nursing Management/May 1998 www.nursingtnanagementconi