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chapter 8 | People and the Process of Change 107 CikguOnline
be a very small change in routine had provoked sur- written materials distributed to everyone involved
prisingly strong resistance because it threatened the via print or electronic means.
clerk’s sense of importance and power.
Disconfirming Currently Held Beliefs
Recognizing Resistance Disconfirming current beliefs is a primary force for
Resistance may be active or passive (Heller, 1998). change (Schein, 2004). Providing evidence that
It is easy to recognize resistance to a change when what people are currently doing is inadequate,
it is expressed directly. When a person says to you, incorrect, or inefficient can increase people’s will-
“That’s not a very good idea,” “I’ll quit if you ingness to change. The dramatic presentations
schedule me for the night shift,”or “There’s no way described in the section on receptivity disconfirm
I’m going to do that,” there is no doubt you are current beliefs and practices.The following is a less
encountering resistance. Active resistance can take dramatic example but still persuasive:
the form of outright refusal to comply,such as these
Jolene was a little nervous when her turn came to
statements, writing memos that destroy the idea,
present information to the Safe Clinical Practice
quoting existing rules that make the change diffi-
Committee on a new enteral feeding procedure.
cult to implement, or encouraging others to resist.
Committee members were very demanding: they
When resistance is less direct, however, it can be
wanted clear, research-based information presented
difficult to recognize unless you know what to look
in a concise manner. Opinions and generalities were
for. Passive approaches usually involve avoidance:
not acceptable. Jolene had prepared thoroughly and
canceling appointments to discuss implementation
had practiced her presentation at home until she
of the change, being too busy to make the change,
could speak without referring to her notes. The pre-
refusing to commit to changing, agreeing to it but
sentation went well. Committee members commented
doing nothing to change, and simply ignoring the
on how thorough she was and on the quality of the
entire process as much as possible (Table 8-1).
information presented. To her disappointment,
Once resistance has been recognized, action can be
however, no action was taken on her proposal.
taken to lower or even eliminate it.
Returning to her unit, she shared her disap-
Lowering Resistance pointment with the nurse manager. Together, they
used the unfreezing-change-refreezing process as a
A great deal can be done to lower people’s resis-
guide to review the presentation.The nurse manager
tance to change. Strategies fall into four categories:
agreed that Jolene had thoroughly reviewed the
sharing information, disconfirming currently held
information on enteral feeding. The problem, she
beliefs, providing psychological safety, and dictat-
explained, was that Jolene had not attended to the
ing (forcing) change (Tappen, 2001).
need to unfreeze the situation. Jolene realized that
Sharing Information she had not put any emphasis on the high risk of
contamination and resulting gastrointestinal dis-
Much resistance is simply the result of misunder-
turbances of the procedure currently in use. She had
standing a proposed change. Sharing information
left members of the committee feeling comfortable
about the proposed change can be done on a
with current practice because she had not empha-
one-to-one basis, in group meetings, or through
sized the risk involved in failing to change it.
At the next meeting, Jolene presented additional
information on the risks associated with the current
table 8-1 enteral feeding procedures. This disconfirming
Resistance to Change evidence was persuasive. The committee accepted
her proposal to adopt the new, lower-risk procedure.
Active Passive
Attacking the idea Avoiding discussion Without the addition of the disconfirming evidence,
Refusing to change Ignoring the change it is likely that Jolene’s proposed change would never
Arguing against the change Refusing to commit to the have been implemented. The inertia (tendency to
change
remain in the same state rather than to move toward
Organizing resistance Agreeing but not acting
change) exhibited by the Safe Clinical Practice
of other people
Committee is not unusual (Pearcey & Draper,1996).