Resistance to change

CAUSES AND SOLUTIONS

Making changes in a healthcare organisation is a process complicated by resistance. Elizabeth Curtis and Patricia White examine some of the factors that lead to resistance to change and strategies for overcoming it
CHANGE IN healthcare occurs at a rapid pace and all nurses, whatever their grade, must be knowledgeable and skilled in the change process (White 1998). Reasons for change include restructuring in the workplace, advances in technology, a greater need for efficiency and the growth of new services (White 1998). White (1998) suggests that 'change itself is neither good or bad, it is inevitable ... Change will, must and should occur'. Change can affect people in different ways regardless of its type. For example, people may experience feelings of achievement, loss, pride and stress (Marquis and Huston 2000). Change also brings uncertainty, ambiguity and a loss of control and predictability (Muchinsky 2000). Marquis and Huston (2000) argue that because change can disrupt the 'homeostasis, or balance, within a group resistance should always be expected'. The level of resistance will depend on the type of change. There is less resistance to technological change than there is to social change or to change that is not consistent with established customs or norms. For example, nurses are more likely to accept a change in the type of intravenous pump used than a change regarding who is able to administer intravenous therapy. Harvey (1995) believes that 'change without resistance is no change at all - it is an illusion of change'. Therefore, it is important that nurses are able to recognise resistance and plan and implement strategies to reduce or prevent it. Resistance to change refers to any employee behaviours that discredit, delay or prevent the implementation of a work change (Newstrom and Davis 1997). Employees may resist change for several reasons, and understanding them may help change leaders or agents to implement change more effectively (Daft 2000). According to Dent and GallowayGoldberg (1999) resistance to change has become 'a standard part of management vocabulary' (indeed, as a topic, resistance to change was discussed in the majority of texts reviewed for this article). Resistance as a concept came into the literature on organisational change through psychoanalysis and the human relations movement. In examining this concept in its origins of psychology literature, there appears to have been a shift from a blind acceptance and linear understanding of resistance to change, to questioning this acceptance (Dent and Galloway-Goldberg 1999), searching for a deeper understanding of the factors that contribute to resistance (Stapley 1996) and moving towards understanding change as an open-ended and evolving process (Weick and Quinn 1999).

Reasons for resistance

In preparing this article the authors reviewed material from management and psychology. The management literature suggest that resistance often greets change and that managers must be aware of the reasons why people resist change and the strategies for overcoming this resistance. The psychology literature examines the individual's psychological reaction to change. This approach does however lead to a focus on the individual as the main

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cause of resistance, rather than the change itself or the implementation process (Meston and King 1996). Although this article examines an individual's psychological reaction to change, it must be considered in the context of a broader organisational structure. Several reasons for resistance have been identified in the literature but those oudined below are among the most frequendy mentioned. Increased stress Dent and Galloway-Goldberg (1999) argue that often the resistance is not towards the organisational change per se but towards the consequences of such change, for example loss of status, pay or comfort. One way to conceptualise resistance to change is to approach it from the framework of the life change model of stress (Holmes and Rahe 1967). This model takes the causes of stress to be changes that occur in a person's life. It hypothesises that any change, positive or negative, planned or unplanned, requires the individual to readjust to their environment and thus constitutes a stressor. Just as organisational change brings about a disruption in the equilibrium of a group, stress is caused by the resultant change in homeostasis of the individual. Therefore, organisational change by its very nature will bring about stress in the individual and hence resistance. ' Denial One of the ways in which people cope with stressful events is through the use of defence mechanisms. Originating in psychoanalysis, these are unconscious strategies that people use to deal with anxiety. One of the most commonly used defence mechanism is denial. Rashford and Coghlan (1994) discuss denial within Lewin-Schein's model of change. Denial of the need for change occurs in the first 'unfreezing stage', when information about change in the organisation is first presented. They argue that denial should be considered a normal, healthy reaction to organisational change, which has both cognitive and emotional aspects. In the cognitive dimension, attempts are made to understand the perceived impact of

the change by exploring issues such as why the change is necessary, level of choice to accept the change, identity of the driving force behind the change and possible consequences of change. The emotional dimension looks at the psychological safety in an organisation, such as feeling able to express anxieties and concerns that will be listened to by managers. If both of these dimensions are addressed in an organisation, for example, through full information being presented and empathy expressed, its members can progress beyond denial and engage in the steps of organisational change. Self-interest Some people may resist change because they believe that the change will affect their selfinterest and could diminish their power or influence. Stapley (1996) suggests that all changes to an organisation's culture involve a loss. This fear of personal loss is probably the major obstacle to change within organisations (Daft 2000, Griffin 1993, Weihrich and Koontz 1993). Change can also impact on a person's self-esteem. Self-esteem is the largest determinant of behaviour and nothing is more central or pervasive in behaviour than people's beliefs about themselves (Bandura 1995). Arthur (1992) suggests that there is a continuing problem of nurses having low selfesteem. Nurses with low self-esteem may perceive change as exerting unwanted pressure and undermining them (Randle 2001). Individuals with high self-esteem are expected to initiate transformational change because they are more confident about what they can achieve (Brockner 1988). Nurses with a healthy selfesteem will perceive the changes in nursing as beneficial challenges and take a proactive stance (Randle 2001). Closely linked to self-esteem is a person's perception of their skills, ability and knowledge to perform certain tasks - or self-efficacy (Bandura 1982). How a person responds to change seems to be closely governed by their sense of self-efficacy (Crouch et al 1992). So how individuals previously reacted and coped with change influences how they assess themselves to have the necessary resources to cope with the current change.

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nLack of understanding, trust and ownership Resistance may also occur if people do not understand the purpose of the change or distrust the intentions behind it (Daft 2000, Weihrich and Koontz 1993). For example, if the working relationship between a manager and staff members has been problematic then it is likely that resistance will occur if the manger initiates change. People may also resist change if it is introduced in an authoritarian and insensitive manner (Newstrom and Davis 1997). Resistance can also occur if employees lack ownership for the change. For example, people are more likely to accept change that they themselves have identified and planned. Any change that is imposed will be viewed negatively and result in resistance (Har\'ey 1995). n Uncertainty 'Change is inevitably to some extent an excursion into the unknown' (Stapley 1996). Uncertainty refers to the lack of information about future events. People may worry and become nervous about the change. For example, they may have fears about meeting the demands that the change may produce and have serious concerns about the security of their job (Daft 2000, Griffin 1993, Weihrich and Koontz 1993). These uncertainties are linked to a sense of loss of control. A high need for a sense of control has been identified as an important factor in contributing to resistance to change (King and Anderson 1995). Personal control is the feeling that one can make decisions and take effective action to produce desirable outcomes and avoid undesirable ones (Rodin 1986). In the midst of imposed organisational change, it will be difficult for the individual to maintain a sense of personal control. The consequences of this include, uncertainty', loss of predictability, loss of stability, fear of the unknown and stress (Steptoe et al 1993). n Motivation Hultman (1998) asserts that it is impossible to understand why people resist change without some understanding of motivation. At the bases of motivation is the drive to fulfil our needs. Maslow (1954) described these needs within his hierarchical framework, with our

most basic needs of food and water at the first stage, followed by the needs for safety, lx;longing and esteem, rising to the highest need for self-actualisation. The need for self-worth and value as a person is also a central need in the workplace. Organisational change may challenge this sense of belonging and worth in the organisation. Resistance to change therefore, may be symptomatic of this core psychological need not being met (Hultman 1998). Other important motivational factors, such as selfefficacy and control, have already been discussed. L Different assessments or perceptions Resistance sometimes occur if there is a difference in the assessment of a given situation between the manager and staff members. For example, a manager having made an assessment of a situation may decide to recommend a change. Staff memhers may resist the proposed change because they disagree with the manager's assessment or perceive the situation differently (Daft 2000, Griffin 1993, Newstrom and Davis 1997). This conflict between your own beliefs and information or tasks with which you are confronted with is known as cognitive dissonance (Festinger 1957). It is the state of mental tension that exists when what you believe and what you are doing or will have to do are in conflict. Individuals strive to reduce this dissonance by changing their thoughts or behaviour. For example, a new system of technology is to be used by nurses for patient records. In order to reduce the cognitive dissonance they are experiencing ('The old system was fine' plus 'I have to use the new system'), nurses may (a) change their behaviour by not using the technology' at all (vvhich may not be an option), or (b) change their thoughts or opinions, for example, 'Well, I suppose the old sj'Stem was more time<onsuming' or 'We are more in line now with the rest of the hospital'. With organisational change, an individual may be experiencing cognitive dissonance in relation to their satisfaction with the current functioning of the organisation and their belief that change would not improve the functioning of the organisation.

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' Personality Organisations are made up of individuals with numerous complex personality types. Howevei; personality variables are seldom used in the prediction of resistance to change. Anderson (1988) argues that this is not because of the irrelevance of personality to organisational change but rather, due to the theoretical and educational backgrounds of researchers and change agents. Hultman (1998) proposes the use of his change opinion profile to help determine causes of resistance to change. The results allow for a profile to be devised along a continuum of openness to change to resistance to change. Openness to experience is one of the five personality traits of the 'Big Five' trait theory (McCrae and Costa 1999). The other four are conscientiousness, extraversion, agreeableness and neuroticism. What is important to acknowledge from this theory is that alongside the many factors that have already been identified as influencing resistance to change, there may be an inherent personality trait that renders an individual less open to change. Stapley (1996) takes a psychodynamic perspective and examines the personality of the whole organisation, just as you would an individual, with all of its underlying unconscious history. The development of an organisation's personality is a transitive and dynamic process. It is developed through the psychosocial interactions of its members. Each organisation (or parts of the organisation) has its own unique personality, its own level of maturity, language, behaviours, support systems, and cognitive and emotional needs. Understanding this 'personality' will enable the change agent to predict possible sources of resistance and thereby implement strategies to reduce the resistance. ~ Introduce change slowly One of the easiest strategies for reducing resistance is to introduce the change slowly. This allows all the people involved with the change time to think about and adjust to the change, seek out information, determine whether further education or training is required and accept it (White 1998). D Participation According to Griffin (1993) participation is the most effective strategy for reducing or overcoming resistance to change. This allows all the people concerned with the change to take an active part in the planning and implementation of the change (Rocchicciole and Tilbury 1998, Schermerhorn 1999). Although this strategy can be time consuming its success rate is quite high. For example, uncertainty is reduced, and self-interest is less threatened. Having the opportunity to express their ideas and fears and to understand the perspectives of others will result in people accepting the change more readily (Griffin 1993). Psychological ownership Psychological ownership is emerging as a key theory to decreasing psychological resistance to change. It refers to a feeling of being psychologically tied to an object/organisation and having a feeling of possessiveness for that object/organisation (Dirks etal 1996). This theory states that there are three basic self-needs: self-enhancement, self-continuity and control and efficacy. It has been well established within psychological research that the 'self is a strong indicator of an individual's attitudes and behaviours. These three self-needs influence how individuals will resist change but it is also dependent upon the type of organisational change and whether it is perceived as being attractive or unattractive to the individual. Dirks et al (1996) discuss three dichotomies of organisational change: self-initiated and imposed change; evolutionary and revolutionary change; and additive and subtractive change. Individuals may be less likely to resist change when it is self-initiated, evolutionary and/or additive as these types of change do not threaten fundamental selfneeds, or psychological ownership.

Strategies for reducing resistance

The literature reviewed suggests that managers or change agents must not only expect resistance when introducing change, but also that they must be able to deal effectively with it if staff members are to accept change collectively (Griffin 1993, Harvey 1995, Hein and Nicholson 1994, New and Couillard 1981, Newstrom and Davis 1997). The strategies discussed here are some of the most frequently identified in the literature.

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n Education and facilitation Educating people about the need for the change and its potential benefits is very important and may help to reduce resistance (Griffin 1993). Information regarding the change should be provided on a regular basis through discussions and presentations (Schermerhorn 1999, White 1998). In addition, several facilitation procedures are available to those planning change. For example, managers should announce any planned changes well before the implementation is due to take place and sufficient time provided for employees to adjust to new ways of doing things (Griffin 1993). D Development of trust The development of trust between the change agent and those involved in the change is vital to the successful implementation of any change. For this to occur open and honest communication must be used throughout the change process. This often minimises uncertainty and misunderstandings and ensures that all those involved in the change receive the same informadon. Clarification during the change provides opportunities for people to ask quesdons and seek a clearer understanding of issues they may have reservations about (Griffin 1993, White 1998). Yet another strategy for developing trust is confrontation. Face-to-face meetings either individually or in a group, to confront the issues causing resistance allow everyone to communicate their feelings and to work collectively to resolve the issues idendfied (White 1998). This building of a trusting reladonship ensures that the methods used for dealing with resistance are transparent (White 1998). n Addidonal support Providing addidonal support to those involved in change is often overlooked as a strategy for reducing resistance to change. Additional support can facilitate change by reducing anxiety and fear of both the change process and the change itself. Examples of addidonal support include listening actively to problems and suggestions (Schermerhorn 1999), extra education or training, addidonal staff during training peri-

ods and a reduction in workload during the change process (White 1998). Social support has been well documented as acting as a buffer against work stress (LaRocco et al 1980, Tyler and Gushway 1995) and stress from other sources (Berkman 1995, Cameron 1996). Kanter (in Spreitzer and King 1983) identifies three important support mechanisms: sharing information, sharing resources and providing access to key socio-political networks. : Change agent A final strategy that can be used to reduce resistance to change is the use of an external change agent. Having an objective person from outside the ward or organisation taking on the responsibility for introducing the change may help to facilitate the introduction of a change (White 1998). The change agent begins by assessing the situation before planning and implementing the change. However, early involvement of staff who will be affected by the change is essential to the success of this strategy and the introduction of the change.

Conclusion
whatever type of change is taking place, all major change can result in feelings of achievement, loss, pride, and stress. Marquis and Huston (2000) suggest that because change disrupts the balance within a group, resistance should always be expected. Despite this, however, change must occur and should be viewed not as a threat but as a challenge or an opportunity to undertake something new. It is important that managers or those responsible for initiating change are aware of the reasons why people resist change and familiarise themselves with strategies that could be used to reduce it. This article described eight reasons why people resist change but more importandy it has suggested some simple strategies that could by employed to reduce or prevent its occurrence. To bring about effective change, nurse managers need a thorough understanding of change at an organisational and individual level. They need to both expect and accept resistance, for as the aphorism goes, 'change is here to stay' [ Q

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Elizabeth Curtis RGN, ONC, DMS, Dip Res Meth, Dip CHHP, MEd is lecturer and BNS Programme Leader, School of Nursing and Midwifery Studies, The University of Dublin, Trinity College, Dublin.

Patricia White, DipStats, MPsych, Dip AppSocStudies, BA(Hons) is health services research fellow. Department of Community Health and General Practice, Trinity College, Dublin.

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