Resistance to changeCAUSES AND SOLUTIONS

Making changes in a healthcare organisation is a process complicated byresistance. 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 rapidpace and all nurses, whatever their grade,must be knowledgeable and skilled in thechange process (White 1998). Reasons forchange include restructuring in the workplace,advances in technology, a greater need for effi-ciency and the growth of new services (White1998).

White (1998) suggests that 'change itself isneither good or bad, it is inevitable ... Changewill, must and should occur'. Change canaffect people in different ways regardless ofits type. For example, people may experiencefeelings of achievement, loss, pride and stress(Marquis and Huston 2000). Change alsobrings uncertainty, ambiguity and a loss ofcontrol and predictability (Muchinsky 2000).

Marquis and Huston (2000) argue thatbecause change can disrupt the 'homeostasis,or balance, within a group resistance shouldalways be expected'. The level of resistancewill depend on the type of change. There isless resistance to technological change thanthere is to social change or to change that isnot consistent with established customs ornorms. For example, nurses are more likelyto accept a change in the type of intravenouspump used than a change regarding who isable to administer intravenous therapy.

Harvey (1995) believes that 'change with-out resistance is no change at all - it is an illu-sion of change'. Therefore, it is important thatnurses are able to recognise resistance andplan and implement strategies to reduce orprevent it.

Resistance to change refers to any employ-ee behaviours that discredit, delay or prevent

the implementation of a work change (New-strom and Davis 1997). Employees may resistchange for several reasons, and understand-ing them may help change leaders or agentsto implement change more effectively (Daft2000). According to Dent and Galloway-Goldberg (1999) resistance to change hasbecome 'a standard part of managementvocabulary' (indeed, as a topic, resistance tochange was discussed in the majority of textsreviewed for this article).

Resistance as a concept came into the lit-erature on organisational change through psy-choanalysis and the human relationsmovement. In examining this concept in itsorigins of psychology literature, there appearsto have been a shift from a blind acceptanceand linear understanding of resistance tochange, to questioning this acceptance (Dentand Galloway-Goldberg 1999), searching fora deeper understanding of the factors thatcontribute to resistance (Stapley 1996) andmoving towards understanding change as anopen-ended and evolving process (Weick andQuinn 1999).

Reasons for resistanceIn preparing this article the authors reviewedmaterial from management and psychology.The management literature suggest that resis-tance often greets change and that managersmust be aware of the reasons why peopleresist change and the strategies for overcom-ing this resistance. The psychology literatureexamines the individual's psychological reac-tion to change. This approach does howeverlead to a focus on the individual as the main

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cause of resistance, rather than the changeitself or the implementation process (Mestonand King 1996).

Although this article examines an individ-ual's psychological reaction to change, it mustbe considered in the context of a broaderorganisational structure. Several reasons forresistance have been identified in the literaturebut those oudined below are among the mostfrequendy mentioned.

Increased stressDent and Galloway-Goldberg (1999) arguethat often the resistance is not towards theorganisational change per se but towards theconsequences of such change, for example lossof status, pay or comfort. One way to con-ceptualise resistance to change is to approachit from the framework of the life change mod-el of stress (Holmes and Rahe 1967). Thismodel takes the causes of stress to be changesthat occur in a person's life. It hypothesisesthat any change, positive or negative, plannedor unplanned, requires the individual to read-just to their environment and thus constitutesa stressor.

Just as organisational change brings abouta disruption in the equilibrium of a group,stress is caused by the resultant change inhomeostasis of the individual. Therefore,organisational change by its very nature willbring about stress in the individual and henceresistance.

'• DenialOne of the ways in which people cope withstressful events is through the use of defencemechanisms. Originating in psychoanalysis,these are unconscious strategies that peopleuse to deal with anxiety. One of the mostcommonly used defence mechanism is denial.Rashford and Coghlan (1994) discuss denialwithin Lewin-Schein's model of change.Denial of the need for change occurs in thefirst 'unfreezing stage', when informationabout change in the organisation is first pre-sented. They argue that denial should be con-sidered a normal, healthy reaction toorganisational change, which has both cogni-tive and emotional aspects.

In the cognitive dimension, attempts aremade to understand the perceived impact of

the change by exploring issues such as whythe change is necessary, level of choice toaccept the change, identity of the driving forcebehind the change and possible consequencesof change. The emotional dimension looks atthe psychological safety in an organisation,such as feeling able to express anxieties andconcerns that will be listened to by managers.If both of these dimensions are addressed inan organisation, for example, through fullinformation being presented and empathyexpressed, its members can progress beyonddenial and engage in the steps of organisa-tional change.

Self-interestSome people may resist change because theybelieve that the change will affect their self-interest and could diminish their power orinfluence. Stapley (1996) suggests that allchanges to an organisation's culture involve aloss. This fear of personal loss is probably themajor obstacle to change within organisations(Daft 2000, Griffin 1993, Weihrich andKoontz 1993). Change can also impact on aperson's self-esteem. Self-esteem is the largestdeterminant of behaviour and nothing is morecentral or pervasive in behaviour than peo-ple's beliefs about themselves (Bandura 1995).Arthur (1992) suggests that there is a contin-uing problem of nurses having low self-esteem.

Nurses with low self-esteem may perceivechange as exerting unwanted pressure andundermining them (Randle 2001). Individu-als with high self-esteem are expected to ini-tiate transformational change because they aremore confident about what they can achieve(Brockner 1988). Nurses with a healthy self-esteem will perceive the changes in nursing asbeneficial challenges and take a proactivestance (Randle 2001).

Closely linked to self-esteem is a person'sperception of their skills, ability and knowl-edge to perform certain tasks - or self-effica-cy (Bandura 1982). How a person respondsto change seems to be closely governed bytheir sense of self-efficacy (Crouch et al 1992).So how individuals previously reacted andcoped with change influences how they assessthemselves to have the necessary resources tocope with the current change.

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nLack of understanding, trust and ownershipResistance may also occur if people do notunderstand the purpose of the change or dis-trust the intentions behind it (Daft 2000,Weihrich and Koontz 1993). For example, ifthe working relationship between a managerand staff members has been problematic thenit is likely that resistance will occur if themanger initiates change.

People may also resist change if it is intro-duced in an authoritarian and insensitivemanner (Newstrom and Davis 1997). Resis-tance can also occur if employees lack own-ership for the change. For example, people aremore likely to accept change that they them-selves have identified and planned. Anychange that is imposed will be viewed nega-tively and result in resistance (Har\'ey 1995).

n Uncertainty'Change is inevitably to some extent an excur-sion into the unknown' (Stapley 1996). Uncer-tainty refers to the lack of information aboutfuture events. People may worry and becomenervous about the change. For example, theymay have fears about meeting the demandsthat the change may produce and have seri-ous concerns about the security of their job(Daft 2000, Griffin 1993, Weihrich andKoontz 1993). These uncertainties are linkedto a sense of loss of control.

A high need for a sense of control has beenidentified as an important factor in con-tributing to resistance to change (King andAnderson 1995). Personal control is the feel-ing that one can make decisions and takeeffective action to produce desirable outcomesand avoid undesirable ones (Rodin 1986).

In the midst of imposed organisationalchange, it will be difficult for the individualto maintain a sense of personal control. Theconsequences of this include, uncertainty', lossof predictability, loss of stability, fear of theunknown and stress (Steptoe et al 1993).

n MotivationHultman (1998) asserts that it is impossibleto understand why people resist change with-out some understanding of motivation. At thebases of motivation is the drive to fulfil ourneeds. Maslow (1954) described these needswithin his hierarchical framework, with our

most basic needs of food and water at the firststage, followed by the needs for safety, lx;long-ing and esteem, rising to the highest need forself-actualisation.

The need for self-worth and value as a per-son is also a central need in the workplace.Organisational change may challenge thissense of belonging and worth in the organi-sation. Resistance to change therefore, maybe symptomatic of this core psychologicalneed not being met (Hultman 1998). Otherimportant motivational factors, such as self-efficacy and control, have already been dis-cussed.

L Different assessments or perceptionsResistance sometimes occur if there is a dif-ference in the assessment of a given situationbetween the manager and staff members. Forexample, a manager having made an assess-ment of a situation may decide to recommenda change. Staff memhers may resist the pro-posed change because they disagree with themanager's assessment or perceive the situationdifferently (Daft 2000, Griffin 1993, New-strom and Davis 1997).

This conflict between your own beliefs andinformation or tasks with which you are con-fronted with is known as cognitive dissonance(Festinger 1957). It is the state of mental ten-sion that exists when what you believe andwhat you are doing or will have to do are inconflict. Individuals strive to reduce this dis-sonance by changing their thoughts or behav-iour. For example, a new system oftechnology is to be used by nurses for patientrecords.

In order to reduce the cognitive dissonancethey are experiencing ('The old system wasfine' plus 'I have to use the new system'), nurs-es may (a) change their behaviour by notusing the technology' at all (vvhich may not bean option), or (b) change their thoughts oropinions, for example, 'Well, I suppose the oldsj'Stem was more time<onsuming' or 'We aremore in line now with the rest of the hospi-tal'. With organisational change, an individ-ual may be experiencing cognitive dissonancein relation to their satisfaction with the cur-rent functioning of the organisation and theirbelief that change would not improve thefunctioning of the organisation.

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mi

' PersonalityOrganisations are made up of individuals withnumerous complex personality types. Howevei;personality variables are seldom used in the pre-diction of resistance to change. Anderson (1988)argues that this is not because of the irrelevanceof personality to organisational change butrather, due to the theoretical and educationalbackgrounds of researchers and change agents.Hultman (1998) proposes the use of his changeopinion profile to help determine causes of resis-tance to change. The results allow for a profileto be devised along a continuum of openness tochange to resistance to change.

Openness to experience is one of the fivepersonality traits of the 'Big Five' trait theory(McCrae and Costa 1999). The other four areconscientiousness, extraversion, agreeablenessand neuroticism. What is important toacknowledge from this theory is that alongsidethe many factors that have already been iden-tified as influencing resistance to change, theremay be an inherent personality trait that ren-ders an individual less open to change.

Stapley (1996) takes a psychodynamic per-spective and examines the personality of thewhole organisation, just as you would an indi-vidual, with all of its underlying unconscioushistory. The development of an organisation'spersonality is a transitive and dynamicprocess. It is developed through the psy-chosocial interactions of its members.

Each organisation (or parts of the organi-sation) has its own unique personality, its ownlevel of maturity, language, behaviours, sup-port systems, and cognitive and emotionalneeds. Understanding this 'personality' willenable the change agent to predict possiblesources of resistance and thereby implementstrategies to reduce the resistance.

Strategies for reducing resistanceThe literature reviewed suggests that man-agers or change agents must not only expectresistance when introducing change, but alsothat they must be able to deal effectively withit if staff members are to accept change col-lectively (Griffin 1993, Harvey 1995, Heinand Nicholson 1994, New and Couillard1981, Newstrom and Davis 1997). Thestrategies discussed here are some of the mostfrequently identified in the literature.

~ Introduce change slowlyOne of the easiest strategies for reducing resis-tance is to introduce the change slowly. Thisallows all the people involved with the changetime to think about and adjust to the change,seek out information, determine whether fur-ther education or training is required andaccept it (White 1998).

D ParticipationAccording to Griffin (1993) participation is themost effective strategy for reducing or over-coming resistance to change. This allows allthe people concerned with the change to takean active part in the planning and implemen-tation of the change (Rocchicciole and Tilbury1998, Schermerhorn 1999). Although thisstrategy can be time consuming its success rateis quite high. For example, uncertainty isreduced, and self-interest is less threatened.Having the opportunity to express their ideasand fears and to understand the perspectivesof others will result in people accepting thechange more readily (Griffin 1993).

• Psychological ownershipPsychological ownership is emerging as a keytheory to decreasing psychological resistance tochange. It refers to a feeling of being psycho-logically tied to an object/organisation and hav-ing a feeling of possessiveness for thatobject/organisation (Dirks etal 1996). This the-ory states that there are three basic self-needs:self-enhancement, self-continuity and controland efficacy. It has been well established with-in psychological research that the 'self is astrong indicator of an individual's attitudes andbehaviours.

These three self-needs influence how indi-viduals will resist change but it is also depen-dent upon the type of organisational changeand whether it is perceived as being attractiveor unattractive to the individual.

Dirks et al (1996) discuss three dichoto-mies of organisational change: self-initiatedand imposed change; evolutionary and revo-lutionary change; and additive and subtrac-tive change. Individuals may be less likely toresist change when it is self-initiated, evolu-tionary and/or additive as these types ofchange do not threaten fundamental self-needs, or psychological ownership.

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n Education and facilitationEducating people about the need for thechange and its potential benefits is veryimportant and may help to reduce resistance(Griffin 1993). Information regarding thechange should be provided on a regular basisthrough discussions and presentations (Scher-merhorn 1999, White 1998). In addition,several facilitation procedures are availableto those planning change. For example, man-agers should announce any planned changeswell before the implementation is due to takeplace and sufficient time provided foremployees to adjust to new ways of doingthings (Griffin 1993).

D Development of trustThe development of trust between the changeagent and those involved in the change is vitalto the successful implementation of anychange. For this to occur open and honestcommunication must be used throughout thechange process. This often minimises uncer-tainty and misunderstandings and ensures thatall those involved in the change receive thesame informadon.

Clarification during the change providesopportunities for people to ask quesdons andseek a clearer understanding of issues theymay have reservations about (Griffin 1993,White 1998). Yet another strategy for devel-oping trust is confrontation. Face-to-facemeetings either individually or in a group, toconfront the issues causing resistance alloweveryone to communicate their feelings andto work collectively to resolve the issues iden-dfied (White 1998). This building of a trust-ing reladonship ensures that the methods usedfor dealing with resistance are transparent(White 1998).

n Addidonal supportProviding addidonal support to those involvedin change is often overlooked as a strategy forreducing resistance to change. Additional sup-port can facilitate change by reducing anxietyand fear of both the change process and thechange itself.

Examples of addidonal support include lis-tening actively to problems and suggestions(Schermerhorn 1999), extra education ortraining, addidonal staff during training peri-

ods and a reduction in workload during thechange process (White 1998). Social supporthas been well documented as acting as abuffer against work stress (LaRocco et al1980, Tyler and Gushway 1995) and stressfrom other sources (Berkman 1995, Cameron1996). Kanter (in Spreitzer and King 1983)identifies three important support mecha-nisms: sharing information, sharing resourcesand providing access to key socio-politicalnetworks.

: Change agentA final strategy that can be used to reduceresistance to change is the use of an externalchange agent. Having an objective personfrom outside the ward or organisation tak-ing on the responsibility for introducing thechange may help to facilitate the introductionof a change (White 1998). The change agentbegins by assessing the situation before plan-ning and implementing the change. Howev-er, early involvement of staff who will beaffected by the change is essential to the suc-cess of this strategy and the introduction ofthe change.

Conclusionwhatever type of change is taking place, allmajor change can result in feelings ofachievement, loss, pride, and stress. Marquisand Huston (2000) suggest that becausechange disrupts the balance within a group,resistance should always be expected.

Despite this, however, change must occurand should be viewed not as a threat but as achallenge or an opportunity to undertakesomething new. It is important that managersor those responsible for initiating change areaware of the reasons why people resist changeand familiarise themselves with strategies thatcould be used to reduce it.

This article described eight reasons whypeople resist change but more importandy ithas suggested some simple strategies thatcould by employed to reduce or prevent itsoccurrence. To bring about effective change,nurse managers need a thorough understand-ing of change at an organisational and indi-vidual level. They need to both expect andaccept resistance, for as the aphorism goes,'change is here to stay' [ Q

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' i U ' J ^ M I I l M I I M

Elizabeth Curtis RGN, ONC, DMS, DipRes Meth, Dip CHHP, MEd is lecturer andBNS Programme Leader, School of Nursingand Midwifery Studies, The University ofDublin, Trinity College, Dublin.

Patricia White, DipStats, MPsych, DipAppSocStudies, BA(Hons) is health servicesresearch fellow. Department of CommunityHealth and General Practice, TrinityCollege, Dublin.

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