In this blog post Story of Going Lean in Healthcare: On the Mend and in a recent podcast, Transforming Healthcare thru Lean. I was introduced to the 5 Stages of Change outlined by one of the co-authors, John Toussaint, MD. Recently, when I was reading the book Mastery: The Keys to Success and Long-Term Fulfillment and most specifically the chapter, Why Resolutions Fail. The reluctance or resistance to change were further enforced and I found myself thinking of the 5 Stage outline.

When you start a continuous improvement process such a Lean or Six Sigma many times you will get that initial surge and after some additional hard work , you might feel that you have developed a good process for continuous improvement. You’re happy and the employees are happy and things could not be better! Then it stops, why?

Our basic instinct is that we have a tendency to keep things as they are even if they aren’t very good. We resist all change. If you have been doing something for 20 years one way, a 60 day improvement is minuscule in comparison. I was always taught when training bird dogs that once a habit is created it takes at least twice as long to break it. There are exceptions if a traumatic or an extraordinary circumstance takes place but for the most part it takes time.

So if a organizational culture change occurs large resistance, it may be because it is a really terrible idea or a really good idea. Small incremental improvements meet the least amount of resistance and is much easier way to gain acceptance. But can you afford to wait?

According to George Leonard, author of the Mastery it is a universal experience.

Every one of us resists significant change, no matter whether it’s for the worst or for the better. Our body, brain, and behavior have ability and tendency to stay the same within rather narrow limits.

It is safe to assume that resistance to change even the beginning of a change for the better is interpreted as a threat. No need to count the ways that organizations and cultures resist change and backslide when change does occur. Just let it be said that the resistance here is proportionate to the size and speed of the change, not to whether the change is a favorable or unfavorable one.

Leonard also outlined five guidelines, which I have taken the liberty of changing slightly to fit this discussion:

1. Expect resistance and backlash: Realize that when the alarm bell starts ringing it doesn’t necessarily mean you’ve made a bad decision on the journey for continues improvement. In fact you might take these signals as an indication that your life is deftly changing just what you wanted. Of course it might be that you have started something that’s not right for you: only you can decide. But in any case don’t panic and give up at the first out of trouble. Expect resistance from coworkers and managers. You might figure that they should be overjoyed if things have improved but bear in mind that an entire system has to change when any part changes. So don’t be surprised if some of the people start covertly or overtly undermining your self-improvement.
2. Be willing to negotiate with your resistance to change: So what should you do when you run into resistance is don’t back off and don’t bully your way through. Negotiation is a ticket to successful long-term change in everything and in particular to transforming your organization. The change oriented manager keeps his or her eyes and ears open for signs of the dissatisfaction, then plays the edge of discontent, the inevitable escort a transformation. The fine art of playing the edge in this case involves a willingness to take one step back for every two forward, sometimes vice versa. It also demands and termination to keep pushing, but not without awareness. Simply turn off your awareness to the warnings deprives you of guidance and risk damaging the system. Simply pushing her way through despite the warning signals increase the chances for backsliding.
3. Develop a support system:. You can do it alone but it helps a great deal to have other people with whom you can share the joys and perils of the change are making. The best support system would involve people gone through or are going through a similar process, people who can tell their own story of change and listen to yours, people who breach you up when you start to backslide and encourage you when you don’t.
4. Follow regular practice: People embarking on a any type of change can gain stability and comfort to practicing some worthwhile activity on a more or less regular basis not so much for the sake of achieving an external goal as simply for its own sake. A traveler in the path of continuous improvement is again fortunate for practice in this sense is the foundation of the path itself. If you already have particular practices in place use them as the method for introducing change. Provide a stable base during the instability of change can significantly help the transition.
5. Dedicate yourself to lifelong learning: To learn is to change. Education and training plays a pivotal role in any transformation process. Don’t try to institute a continuous program without the learning. I think what made Six Sigma so successful and sustainable at places like GE, Motorola and Xerox is the training programs they instituted. The levels of knowledge created by the color of belts may be chastised by many but I thought it was a great internal mechanism provided by those organizations. On a broader perspective, the book On the Mend was about change and the authors illustrated the 5 Stages of Change with a diagram that bears many similarities to the outline by George Leonard.

I am amazed how closely the description of change that Dr. Toussaint outlines in On the Mend and in our podcast resembles the path that Leonard describes in Mastery.  A good example is the partnership between the Lean Enterprise Institute (LEI) and the ThedaCare Center for Healthcare Value (TCHV). It brings together two of the world’s leaders in “lean thinking,” with a combined 20 years of experience in lean implementation and education. Working in partnership allows LEI and the TCHV to leverage Leonard’s 5 step process for overcoming the resistance of change.

If you would like to learn more, join John Toussaint, MD, and Roger Gerard, PhD, on Monday, September 13, 2010, at 2:00 p.m. (Eastern) for a free webinar on how to engage people and put culture change at the center of your lean management conversion.

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Story of Going Lean in Healthcare: On the Mend
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