Four Simple Steps for Building a Case for Change

When someone on the “front lines” of a business notices a problem that requires fixing, too often it’s ignored because it will be a hassle to convince others to change the status quo. Niccolo Machiavelli said in 1515, “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things.” Attempting to bring about true change creates emotional and social disequilibrium; this disequilibrium must be carefully managed. I’m going to tell you a story of change from my own experience, but first, let me give you some pointers on how to do this yourself.

In order to encourage change and improvement, we must first create a sense of urgency. Asking guiding questions can build a desire to change. “Why do we need to correct this problem now?,” “What are the consequences if we don’t change?,” and “How will this change allow us to achieve our ultimate goal?” and similar questions will encourage colleagues to actively think about the problem. This is true for both co-workers and management.

Always try to identify the administrator who’s open to change, and avoid those you know will resist. You must show how the improvement has the potential to make his job easier and/or make him look good.

Keeping four simple steps in mind will help even those most stubborn to change come up with better solutions than the status quo:

1. Be careful not to dominate the problem-solving sessions.

2. Once you have identified the problem, sit back and take notes.

3. Read back others’ ideas and foster continued brainstorming.

4. Try to encourage workers who are not participating to share their ideas.

Unfortunately, we know not all people are open to change. When resistance becomes too great, the person leading the change needs to back off and slow down implementation. This was especially true as I tried to implement Gatorounds, a process that applies athletic principles to healthcare and focuses on a team approach and efficient communication in order to reduce the length of work shifts.  In the beginning, I didn’t understand the nature of adaptive leadership and I underestimated the profound resistance I would encounter. I now understand that when someone tries to truly change the way things are done, those in favor of the status quo will defend the old way because they feel threatened by change. After some time away from the university, the disequilibrium I had generated dissipated, and by the time of my return the following year, Gatorounds was a familiar term and had become the status quo.

Experiencing problems trying to overcome the status quo is not a new problem, as emphasized by Machiavelli’s famous quote; it’s something man has faced since the beginning of time. Once team members take on the problem as their own and begin to act to fix it, you and your team will begin to experience increased mental focus and active involvement, and will become part of the solution – rather than being part of the problem.

Dr. Fred Southwick

Frederick Southwick, M.D., is a Professor of Medicine at the University of Florida and manages New Quality and Safety Initiatives for the University of Florida and Shands Health Care System. He also is the author of "Critically Ill: A 5-Point Plan to Cure Healthcare Delivery."

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