How To Realize The Wisdom In Resistance


If we as leaders over focus on quieting the voices of those who resist change, we will only evoke more hard feelings that interfere with progress.  Twenty years ago, through the Polarity Management work of Barry Johnson I heard a new perspective.  It’s simple and it’s a game changer;  “There is wisdom in resistance.“  This started me on a path of developing ways to use the wisdom of the resistors to implement successful change.

Ways for finding wisdom in resistance

Change your reaction to resistance

lung_fn.gifThere is a natural tension when polarities exist. Take breathing for example, we have to inhale and exhale. Though both ends of this dynamic seem opposite, they are interdependent and predictable. There is an upside and a downside to both sides. To survive, we need to maximize the benefits of O2 and CO2 while minimizing the downside of each.

In one organization over focusing on change at the expense of stability negatively impacted results.

Like breathing, a dynamic in organizations and life is the “Change- Stability” polarity.   Teaching this technique, I proposed to an executive team of a failing hospital that there was value to having both change and stability.  The CEO exclaimed, “ Stability is death, we must always seek change at all costs.”  There was resistance to his belief by those who were tired of change for change sake. Employee turnover was high, patient satisfaction was low, there was confusion & fear of the unknown, leading to poor results. The CEO and the team realized that more stability was needed.

Resistors, instead of quieting the voices of those in opposition, hear them out.  There is always a reason for the resistance, use the information.  

A front line nurse manager on a technology project opposed and was even sabotaging1410569488528_wps_117_Nurse_using_an_MCA_talks_.jpg the project. When asked, he revealed that he felt everyone was so focused on the technology that basic clinical care was at risk.  He was very passionate and committed to excellence, and a resistor. His insights were right on with national concerns for healthcare workers over focusing on the technology at the expense of  patient interaction. Once the technological and care polarity was recognized and used to balance the plan, his resistance was no longer present.

Actions to change reactions to resistance:

  • Teach the project team to expect, welcome and use resistance in this game changing way.
  • Use the power of 1:1 conversations to uncover the real reasons for resistance.

Seek to understand why people resist change

We have all been resistors at one time or another and There are many reasons why we have these behaviors.

job-interview.jpgLoss of control

Fear of failure

Fear of uncertainty

Perceived threat to core beliefs

Past resentments

Concerns about implementation

Resistance can be dealt with head on by labeling it as normal. Setting the expectation that all feedback is welcome even if some people can’t express it diplomatically.   We want people to be candid and diplomatic when speaking their truth.  This is another very important polarity to master as a leader. Pick your battles, and be both candid and diplomatic with your words.

Actions to welcome the voice of resistance

  • When possible, plant seeds and give hints of what might be coming, seek input early in the process from key people.
  • Help people maintain dignity by honoring those elements of the past that paved the way for the next change.
  • Create certainty of process, with clear, simple steps and timetables. Ensure everyone knows the plan need not be perfect, we can course correct long the way.

Empathize with resistors by finding the resistor in you

Everyone has been resistant at some point in our lives. Think about a time when you dug your heals in and resisted.


resistance.pngWhat was at the heart of your resistance?

Were you ever successful in bringing concerns that actually helped an initiative more forward?

We speak of resistors as non-compliant, negative people, which is not always the case. In one organization, a VP was very negative about leading an organizational change.   When discussing the situation with her and identifying the reason for her resistance, it was clear that she was struggling in her job.  She felt the change might reveal her shortcomings even more.  Strategically, she was reassigned to a different role that lined up with her strengths and she became a very successful leader in the organization.

Actions to empathize with resistance

  • Avoid the temptation to craft changes in secret and then announce them all at once.
  • Consider all affected parties, ask for ideas and concerns, avoid judgment and listen from the resistor within yourself.
  • If a change does pose a significant threat, be honest, transparent, act fast, and fair.

 Be a leader who uses the wisdom in resistance

It is no longer about driving resistors underground.  There may be time when some people are genuinely out to sabotage changes, however it is dangerous to put everyone in this category.  Not all resistors are out to intentionally do harm. Use the information at hand, seek understanding and tap your intuition in working with resistance.  Seek the wisdom resistors bring and involve the planning, giving them ownership



Contact Edgework Institute for assistance in advancing your Healthcare organization


Are you staying afloat with staffing? Avoid These 5 Common Mistakes

life preserver

The issue of staffing never seems to go away, I have dealt with it for over 30 years in healthcare and learned that there are fundamental mistakes to avoid and proven strategies to employ to have successful results.

I noticed a pattern in my professional life, I am often called into help manage the most difficult situations. When leaders need to: Make meaningful data useful, Ask the crucial questions, Provide unconventional ideas, Or engage the courage and wisdom of a developing team, there is help out there.

From troubleshooting staffing in a fast paced, demanding level I trauma and open heart ICU to overhauling staffing in hospitals experiencing critical staffing needs, I find the challenge invigorating and the people I work with full of great ideas.

There Are Big Dynamics Operating Underneath The Daily Problems

 I learned early on that there are underlying dynamics that seem to be competing, but, when managed well, offer a balanced approach and reduce resistance. These are called polarities. I was educated and trained by Barry Johnson, who wrote the book, “Polarity Management:Identifying and Managing Unsolvable Problems.”

 For instance, can you hear these questions rumbling around in your head?

  • Should we be reactive or proactive?
  • Do we address Unit/Department needs or global needs?
  • Should we focus on recruitment or retention?
  • Is Cost or Care more important in our decisions?

The answers are yes to each question!  If our plans don’t have actions for each of these equally, we will find ourselves swinging from one extreme to the other.  Are you experiencing staff dissatisfaction, short staffing, concerns about patient safety, or stress related to meeting your accountability in managing the salary budget and meeting workforce demands? Examining the following mistakes can lead to working with scheduling and staffing in more effective ways.  Are your leaders aware of these undercover dynamics or how to effectively manage them?

5 Common Mistakes

 1.  Living in a reactive rut by over-focusing on daily fire fighting

Yes, we have to be responsive, staffing in healthcare changes frequently.  Being flexible and creative in the daily decisions is important and we also need to be proactive.  It starts with a solid flexible budget process, based on data, to assess volume needs, as well as forecasting patterns. Are you holding too many patients in the ER?  Maybe opening a unit would be more cost-effective and offer better quality.  How about adding FTE’s to replace overtime?  Who helps you balance fire-fighting and proactive planning?

2.  Working in silos and minimizing global needs

A very big mistake is to not have enough contingency options.  It’s important to keep staffing decisions closest to where the care is given, yet as leaders we have to bring a sense of the whole hospital staffing needs.  We will never survive if departments defend and protect only themselves and operate in silos. One option is to have the right amount of core and contingency staff at the unit level AND develop a floating flex pool with contingency staffing as well.  We are not talking about the same old float pools anymore, in fact, many hospitals have a central resource center that has contingency staff offering staffing help to nursing units, and ancillary departments.  I recently assisted an organization in using an approach to determine right sizing of unit per-diem staff and Flex pool growth.

First, it was necessary to clarify terminology.  Core and contingency staff terminology is standard in healthcare.  This is one example.

def core conting Screen Shot 2018-08-18 at 8.22.04 PM

Further clarifying the desired size of each staff contingency category and conducting a core staff analysis of each unit’s core and contingency staffing.  Do you have collaborative directors who could engage in this activity to honestly, equally address local and global needs?

 cont sizing Screen Shot 2018-08-18 at 8.22.21 PM

 3.  Focusing on recruitment at the expense of retaining

Recruitment is important; in fact, you need a hire-ahead protocol to get ahead of vacancies, especially in hard to recruit areas like ICU, OR, and NICU.   I also think it’s equally important to “Grown Your Own”.  Good, experienced nurses, techs, etc. are hard to find these days and shortages in health care labor are predicted to rise within the next 5 years. I have found that investing in new graduate residency programs and specialty internships are a sure way to keep your positions filled.  This goes for leadership succession planning as well. Instead of spending thousands of dollars on hiring search firms, it makes sense to promote from within your organization.  Do you have a process in place to identify and groom potential leaders? If not, there is a high probability you will lose very capable and committed people.

4.  Not balancing Cost & Care in our decisions

Some managers over-focus on advocating for their staff, at the cost of upholding the expense side of salary decisions.  Quality is the result of managing cost and care.

A manager that blames the organization or executive leadership for all the problems does not understand their accountability to learn finances, and teach staff about their role healthcare cost management.  I once met a manager that consistently said; “we are always short-staffed”, “patients will die”  “staff will leave in droves”, “this place is a disaster”.  This made the staff feel insecure, and it indicated to senior leadership that he was incapable of taking action to address the problems.  Do your managers, directors, and executives have the tools and practical guidance to assume their accountability

5.  Ignoring your own intuition

The 5th mistake, is to dismiss your own wisdom and intuition.   Is it  natural to pay attention to your gut?  Like a muscle, I have had to exercise this practice.  I do know, that when I ignore my intuition, it hasn’t gone well. The best decisions are made by leaders who use data, best practices, staff input, patient care results and their own intuition.  Do you have ways for leaders to learn and access information about meaningful data, best practices and intuition?