Resistance to change is generally based on loss of identity, fear of the unknown or lack of trust.  Habits, attitudes, assumptions and beliefs are components of identity, which are challenged when people are asked to change.  Giving up the "way we always do things" is difficult for two reasons.  First, because habitual behaviors and patterns are by nature predicable and offer stability and second, because imbedded in the process of giving them up is the notion that one is being disloyal to a deep attachment-an underpinning of identity.

Because change triggers a re-definition of identity, it also can raise questions about competence.  Resistance is a symptom of the underlying combination or fear, loss, disloyalty, or challenge to competence.  The remedy is to proactively and systematically build trust.  The Reinas' Transactional Trust model offers rich insight.  Trust is a value that is often communicated in the abstract.  It is emotionally provocative; highly complex and can mean different things to different people.  

When change is called for, the message that "what we are today is not good enough" is often internalized as a betrayal.  This is particularly true in environments where patterns of communication, collaboration and involvement are ineffective.  When people experience betrayal, their capacity for trust declines and they begin to lose a sense of self.  Messages about change need to reach for the higher purpose of striving to be better.  Resistance is often a reflection of lack of trust in the process or the fact that people don't yet trust themselves to move to the new territory.  

Capacity to trust can be increased through understanding, clear expectations and goals, and building competency and confidence.  Transactional trust is created incrementally by actions that enhance character, capability and ethical truth.  At the heart of transformation lies the healing and building of relationships based on trust-a cumulative, long-term process.

(Kimball, 2005)

By thinking about daily activities as processes, we gain insights for making improvements. All processes have inputs, all processes have steps, and all processes have outcomes.  For each step, one could also identify where work is backing up or the reasons for rework or problems. Ideas for improvement could be developed and tested from this information. 

For an individual or organization just beginning to develop the skills of improvement, creating standard processes to replace chaotic and wasteful activity is an important source of improvement.  As people advance in their skills at making improvements, they realize that further improvements can be made by putting processes in the context of the system in which the processes are embedded. 

A system is an interdependent group of items, people, or processes with a common purpose. Driving to work is a process. Getting a family out of bed, fed, dressed, and transported to work and school is a system. Orienting a new employee is a process; creating satisfied, productive employees takes a system. In a system, not only the parts but the relationships among the parts become opportunities for improvement.

The process of obtaining a blood analysis is part of the bigger system of delivering health care for a patient in a hospital. The process for obtaining the blood analysis may be flawless, but care will be affected by the timely and effective action taken for the patient on the basis of the analysis. 

In a system, everything affects everything else. One area could make a change that results in improvement for some people but harm the overall system. From the customer's viewpoint, things could be worse. For example, the purchasing department may change suppliers of a raw material to reduce costs, which results in a lower-quality product and more returns from customers. When fundamental changes are developed, the interdependencies within the system must be considered.

 Langley, Gerald J.; Moen, Ronald D.; Nolan, Kevin M.; Nolan, Thomas W.; Norman, Clifford L.; Provost, Lloyd P. (2009-06-03). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (JOSSEY-BASS BUSINESS & MANAGEMENT SERIES) (Kindle Locations 951-953). Wiley Publishing. Kindle Edition.

The next webinar will be Tuesday, December 11th, 2:00 - 3:00 PM.  Please plan to have at least one person from your team on the call so we can hear your 'voice'.  

 Each team be prepared to provide a 2-3 minute update on what your team is currently working on. We will review the latest data and the revised data collection tool. Please come prepared with ideas for the next PDSA cycles around Skin to Skin.   

Over the next 5 months we will focus our attention as a collaborative on specific process measures for improvements. So you and your team can begin to think about these areas the schedule will be as follows:

• Nov/Dec: Skin-to-Skin 
• Jan: Pump Use 
• Feb: Breastfeeding support 
• Mar: Establishing milk supply 

If any team would be willing to present on any of these topics on the monthly webinars please contact me or I will be contacting you.

Click here for webinar information.

Contact

Tammy.Haithcox@pqcnc.org