Recently I have been dipping into the social psychology literature to support my understanding of the complexities of organizational behavior and relationships, in particular work on ‘restrictions to personal freedom’. I have been pondering this notion and how it can be applied to users of health services, students, researchers and staff of healthcare and academic institutions. Here are three recent examples noted from my personal and professional life:
- As a relative – freedom to be with someone when they are in hospital because ‘’the system” says visiting is only at 7pm (will the NHS ever take the brave step of open visiting ?)
- As an Assistant Director, freedom to express concerns about professional ‘silos’
- As a Professor, freedom to change my mind about an academic collaboration decision that could be inconsistent with my personal values
I recently read an interesting article on this topic by North American researchers (Laurin, Kay and Fitzsimons, 2012) The study concluded that when a restriction (or change) is absolutely certain to come into effect people tended to consider the situation in a positive light (to rationalize it). When participants viewed the restrictions as having a small chance of being implemented then these were viewed less favourably and the status quo position was valued even more (participants displayed ‘reactance’ to it).
Collective Commitment to Change
In my career so far, I have had the privilege of working with many inspirational nurses, medical staff, pharmacists, managers, academics, civil servants and support staff. This has often been on change initiatives to introduce new approaches or identify new knowledge. The most rewarding of these roles has been when I have been working as part of a team where the changes required are absolutely certain to come into effect (usually due to strong, consistent and authentic leadership); when the team has been open to developing and discussing collective insights and where there is a strong sense of valuing the diversity of ideas that are focused around an absolute clear commitment that change must occur – we have all understood what the right thing to do is.
The least rewarding and most demoralising times in my career to date have been, when there have been ambiguous or contradictory directions from leadership or when colleagues have not believed in the change message. Laurin and her colleagues note that “…. when there is a chance, even a slim one that the restriction will not come into effect, people respond negatively to it and exaggerate the importance they attach to the restricted freedom’ (p. 209). It can be tough going when the climate for change (Kotter, 1996) is not present, particularly when culture and climate in organizations and teams is so closely associated with clinical outcomes, morale, staff turnover, innovation and productivity.
Bohmer (2011) has stated that one of the four habits of high performing healthcare organizations is “self-study,…….these organizations examine positive and negative deviance in their own care and outcomes, seeking new insights and better outcomes for their patients” (p.2046). Self-study can be challenging though. What if examining “negative deviance” (to use Bohmer’s term) creates strong emotions ? Florence Nightingale once said “How little can be done under the spirit of fear”. Most of us will be able to identify with how the fear of an inspection, test, exam or not having the answer to a challenging question stifles confidence, creativity and learning.
Is it the self-study, the inspection, test or question that is driving the fear or inhibiting positive response to change – could it be that it is the wider culture, the ‘climate’ that is playing a greater part in the generation of fear or negative reaction ? If an organisation does not encourage self-study , or ‘allows’ perceptions to be held that change and new behaviours are ‘optional extras’ or apply to some staff and not others then, according to Laurin’s research, the status quo will become valued even more – behaviours will resonate towards this position and change will not happen. If there is not a clear commitment or desire to stand up for the right thing (Bennis, 2003) then changes will not be embraced and energies will tend to be devoted to the maintenance of the status quo, and not to understanding, studying or standing up for what is right.
Changes can be difficult when they threaten personal freedoms, particularly when this happens without a collective and absolute commitment to a climate that supports change and self-study. Change is exciting and empowering when visions are clear, culture is supportive and self-study is encouraged. Change is inevitable across our health and social care organisations and within academic institutions.
If you are part of this change – ask yourself
- Which of your personal freedoms does this change threaten most ?
- Do you think you will ‘rationalize’ or ‘react’ ?
- Is this because this is your pattern or your organisation’s culture or both ?
- Could an approach based on Bohmer’s notion of self-study help you embrace and be part of creating the sort of absolute commitment to change in your organisation that energises and empowers people ?
Bennis ,W (2003) ‘On Becoming a Leader’, Cambridge, Perseus Publishing
Bohmer, R.M.J. (2011). ‘The Four Habits of High-Value Health Care Organisations’, New England Journal of Medicine, 365:22, 2045-2047.
Kotter, John. P (1996). Leading Change. Harvard Business School Press
Laurin, K, Kay, A.C. and Fitzsimons, G.J. (2012). ‘Reactance Versus Rationalisation: Divergent Responses to Policies That Constrain Freedom’, Psychological Science, 23(2), 205-209.
Craig A. White (@craigwhitephd) is Assistant Director in the Executive Medical Directorate of NHS Ayrshire and Arran (@nhsaaa) and Professor in the Faculty of Education, Health and Social Sciences at the University of the West of Scotland (@uwshealth).
Next week’s blog is by @suzi_hannah and will consider the benefits of a collaborative approach to influence clinical improvement.