How Defiance Can Help Your Hospital Accelerate Change


At DTA, we’re big on defiance. Well, not all defiance, but good defiance with a positive outcome.

By definition, defiance means “challenging what seems impossible” or “bold disobedience”; this is the mindset needed to move organizations from “volume to value.” Leaders often face resistance to fresh ideas they come up with to overcome persistent problems (asymptotes) as they try to do things like help deliver a consistent standard of care, create seamless transitions for patients, or realize efficiencies in administrative areas. Resistance may manifest itself in the passive aggressive behavior that occurs in the “meeting after the meeting” or when trying to move an organization to a different way of working together.

Defiance should occur at the critical juncture of moving an idea to reality—that is, taking what might be an executive leadership idea and making it happen by engaging physicians or directors of operations. But often this doesn’t happen and depletes optimism, resulting in a waste of energy, time, and talent by those who engaged in the idea of changing the status quo. No one wants to be on this team.

What are the sources of resistance many face? Consider four possibilities:

  •  A power differential—Is it safe for a director to challenge executive leadership? What is the forum or venue to do so? Is leadership receptive to this?
  •  A lack of understanding of the complexities to make change occur—Do leaders have/take the time to understand what it takes to deliver on a bold idea?
  •  Underestimating the trickle-down effect—Do directors help leaders understand the trickle-down effects of a decision? What does it mean in terms of revenue, cost, or impact of compensation considerations to physicians and management incentive plans?
  •  Failing to rally the troops—People who go into healthcare have an innate need to contribute to the greater good of their patients and will do so if engaged fully. This is the best part of working in health care.

I have found that for significant change to occur, creating a venue for interaction among leaders, directors, and physicians is critically important. Here’s how to do that:

  • Take an existing meeting, add key stakeholders, and create focused dialogue around a change.
  • Develop an agenda that is informative, seeks stakeholder input, and is action-oriented. Bring forward information in terms of the complexities of the current state. Map out this process in real-time with those closest to the care and invite your leadership. (In short, replace a boring agenda with real work.)
  • Finally, articulate the work: What does it mean in terms of the existing disciplines, support structures, and roles? Clearly defining the what, who, and when helps people know their role to play, how big it is, and when it needs to be done.

Here is what one clinical care coordinator said about a redesign process in care management that we have recently been supporting: “What a fabulous opportunity to work with others from the organization that we don’t normally see! Having all the stakeholders identifying ways we can streamline the entire process by involving all aspects of [our system] has been an eye opener. Thank you for allowing this useful [care management] platform to be developed. I look for really great things to come out of this work.”

You, too, can cultivate healthy defiance. Bringing together those closest to the care and those who support the care, creating an environment of shared understanding of the work, designing what we do around the patient, and creating optimism are all powerful ways to defy resistance and move great ideas forward. In short, believe in the talents of the people that serve your patients.

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