~Mary Beth Lepkowsky, CEO, Helen Sanderson Associates USA

The pace of change is intense!  The system pressure has heightened with the 2014 CMS Final Rule and the expectation that organizational funded by federal waiver dollars will comply with Home and Community Based Services requirements by March 2022. Providing good, person centered support has always been a good thing to do, and now the system is catching up with person centered values and building in some expectation and accountability.  Person centered values have been in place for a long time across the globe, but why has it been so hard to see real change within organizations and systems in the US? I’m hoping that the federal requirements will provide a vehicle for insights and ahas along the way and help people to genuinely experience person centered thinking, planning and practices as a gateway to better lives.  

As we look for ways to support people better, and in so doing seek to meet these HCBS requirements we will inevitably experience change fatigue, burnout and a fair amount of resistance to change.

You can stay the course with some tips for managing change. As you work to personalize your services and supports to people, you may discover a need for sweeping reform across your organization. Beth Mount, co-author with John O’Brien, of “Pathfinders” shared that person centered planning was never intended to be separate from organizational change.  As we learn from people with disabilities about what needs to change in their lives, so too do we learn about what needs to change within our personal approach to support and across our organizations, systems and communities. Preparing for personal or professional change is not easy, in fact the vast majority of organizational change efforts fail. One of the factors in the success or failure of a change initiative is the psychological safety that is created in the environment to support employees to do their work differently.

I have spent a lot of time with small and large organizations, helping them with person centered organizational change. Without exception, about six months into supporting an organization through person centered thinking and person centered organizational change, I’m asked, “How do we get staff “on the same page?” or “How do we get the admin department to ‘buy-in’” and so the ripple…and the resistance begins.

In a large scale organizational change or in a rapidly changing work environment, leaders and trainers talk about team members who are “resistant” to using Person Centered Thinking skills. They seem to be looking for the easy button that will provide the ‘attitude adjustment’ needed to replace resistance.   

While you can force someone to comply, you can’t force anyone to commit to change. You can only help people discover the value of change within themselves. And you can foster a supportive environment that watches out for people who may be feeling vulnerable, angry, frustrated or overwhelmed by the mere thought of change, let alone the actual implementation of change. Our best results as change agents, come through listening to what staff are trying to tell us through their “resistant behavior,” remember that ALL behavior is communication! Resistance to change is usually an expression of fear; fear of the unknown, fear of losing control, fear of loss of the familiar, fear of success. Marilyn Ferguson spoke a wonderful line about change, 

“It’s not so much that we’re afraid of change or so in love with the old ways, but it’s the place in between that we fear…It’s like being between trapezes. It’s Linus when his blanket is in” the dryer. There’s nothing to hold on to.”

Person centered change and the grief cyclePerson centered change in organizations impacts everything, reshaping the culture of work. Big change induces fear of big loss and an emotional roller coaster ensures that follows a similar trajectory as found in the five stages of grief outlined by Elizabeth Kubler Ross. Employees will travel through denial, anger, bargaining, depression, and acceptance as they work through how they will adapt to person centered change.  On the job, this might sound like,

Denial  – “This too shall pass, it’s just the social work flavor of the month.”

Anger – “There’s no way I can do this with all the work I have on my plate.  I don’t’ have enough time for this.”

Bargaining – “Do I have create person centered plans with everyone I support?” “Can I start with those who are preparing for adulthood?”  or “Why should I do this when I don’t see senior managers practicing what they preach?”

Depression – “I want to talk about what’s working and not working with my team”  

Acceptance – “I tried creating a person-centered description with Mario and I have to say it really did make a difference.  He is feeling heard and valued and the way his direct support is interacting with him has changed. He’s walking with more confidence which is great to see. I guess I can see the value in this person centered approach and I’m going to try this with more people who I support.”

We all travel this path, some more quickly than others.  Our hope is to support people to travel through the grief cycle, also known as the change curve, and spend as little time as possible in anger and depression, moving more quickly to acceptance and seeking ways to innovate.

So what do we do?

We know that it doesn’t work to tell someone “You have to do this!”  They may comply for a bit, but ultimately may check out physically or emotionally.

When staff appear to be “resistant” or disinterested we CAN do to help them journey through the change curve is:

  1. Approach them neutrally and seek to understand what their concerns are – what would they like to see differently?
  2. We can then say “Given that our organization will continue to move in this direction, what will help you be more OK with this?
  3. Help staff “break from the past” – acknowledge what is over; what they are giving up….and acknowledge what is not over; what remains intact for them
  4. Create a supportive learning environment so that staff can try small steps with support, feedback and acknowledgment for their efforts.
  5. Acknowledge what is hard about change… recognize the good work that staff are doing and let them tell you what it is that they are giving up and leaving behind as a result of this change. Acknowledge that yes, it is hard to give that up AND it is time to look at some different ways of supporting others.

Like in the quote about Linus and his blanket, if these elements of change are not openly discussed, then all staff have to hold onto is their fear! And that is where the resistance resides.

The ADAPT Framework for Change looks at components of the change process and what is needed to help people through their resistance and toward adoption of person-centered practices. the transition.

A – AWARENESS – do staff have an awareness of the need for change? If all they see is if it ain’t broke don’t fix it… it will be hard for them to get excited. What are you doing to help people recognize the need for change? 

D – DESIRE – does the staff person want to change? What are you doing to help the staff member understand the benefit to them personally… the WIIFM (What’s in it for me?). We have some service coordinators who share that the time invested up front in getting the conversation right by using PCT tools….ultimately saves time in the long run and gets better outcomes…that is a significant benefit.

A – ABILITY – do staff know how to use the tools? Do they have the training, and access to the skill and knowledge needed to be successful? How will they need to be supported around technology to readily access the new resources and apply it to their daily work without adding additional layers of work?  Remember to work smarter, not harder.

P – PRACTICE – do staff have an opportunity to practice and get feedback… or practice and get it wrong….and learn from that experience? Are they seeing the tools modeled by others? Setting up a community of practice, a monthly lunch and learn or other opportunity to reflect on what’s been tried is an important step toward making the new learning stick.

T – TRANSFER – are staff able to transfer what they learn in training to new and different situations? We often make assumptions that this is an easy thing to do. I have worked with many supervisors and organizational leaders to embed PCT tools in the performance development process and assumed that managers would know how to facilitate a working/not working conversation with an employee as part of an annual review. I was wrong in my assumption and surprised to learn that managers had great difficulty understanding how to apply this skill in a different context. While managers may know how to teach or advise staff on how to do the Working/Not Working Tool with families… some struggled to facilitate it themselves in the employee/manager context. So it became important to create opportunities to support managers to practice in that new context.

Congratulations for making the commitment to work toward deep organizational change in order to provide good support to others. And buckle up for an emotional roller coaster ride during the journey.  The ADAPT framework can help you manage the peaks and valleys and move more quickly to celebrate the exhilaration of meaningful and lasting person centered change.

If you are interested in learning more or hosting a facilitated conversation in your organization to navigate change in a way that will last, feel free to reach out to one of our H S A USA Associates.

Or learn how H S A USA can support executive leadership, managers, and teams at our Person Centered Organizations page.