Tai M. Paquin, LADAC

In my time here with Sister Sky, Inc. and the BH2I Team, and working with many of you alongside Dr. Middlebrook in training sessions, I have come to hear the many challenges of building integration from the ground up. One of those challenges frequently acknowledged is resistance from one or more of your stakeholders. This challenge can create limits to collaboration that is not helpful to the integration process and can alter project motivation and our own mental well-being.

Resistance can manifest itself in various ways and to deal with opposition we also need to be able to identify it. Below is a list (not exhaustive) of some common signs and behaviors of resistance. 

  • Lack of involvement. The individual avoids participation in discussions, meetings, or tasks; shows disinterest in project or task; procrastinates or consistently misses deadlines.
  • Nonverbal cues. Individuals are silent, and/or demonstrate tense body language such as crossed arms, avoiding eye contact, sighing during conversations, eye rolling.
  • Passive-aggressive behavior. This type of behavior is displayed through indirect expressions of discontent such as sarcasm, intentionally withholding information or cooperation.
  • Skepticism. Individual has a pessimistic or cynical attitude towards initiative goals, leaders or ideas; this could look like questioning new processes or providers, resistance to implement change(s).
  • Undermining efforts. This individual undermines authority, disrupting the workflow, and/or not following through on agreed upon tasks.
  • Rumors or gossiping.  Individuals create distrust or talk negativity about colleagues or the overall project to reduce their creditability.
  • Defensiveness. The individual reacts defensively when given feedback or criticism, blames others, makes excuses, and may dismiss any feedback.

Recognizing signs of resistance is the initial step to addressing the issue and can be challenging but manageable. Those addressing this challenge should also be willing, communicative, empathetic, and intentional in helping to mitigate and promote collaboration and cooperation among team members. Below are some strategies to overcome resistance.

  • Understand the source. Take the time to talk with providers and understand the root causes of resistance. This may be beneficial to how you perceive their behaviors and how to address their resistance. As noted above, their concerns could be about changes to their workflow, uncertainty about the benefits of the new approach, or skepticism about its effectiveness.
  • Explain the why. Being able to communicate the rationale behind integrated care and its benefits may address some of the root causes. This will help providers understand how integrated care aligns with overall organizational goals, improves patient outcomes, enhances efficiency, and addresses current challenges in healthcare delivery.
  • Be proactive. Rather than waiting for issues to escalate, it is always best to address issues as they surface. Engage in constructive dialogue, seek to understand underlying concerns, and work collaboratively to find mutually acceptable solutions. Clarifying resistance behaviors early can prevent it from spreading and undermining the success of the initiative.
  • Listen to feedback and concerns. Create open (or anonymous) forums for providers to express concerns, ask questions, or give feedback on the integration program. Listen actively to their perspectives, acknowledge their concerns, and provide transparent and honest responses. Addressing concerns directly helps build trust, demonstrates your willingness to move beyond the issues, and move towards solutions.
  • Recognize contributions and successes. Celebrate the milestones and successes achieved through integrated care efforts, and publicly recognize the contributions of providers who are a part of that. Highlighting efforts through social media, billboards, and newsletters will develop a culture of appreciation and encourage engagement. Including (anonymous) community feedback in these may also elevate that effort as providers can see and hear how their efforts helped from the source.
  • Engage providers in decision-making. When providers feel included, as a team member, in the decision-making process, they are more likely to support initiatives. Seek their input on key decisions, such as workflow design, resource allocation, and performance metrics.
  • Offer support and resources. Provide ongoing support and resources to help providers adapt to the changes associated with integrated care. This may include education about HER or technology tools, providing easily accessible workflow or process resources, being or providing provider check-ins.
  • Education and training. Offer education and training programs (through Sister Sky, Inc., or other agencies) to equip providers with the knowledge and skills needed to participate effectively in integrated care. These may address misconceptions or gaps in understanding about the new approach and provide opportunities for hands-on learning and practice.
  • Workflow and integration challenges. We all know our processes in our respective departments so, being able to openly identify and address barriers to workflow integration can help reduce resistance. Work collaboratively with providers to (re)design workflows, streamline processes, and utilize the use of technology to minimize disruptions and maximize efficiency.

Nurturing a program like BH2I requires that we actively support its growth, sustainability, and success over time. Furthermore, I will always stress the importance of remembering that these processes do not occur overnight. When you utilize these strategies consistently, and proactively engage with providers and/or stakeholders, you can effectively address the resistance and rebuild a culture of support for your integrated care setting. Overall, it takes time to integrate complex systems and with your dedication, perseverance, and adaptability you will be on your way.