Many of you are asked to take a leadership role within your department: managing a research team, joining your administration, or spearheading a clinical effort. It is easy to feel unprepared for these roles, and there are many pitfalls waiting to sabotage your team’s productivity. The ALiEM Faculty Incubator has created a series of 10 case-based teaming problems to provide you with evidence-based advice and solutions for tackling some of the more common problems encountered in our professional team experiences.

Case 2:

[box]You are trying to change the format of the Clinical Competency Committee (CCC) at your program. You would like to see the CCC utilize a more evidence-based model of assessment, but you are receiving resistance from faculty who want to keep things the way they are.

What strategies can you use to bring everyone on board with a new CCC format?[/box]

Change is never easy

Implementing change in the assessment tools utilized by your Clinical Competency Committee (CCC) is no small task. Many people may be resistant to embark on such a trek if the current system is seen to be “working fine.” However the assumption that the current model of assessment is the best model simply because it has always worked or always been that way is a recipe for complacency and mediocrity.

In professional contexts, it is easy to become frustrated with the apparent immovability of the committee. Opposition to one’s ideas can lead to a sense of futility and, over the long-term, citizenship burnout.1 There is a large body of literature within business and psychology literature around some of the techniques to promote change in resistant environments.

“Culture eats strategy for breakfast”

Schermerhorn and colleagues2 extrapolated this statement by generating a convenient list of reasons people are change-averse:

  • Fear (of the unknown, loss of security, or loss of power)
  • Lack of good information
  • Lack of resources
  • No reason to change
  • Bad timing
  • Habit

These reasons may apply to the group as a whole or a handful of individuals around the table.

Team Dysfunction

Evaluating the team dynamics of the CCC allows for identification of additional factors complicating group progress. Despite assembling highly qualified and competent individuals, a team may remain dysfunctional. Lencioni offers a framework through which to view team dysfunction and provides guidance on addressing its root cause.3

Using Lencioni’s framework, the dysfunction of any team can be explored, including your own CCC. In addition to acknowledging the intrinsic issues of the team, a strategy is necessary to promote individual behavioral change, as well as cultural change. In 1996, Kotter offered the following eight steps to achieving culture change, which remain relevant and applicable in today’s complex professional environment.4

Using these steps, you can help create the change necessary to move your CCC towards evidence-based practice. In addition to Kotter’s 8 steps, Kotter and Schlesinger have explicitly detailed various methods for dealing with resistance to change in professional environments. The table below is adapted from this reference and details the methods, as well as the advantages and drawbacks of each approach.5

Methods for dealing with resistance to change

ApproachCommonly used in situationsAdvantagesDrawbacks
Education & communicationsWhere there is a lack of information or inaccurate information & analysis.Once persuaded, people will often help with the implementation of the change.Can be very time consuming if lots of people are involved.
Participation & involvementWhere the initiators do not have all the information they need to design the change, & others have considerable power to resist.People who participate will be committed to implementing change, & any relevant information they have will be integrated into the change plan.Can be very time consuming if participants design an inappropriate change.
Facilitation & supportWhere people are resisting because of adjustment problems.No other approach works as well with adjustment problems.Can be time consuming, expensive, & still fail.
Negotiation & agreementWhere someone or some group will clearly lose out in a change, & the group has considerable power to resist.Sometimes it is a relatively easy way to avoid major resistance.Can be too expensive in many cases if it alerts others to negotiate for compliance.
Manipulation & co-optationWhere other tactics will not work or are too expensive.It can be a relatively quick & inexpensive solution to resistance.Can lead to future problems if people feel manipulated.
Explicit & implicit coercionWhere speed is essential, & the change initiators possess considerable power.It is speedy & can overcome any kind of resistance.Can be risky if it leaves people mad at the initiators.

Case Conclusion

[box]After realizing the complexity behind such a widespread change to the CCC, you realize you need a roadmap to tackle the challenging endeavor. The management techniques and guidelines listed above will assist in securing buy-in from colleagues, creating a culture of professional growth, and promoting organizational advancement.[/box]

Maslach C, P. Leiter M. The Truth About Burnout. Jossey-Bass; 2000.
Schermerhorn JR, Osborn RN, Uhl-Bien M, Hunt JG. Organizational Behavior. John Wiley & Sons; 2011.
Zartler J. Lencioni’s 5 Dysfunctions of a Team. Taskworld. Accessed May 18, 2018.
Kotter JP. Leading Change. Harvard Business Press; 1996.
Choosing Strategies for Change. Harvard Business Review. Published July 1, 2008. Accessed September 12, 2018.
Alexandra Mannix, MD

Alexandra Mannix, MD

Assistant Professor
Assistant Residency Director, Assistant Clerkship Director
Department of Emergency Medicine
University of Florida – Jacksonville
Shawn Mondoux, MD, MSc, FRCPC

Shawn Mondoux, MD, MSc, FRCPC

Assistant Professor
Division of Emergency Medicine, Department of Medicine
McMaster University
Institute for Health Policy, Management, and Evaluation
University of Toronto
Shawn Mondoux, MD, MSc, FRCPC

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David Story, MD

David Story, MD

Assistant Professor
Clerkship Director
Emergency Medicine Acting Internship
Department of Emergency Medicine
Wake Forest Baptist Medical Center
David Story, MD

Latest posts by David Story, MD (see all)