Three Tips to Expertly Handle Bomb-Throwers, Obstructionists, Whiners, and other Resisters Threatening to Scuttle Your Patient Safety Initiative

By Steve Harden

This year, I've visited over 30 hospitals, practice groups, ASCs, clinics, hospital associations, leadership retreats, board meetings, and health care conferences. I get the same question from everyone, "How do I get _____________ to buy in?" (Fill in the blank with board members, physicians, administrators, nurses, or staff.)

Everyone needs buy-in, and everyone struggles with getting it.

Why do we need buy-in? To borrow a phrase from the world of commerce, "Nothing happens until a sale is made." Nothing will happen with your project until you "sell" the right people in your organization. Many health care professionals recoil at the terms "sale" and "salesperson." But unless you can, just like an effective salesperson, have a compelling conversation about the value of your initiative, and close the sale by getting the support of the folks whose buy-in you need, your project will never be successful. Getting buy-in is a critical skill for any person involved in performance improvement, risk management, quality improvement, clinical effectiveness, patient safety, or project management.

Here are three strategies we teach every institutional leader during our LifeWings patient safety implementations:

#1 Never hide from the resisters - let them have their say loudly and publicly! Why? Researchers estimate the average professional hears 10,000 ideas, suggestions, and proposals a week from family, friends, colleagues, marketers, salespeople, and media. That's over 520,000 proposals and ideas a year. You need to break through the clutter. Enabling conflict, drama, sparks, and emotions is one way to do that. The first step to getting buy-in is getting attention for your idea. Once you have attention, you can be convincing--but not before then.

#2 Practice your responses to the pushback you know you are going to get. Why? After working with almost 100 health care organizations I can tell you that the types of pushback you will get for patient safety or quality initiatives are almost universally similar. The same "hot button" issues come up again and again. Here are a few of them:

• We're really successful here already--so why change?
• You're exaggerating the problem--it's not as bad as you make it out to be.
• What about this (and that, and this, and that, too--over and over again)?
• This doesn't really fix the problem.
• It's too simplistic to work.
• We tried it before (or something like it) and it didn't work.
• This is not the right time--there are too many other initiatives going on.
• It won't work here--we are not like other hospitals (clinics, doctors' offices, ASCs, etc.).
• We can't afford this.
• You will never convince________, and if you don't convince him/her/them, it will never work.

You only have one chance to handle these objections well--especially in a public forum. Fortunately, there is a simple, concise, and respectful response to each one of these lines of attack. But, if you don't know them, and don't practice them so they become second nature, you will bobble your response and allow a groundswell of resistance to build against your initiative.

#3 Never wrestle with a pig. In the Navy we had a saying, "Never wrestle with a pig. Eventually, you wake up covered in mud and realize that the pig really enjoyed it." This means that the "middle-of-the-bell-curve" folks that are inclined to give you a fair hearing (once you have their attention) are much more important to your cause than the resisters. The support of a couple of champions who will become fans of your cause are also much more important to you than the opposition. Be prepared to handle the resisters well, but keep your focus on the "pack" and your champions. They are the keys to your success.

Don't roll around in the mud with resisters.

Bonus Tip for November