What Women Really Want to Know:
How to Overcome Change Resistance

Beth, a dentist in Indiana, asks:

When I try to introduce changes in the practice, my staff resists and rebels. What can I do?

Recently, while I was explaining to a woman dentist how to overcome her staff's resistance to change, she stopped me with the words: "But I can't do what you're suggesting. You see, I don't have a spine." I immediately replied: "Yes, you do. You have a leadership spine!" If you, too, feel spineless in dealing with the change resistance of your staff, your patients, and even yourself, think of this column as giving you the vertebra you need to stand tall in handling this common issue we all face.

"It'll never work." "I don't like it." "It's not for me." Does this sound like the reaction you get when you introduce a new treatment, technique, or system enhancement? When you have new patients whose number one drive is for security and stability, and you tell them that they need to change their smiles with substantial crown-and-bridge work, congratulations, you now have patients whose lizard brains warn them to fight or flee. When you have a dental assistant who is very comfortable supporting you in traditional crown preparation, and you introduce Cerec restorations, don't be surprised if she curls into the fetal position and cries for her mommy.

We have a natural internal resistance to change, and if we are to overcome it, the potential consequences of not making the change must be greater than the fear of change. There are certain questions you can ask that help others to see the value of making an important improvement and the risks of not making it. Asking these questions will encourage your patients to accept comprehensive treatment and your team members to support practice innovations. We call these the "APEA" questions.

APEA stands for the following types of questions:

A=Achieve questions. Will I get something I want as a result of the change?
P=Preserve. Will I keep something I have and want?
E=Eliminate. Will I remove something I don't want?
A=Avoid. Will I prevent something I don't want?

Power equals the ability to get what you want from your environment. Resistance is the ability to protect yourself from what you don't want. The Achieve and Preserve questions give patients or staff members the power to get what they want from the environment, and the Eliminate and Avoid questions give them the ability to protect themselves from what they don't want. And that, my friends, is the secret of the universe.

Using our example of encouraging the dental assistant to approach more positively a change to Cerec restorations, the first question the leader might ask is: "What would you like to achieve if we made this innovation?" The assistant's answer might include: personal growth, a more efficient schedule, new clinical skills, or even a salary increase.

The next question to ask is: "What would you want to preserve in implementing Cerec?" The dental assistant might say: preserving time to chat with patents, a relaxed atmosphere, or the ability to utilize her expanded duties effectively.

If we went on to ask the "protect" questions, the first one would be: "What would you want to avoid in implementing Cerec?" The dental assistant's answers might include: running from room to room, feeling ineffective or untrained, and not knowing what she was doing.
The next "protect" question would be: "What would you want to eliminate by implementing Cerec?" The answer might include: no longer having to schedule an additional visit for the crown seating, or deal with ineffective temporaries or busy patients rejecting crown treatment because it takes too long.

The decision to embrace or resist a change stems from someone's beliefs. As Henry Ford said, "Whether you think you can or that you can't, you're usually right." Asking the APEA questions gives you the opportunity to encourage your staff to question their beliefs, to examine a potential change differently, to stand up to their own resistance, and to embark on a new direction.

You can use these same APEA questions in your new patient exam. A question such as "What would you like to accomplish in today's visit and in your overall dental treatment?" is an Achieve question. "What aspects of your smile do you like and want to keep?" is a Preserve question. "If you can alter one thing about your dental health, what would that be? is an Eliminate question. And "What could keep you from feeling good about your long-term oral health?" is an Avoid question.

If your patient responds more clearly to Achieve and Preserve questions during the exam, then in the consultation, focus on the desirable effects of having the treatment. (For example, "Getting this taken care of now will insure that you can go on vacation with peace of mind.") If your patient responds more directly to the Avoid and Eliminate questions during the exam, then in the consultation focus on the undesirable effects of not having the treatment, or the worst-case scenario. (For example, "These old fillings could crack and break at any time. I'd hate for this to become an emergency for you while you're away on vacation.")

Doesn't it make sense to use the APEA questions in overcoming change resistance? Think about your own resistance. Don't you overcome your misgivings and hesitations, and commit to making changes when you see how they allow you to achieve or preserve something meaningful to you? Or when you see how the changes allow you to eliminate or avoid further pain? The APEA questions help people rise above their automatic fight-or-flight responses by considering how proposed changes can enhance their lives. Try asking these questions at your next staff meeting, one-on-one feedback session, or new patient exam, and see how effective you can be in influencing others to embark on rewarding new frontiers without the need to cry for their mommies.

Amy Morgan is CEO and lead trainer of Pride Institute.

Originally published in Woman Dentist Journal , August 2007