Table 3 Participants’ change responses
Forms of response (Coetsee) | Categories identified in the data | Quotes from the data (P, physician; RN, registered nurse; NA, assistant nurse) |
|---|---|---|
Involvement | 1. Engaging in bottom-up changes | “When changes are gradual and initiated by ourselves, I never see them as a problem” [P13] |
“I’m very positive to changes, but then changes have to emerge from the bottom up. ... We launched a nurse unit and it was really good. We sort of had the chance to develop and learn ourselves.” [RN5] | ||
“When decisions are taken in the management group which are not anchored in the work units, such changes are not good. They generate frustration.” [RN12] | ||
“The biggest changes always come from above, and they are always the ones that are most problematic.” [NA15] | ||
Support | 2. Supporting well-founded changes | “Changes where you immediately think, ‘This is not grounded in reality’, create a lot of negative emotions. ... Most people handle changes well, they accept changes, if you only understand why [they are made]. [It is important] to explain so you have an understanding of why an initiative is important.” [P9] |
“The condition to go along with a change is that you feel it has some value.” [P13] | ||
“If you do not understand the value, you do not understand the purpose, and then you think, ‘Why are they making these changes? Why is this a priority now?’ And you often know that it is only temporary, then they change and put the money into something else.” [RN30] | ||
“A change where you cannot influence what happens is really bad, of course, and that you do not get an explanation for why it happens, or that you do not understand why it happens. It generates so much bitterness, so much resentment and many become dejected.” [NA11] | ||
3. Supporting well-communicated changes | “All must feel that they have received information and that they have been allowed to express an opinion, to be able to influence [the changes].” [RN25] | |
“Some changes are tough, when you are not prepared. I mean, computer systems and big things like that, where you are prepared, they have put in an effort before [the change]. But these other changes, we changed telephone systems, you do not get any information, you are in the dark.” [RN30] | ||
“It’s all about information, to know why we should change, this new apparatus should be introduced or this system, etc. [It’s important] to get sufficient information that this [change] will lead to this improvement or that patients’ situation is much improved or you get improvements.” [NA 15] | ||
Indifference | 4. Experiencing change apathy | “In one way, I get less agitated today than I did 10 years ago. Because then I was massively disappointed for everything that did not turn out well. Today I’m a bit resigned.” [P9] |
“Resistance is not to bother with this [i.e. the changes], but maybe that’s not resistance. That’s probably more passivity.” [P13] | ||
”Many are a bit resigned and tired and think, ‘Yes, I wonder what will become of this [change] this time, then?’” [RN5] | ||
“Well, you let go of all engagement, you let go of all reflection, you let go really of everything that has not to do with my own person. And at the same time you build a shell around yourself.” [NA11] | ||
5. Experiencing physical responses to changes | “I think this ‘change fatigue syndrome’ has spread like wildfire. It concerns people who consciously or unconsciously are not working in accordance with their values.” [P9] | |
“I used to think, ‘Oh, great fun!’ But that’s not the way any longer; instead I feel like this, ‘Oh, well, how tiresome! Tough!’ I feel that I become disengaged. … So you get disappointed and think that ‘No, damn, I do not give a shit. I’m not going to become engaged. I do not have the stamina to do it one more time.’” [RN5] | ||
”You often share this tiredness. If there are many in a group who are tired of changes, who do not have the energy to think positively about things, then you share it in the workgroup and it can turn into endless whining at the coffee table.” [RN16] | ||
6. Experiencing emotional responses to changes | “There are many who have hit the wall, some sort of reaction, post-traumatic stress. The feelings are very strong, very negative and a lot of stress [is involved]. ... A lot of strong feelings and bitterness and anxiety, stress, anger, frustration.” (P3) | |
“These [i.e., changes] create stress, right? There are changes, they change something and then you have hardly had the time to accomplish change, [for example] to start a new way of working, before they change again.” [P17] | ||
“The joy of working disappears. It’s not fun to go to work.” [RN21] | ||
“It [i.e. the change] created anxiety and a sense of insecurity among the employees.” [RN25] | ||
Passive resistance | 7. Complaining about changes | “The digitalization of the medical records, as a whole, was a process that caused many to curse, sigh, and believe was so bad.” [P6] |
“A lot of negativity is accumulated and, like, too much whining.” [P24] | ||
“You go there and complain and that’s not so good since you contaminate other people with it.” [P29] | ||
“It turned into a lot of fuss and speculation, but it affected everyone.” [NA26] | ||
8. Reducing work effort in response to changes | “It’s even so that you go backwards and try to do as little as possible and only what is absolutely necessary that you perceive that you must do in your job.” [P8] | |
“It’s like this, ‘Now we should do this.’ OK, I’ll do it, but with the least amount of effort.” [RN5] | ||
”Why do I have to make an effort? It’s better that I work slower.” [RN25] | ||
”You have to use different strategies to handle it, everything from completely disconnecting to doing what you have to do, but not more, eight hours a day.” [NA11] | ||
9. Considering quitting the job in response to changes | “And then you start thinking, like, ‘What the heck are we doing?’ That’s when you start thinking about retirement or doing something else.” [P23] | |
“No, I do not have the energy any more, I quit.” [RN4] | ||
“Then I was so tired and felt I did not get any recognition from bosses for working so hard and, well, I did not feel so very good. Sad but that’s a part of the reason why I changed jobs.” [RN10] | ||
“Of course, you would have distanced yourself from these circumstances if you had been able. That’s the way it was, but the labour market wasn’t like that.” [NA11] | ||
Active resistance | 10. Avoiding involvement in changes | “I do not get angry and goes around screaming and shouting, but I do get agitated. Until I get dejected. And then I try to avoid having anything to do with that change.” [P8] |
“That’s what we have to relate to. There are no alternatives, but sometimes I do not give a damn, because I do not have the time, I cannot stand it today, to do that. I do not give a hoot.” [P29] | ||
“I do not take it in, I cannot stand it. And then you get all these mails with information that, ‘Now we will do this or that. Now this will change and here is the starting date for that.’ So I just get involved in what concerns me.” [RN5] |