As someone who seeks information and believes in life-long learning, I find evidence and best-practice –both personally and professionally – to be critical. Evidence can be sufficient reason for undertaking change. When I was diagnosed and undergoing treatment for breast cancer, I dug into the evidence. My research led me to the conclusion that the evidence supported exercise as a key way to improve the odds of avoiding recurrence of cancer, so that was what I did. Some people might argue this was a dispassionate choice, but I believe that people like me are emotionally driven to accept evidence because it aligns with our personal identities.
What is sometimes not fully appreciated is how often emotional, anecdotal arguments are made to protect the soft underbelly of the speaker.
The question that follows from this observation is, what is at play for someone who rejects or avoids evidence? I believe those who resist evidence, particularly among health professionals, can develop emotional attachments to habitual practices. Confirmation bias can be a significant contributor to resistance. This unconscious bias causes the individual to reject arguments that undermine their belief and cleave to those that reinforce it. This creates a blind spot around evidence (Lichfield, 2017; Strong, 2017). A pet peeve of mine is the promotion of anecdotes to argue evidence: ‘my uncle smoked all his life and lived to the age of 90 when he finally passed away in his sleep’. While such anecdotes do not discredit the massive body of research concluding the negative health outcomes of smoking, they are still presented as arguments. What is sometimes not fully appreciated is how often emotional, anecdotal arguments are made to protect the soft underbelly of the speaker. They know, at an unacknowledged level, that they are engaged in a questionable practice, so they defend that practice in order to feel safe. They might undermine change that is based on solid evidence as a result.
How do we manage this resistance? The big advantage we have in health care is that we have better control of the message than is the case for the general population, who are accessing the more questionable corners of information on the web and social media to form their opinions (Lichfield, 2017). We can use education and communication within health organizations to craft tight, compelling, and frequent messaging to sway opinion and shift practice. Supportive, transformational leadership based on trust is also essential to allow clinicians a safe culture to adopt change. Resistance will undoubtedly be higher where staff believe they will be punished for being perceived as wrong (Sinek, 2014). Finally, I return to the concept of ‘positive core’ from Appreciative Inquiry (Kelm, 2011). Most health care practitioners do want to do their best for their clients, and they have been schooled in the value of evidence. With all these factors in play and supportive change-management strategies, I believe most are likely to come around to accepting new, evidence-based practices.
References
Kelm, J. (2011, October 4). What is appreciative inquiry [Video file]. Retrieved from https://www.youtube.com/watch?v=ZwGNZ63hj5k&feature=youtu.be
Lichfield, G. (2017). 21st-century propaganda: A guide to interpreting and confronting the dark arts of persuasion. Quartz. Retrieved from https://getpocket.com/explore/item/21st-century-propaganda-a-guide-to-interpreting-and-confronting-the-dark-arts-of-persuasion
Sinek, S. (2014, May 19). Why good leaders make you feel safe. [Video/DVD] TED. Retrieved from https://www.youtube.com/watch?v=lmyZMtPVodo
Strong, S. I. (2017). Alternative facts and the post-truth society: meeting the challenge. Pennsylvania Law Review, Vol. 165: 137-146. http://www.pennlawreview.com/online/165-U-Pa-L-Rev-Online-137.pdf.