Diriger à travers le changement

The video gives a topic overview and has a viewing time of around 5 minutes. The written learning guide offers a more in-depth exploration and has an approximate reading time of 10-15 minutes.

Learning objectives

By the end of this guide, you will be able to:

• Understand the messy, non-linear reality of leading change over time.

• Recognise what your leadership role needs to be at different points in the change process.

• Maintain momentum through the difficult middle period when enthusiasm fades.

• Deal with setbacks, emerging resistance, and unexpected complications.

• Know when to persist, when to adapt, and when to abandon.

Why this matters

Starting a change is relatively easy. Announcing it. Getting initial agreement. Setting the direction. That's the exciting bit.

Sustaining it through the messy middle is what separates successful change from the graveyard of abandoned initiatives.

Most changes in general practice don't fail at the beginning. They fail a few months in, when the initial enthusiasm has worn off, people are struggling with the reality, and you're exhausted from holding it all together whilst also doing your actual job.

Leading people through change means staying present and active throughout the entire journey, not just at the launch. It means managing your own energy and conviction when things get difficult. It means knowing when to push and when to pause.

This is hard, unglamorous work. But it often determines whether changes actually stick.

The reality: change isn't linear

Textbooks describe change as a series of neat phases. In reality, it's messier than that.

You announce a change. Some people are immediately on board. Others are sceptical but willing. You start implementation. Early progress is encouraging. Then you hit an unexpected complication. Momentum stalls. Someone who was supportive becomes a blocker. You adapt. Things improve. Then something else goes wrong.

This isn't a sign you're doing it badly. It's what change actually looks like.

One useful way to make sense of this messiness is to think about how your role shifts over time, rather than seeing change as a fixed set of stages. The challenge is leading through this messy reality without losing your conviction, burning out, or giving up when it gets difficult.

Your role changes as the change progresses

What people need from you at the beginning of a change is different from what they need in the middle, and different again from what they need at the end.

At the start: clarity and conviction

When you initiate a change, people need to understand why it's happening, what it means for them, and that you're committed to it.

Your role is directive. Set the direction. Be clear about what's changing and what isn't. Explain the rationale. Address immediate concerns.

This isn't about having all the answers. It's about providing enough clarity and conviction that people are willing to start the journey with you.

In the middle: presence and persistence

This is the hardest phase. The initial excitement has worn off. People are dealing with the uncomfortable reality of learning new systems or working differently. Progress is slower than expected. Problems emerge that you didn't anticipate.

Your role is to stay present. Don't disappear into other priorities and assume the change will take care of itself. Keep checking in. Address problems quickly. Acknowledge the difficulty. Maintain your conviction even when yours is wobbling.

This is where many leaders struggle, and where change succeeds or fails.

Towards embedding: stepping back

As the change becomes more established, your role shifts again. You need to step back and let it become normal, not something that requires constant leadership attention.

This means resisting the urge to keep interfering. It means trusting people to own it. It means tolerating things being done differently from how you'd do them, as long as the fundamentals are right.

Knowing when to step back is as important as knowing when to push forward.

The difficult middle: where change stalls

Most change initiatives have a predictable pattern. Initial enthusiasm. Early progress. Then a dip. Energy drops. Problems emerge. People start questioning whether it's worth it.

Why the middle is hard

The novelty has worn off. Progress is slower than expected. Unexpected complications emerge. Early supporters start wavering. You're exhausted from leading change on top of everything else.

What helps in the middle

Acknowledge the difficulty openly

Don't pretend everything's fine when it isn't. "I know this is harder than we expected. The learning curve is steeper than I thought. And we're still doing it because..."

Acknowledging difficulty builds trust. Pretending it's going well when people can see it isn't undermines your credibility.

Create visible progress

When everything feels stuck, find something tangible to point to. "We've now got half the team confident with the new system." "We've reduced errors by 20% since the start."

People need evidence that it's working, even if slowly. Make progress visible.

Solve problems quickly

When complications emerge, address them fast. Don't let problems fester. If something isn't working, acknowledge it and fix it or adapt around it.

This shows you're actively leading, not just hoping things will sort themselves out.

Maintain your presence

Even when you're busy or discouraged, stay visible. Check in regularly. Ask how people are finding it. Notice who's struggling and offer support.

Remind people why

When energy drops, reconnect people to the original purpose. Why are we doing this? What problem are we solving? What will be better when we get there?

People lose sight of the destination when they're struggling with the journey.

Dealing with resistance that emerges mid-change

Not all resistance shows up at the start. Sometimes people agree to a change, then resist once they experience the reality.

This isn't bad faith. It's people responding to reality rather than theory.

How to handle late-emerging resistance

Listen properly

Don't dismiss it as "we already decided this." Something has shifted. Find out what.

"I know you were initially supportive. What's changed?" "What are you finding difficult that you didn't expect?"

Distinguish types of resistance

Some resistance is "this is harder than I thought, I need help." Some is "this isn't working as intended, we need to adapt." Some is "I've decided I don't want to do this and I'm going to undermine it."

Each requires a different response. The first needs support. The second needs problem-solving. The third needs a difficult conversation about commitment.

Don't let it derail everything

One person struggling doesn't mean the whole change should stop. Provide support. Address legitimate concerns. But don't let individual resistance become a reason to abandon progress.

Working with champions and managing blockers

People respond to change differently. Some will champion it. Some will block it. Most will be somewhere in the middle.

Champions: your early adopters

Champions engage positively early. They learn quickly. They help others.

Acknowledge their effort. Use them to support others who are struggling. But be careful not to overburden them or create resentment.

The middle majority

Most people aren't champions or blockers. They're willing to try, but they need support. They'll engage if they can see it's working.

Provide proper support. Make it as easy as possible. Show them early progress. The middle majority determines whether change succeeds.

Blockers: the active resisters

Blockers actively resist or undermine the change.

First, understand why. Are they identifying a genuine problem? Do they have legitimate concerns? Or are they resisting for personal reasons?

Address legitimate concerns. Provide support if they're struggling. But if they're simply refusing to engage, you need a direct conversation.

"This change is happening. I need you to engage with it. What would it take for you to do that?"

Sometimes blockers won't shift. At that point, make clear that their resistance isn't acceptable.

Creating early wins and maintaining momentum

When change is slow and difficult, small wins become essential for maintaining momentum.

What counts as a win

An early win doesn't have to be big. Someone who was struggling has now mastered the new system. A process that was slow has sped up. A patient has given positive feedback.

The point isn't the magnitude. It's having something concrete to point to.

Making wins visible

Don't assume people notice progress. Make it explicit.

"We've now got everyone trained on the new system." "Three people have told me this week that it's getting easier."

This isn't spin. It's reminding people that progress is happening, even when it feels slow.

When things go wrong: dealing with setbacks

Change rarely goes smoothly. Your response to setbacks shapes whether people keep going or give up.

Acknowledge setbacks honestly

Don't minimise problems. "The new appointment system crashed this morning and we had chaos. That's not acceptable, and we're fixing it."

People know when things aren't working. Pretending they're fine destroys trust.

Fix problems quickly

Address issues fast. If a system isn't working, fix it or find a workaround. Speed of response matters.

Separate the setback from the change

A setback doesn't mean the change was wrong. It means implementation hit a problem.

"The system failure was frustrating. It doesn't mean the new system is wrong. It means we need to address the technical issue."

Maintain conviction

When things go wrong, your conviction is tested. You can acknowledge difficulty without losing conviction.

"This has been harder than expected. I'm still convinced it's the right direction."

Knowing when to persist, adapt, or abandon

Not all changes should succeed. Sometimes the right call is to adapt or abandon.

When to persist

Persist when the change is fundamentally sound but implementation is difficult. When people are struggling with the learning curve but progress is happening. When setbacks are fixable rather than fundamental.

Most changes require persistence through difficulty.

When to adapt

Adapt when the original plan isn't working but the goal is still valid. When resistance is highlighting genuine problems. When a different approach would achieve the same outcome more effectively.

Adaptation isn't failure. It's responsive leadership.

When to abandon

Abandon when the change was fundamentally flawed. When the costs outweigh the benefits. When something has shifted that makes the change no longer relevant.

Abandoning a change isn't failure if it's the right call. Continuing with a doomed change because you're too proud to stop is poor leadership.

How to tell the difference

Ask yourself:

• Is this difficult because change is hard, or because this specific change is wrong?

• Are the problems fixable, or fundamental?

• If we persist, are we likely to get to a better place?

Get input from others. You may be too close to judge objectively.

If you do abandon a change, be explicit about why and what you've learned.

Leading change while doing everything else

Leading change in general practice is not your only job. You're doing it whilst also potentially seeing patients, managing day-to-day operations, and everything else.

The energy cost

Leading change is draining. You're holding everyone else's doubt, managing resistance, solving problems, maintaining conviction. On top of your usual workload.

This creates a real risk of burnout.

What helps

Protect some time for change leadership

Carve out some protected time (even if it's just an hour a week) to focus on the change. Check in with people. Review progress. Address problems.

If you can't protect any time, you probably can't lead the change effectively.

Share the load where possible

Identify people who can take on elements. Champions who can support others. Partners who can lead specific aspects.

You don't have to do everything yourself.

Manage your own conviction

Find someone you can talk to honestly. A trusted colleague. A mentor. Don't try to hold all the doubt yourself.

Look after yourself

If you're exhausted and running on empty, you can't lead effectively. Proper breaks. Sleep. Whatever restores you. This isn't self-indulgent. It's essential.

Knowing when change is embedded

How do you know when a change has stuck?

Signs change is embedded

People do the new thing automatically. New staff are trained in the new way as "how we do things here." When problems arise, people solve them within the new system rather than reverting to the old way.

It's become normal.

When to step back

Stay engaged longer than you think you need to. Better to over-support than under-support.

But at some point, you need to let go and trust it to hold.

Practical strategies: leading through the full journey

1. Create a simple progress check

Monthly (or weekly for rapid changes): What's working? What's not? Who's struggling? What needs addressing? Create a deliberate moment to review.

2. Maintain visible presence

Even when you're busy, stay visible around the change. Regular check-ins. Brief team updates. Acknowledge effort.

3. Celebrate small progress

Don't wait until the end to acknowledge progress. Celebrate small wins along the way.

4. Have a "decision point" conversation

For major changes, build in a deliberate review point. "We'll try this for three months, then review whether to continue, adapt, or stop."

5. Know your own limits

You can't lead every change personally. Some you'll need to delegate. Some you'll need to delay. Be realistic about your own capacity.

Points clés

• Leading change is about sustaining it through the messy middle, not just launching it well.

• One useful way to think about your role is to notice how it shifts over time: directive early, present and persistent in the middle, stepping back as it embeds.

• The middle period is where change often stalls. Acknowledge difficulty, create visible progress, maintain presence, and remind people why.

• Resistance can emerge mid-change. Listen properly, distinguish types of resistance, and don't let individual resistance derail progress..

• Work with champions, support the middle majority, and address blockers directly when needed

• When setbacks happen, acknowledge them honestly, fix problems quickly, and maintain conviction.

• Know when to persist (fundamentally sound but difficult), adapt (problems need addressing but goal is valid), or abandon (fundamentally flawed).

• Leading change while doing everything else is exhausting. Protect time, share the load, and look after yourself.

Actions: try this week

1. Review one current change: If you're currently leading a change, honestly assess: What phase are you in? What does your leadership role need to be right now? Are you doing that?

2. Identify your champions and blockers: For a current or recent change, map out: Who are the champions? Who's in the middle? Who are the blockers? How are you working with each group?

3. Create a progress check: Set up a simple, regular review for any ongoing change. What's working? What's not? Who's struggling? What needs addressing?

4. Make one win visible: Identify one piece of progress in a current change and make it explicit to the team. Help people see that movement is happening.