Swimming against the current: keeping going with change when it gets hard

It is a turbulent time for perinatal care. In response to an expanding evidence base, a diversifying

MDT and local and national safety incidents, perinatal service improvements are proliferating at a staggering pace: periprem, family integrated care, digital maternity records,  psychologically informed care, compassionate team cultures... Change is coming.

These changes are good stuff. They aim to improve quality and safety. On the whole they take a preventative approach and are supported by a growing cross-disciplinary evidence base. But these changes are also hard – and sometimes lonely – work.

What changes are you part of in your team? How is change going? How does it feel?

Exciting? Invigorating? Meaningful? Exhausting? Frustratingly slow? Hopeless?

It can feel like you are swimming upstream.

Leading on change – especially change to a core part of your team’s culture – can feel like a mix of all of these. It can feel like you are swimming upstream: sometimes swimming against a gentle current of resistance, other times swimming against a surging torrent of opposition. There are times when the flow of “business as usual” is so strong that your attempts at change get washed away like sandcastles in the tide.

The status quo is fed by many tributaries that keep it flowing in the face of our efforts to bring about change: the natural human comfort in the familiar; and anxiety and distrust in the unfamiliar; people’s full up heads and burnt-out bodies. Many of these rivers we are trying to navigate are long-established with broad banks and deep beds. In trying to bring about change we often find ourselves heading in a different direction to people who hold positions of power, either because of their designated role or because of their age, gender, class or ethnicity. Our attempts to swim against the current of dominant ways of working get even harder when there is a serious event, either locally or nationally. The threat that ripples through the system can feel like a heavy rainfall, swelling the flow of the status quo.

The status quo is fed by many tributaries that keep it flowing in the face of our efforts to bring about change.

With the best will in the world, it is hard to hold the motivation when you meet such resistance to change. You might find yourself climbing out and seeking a different river to swim in, where the current of opposition doesn’t flow quite as strong. Or maybe you decide to swim harder and faster, ploughing more time and energy into your efforts. That’s fine, until you just can’t swim any longer and get swept along or washed away by the status quo.

So what helps us to navigate these swirling waters? How can we sustain ourselves in our efforts to swim upstream and change perinatal services for the better?

1. Who’s swimming with you? It can feel lonely and isolating holding a position of difference in your team. Knowing who your allies are and seeking support from them is key. Who’s not in the water yet, but could be persuaded to join you?

2. Who’s standing on the bank cheering you on? Feeling connected with a community of people beyond your immediate team who can encourage you and cheerlead your efforts can help you keep going.

3. Who is standing on the bank coaching you? Having a mentor or supervisor who is removed from your situation can help you maintain a different, birdseye perspective. It’s hard to see this when you’re in the river yourself. Who do you know who can see the bigger picture?

4. What do you need to keep your energy up? Swimming upstream is tiring work and can leave you feeling depleted. How are you recharging yourself?

5. What will you hold onto when the current becomes a torrent? Like a branch on the river bank, or a lifebelt, we need something that can keep us safely anchored when resistance becomes overwhelming. Sometimes we need to be rescued. What offers that for you? Is it a person? An object? An idea? A memory? An origin story?

6. When is it ok to let yourself be washed along? Allow yourself respite by picking your battles. It is not realistic to be implementing change on every front with every colleague all of the time. It can help to prioritise which aspects of change matter most, which aspects you will address next, and which aspects of existing practice you give yourself permission to overlook even though they’re not ideal.

7. What structures – dams, reservoirs or meanders could you put in place to slow down the flow of the status quo? What changes can you make to policies, meetings, or the physical environment that will help you consolidate the changes you’re making?

How can we sustain ourselves in our efforts to swim upstream and change perinatal services for the better?

More than anything, it’s important to get to know the twists and turns of the river that you are swimming up. What are the common triggers that open the floodgates? Is it particularly at times of high acuity, short staffing or external scrutiny when change becomes less welcome? Where and who are the strongest undercurrents of resistance? Do you aim to get them on board first, while you have the energy to take on the challenge? Or do you wait for later when you’ve made more progress and have a group of other swimmers to help and support you?

Swimming upstream is hard work, just like leading on changes in a complex system. If we can sustain ourselves and each other in all these ways we might make more progress. And even if we don’t, we might find more joy in work – and take more meaning from it – along the way.

If you’re interested in finding out more about these ideas, particularly the idea of working with resistance, please check out our upcoming webinar series. Or get in touch to discuss ways that we could help you and your team collaborate together on positive change.

Thanks for reading!