In state hospitals where resources are already constrained, effective leadership becomes the critical factor determining whether patients receive quality care or suffer from systemic neglect. When healthcare administrators exhibit deep-seated resistance to change, this fear creates ripple effects throughout the organization, ultimately compromising patient safety and treatment outcomes.
This problem is particularly acute when administrators make staffing decisions based on their comfort with the status quo, rather than the qualifications to deliver excellent care. The staffing decisions by hospital administrators directly influence clinical outcomes, employee morale, and organizational sustainability. When these decisions are driven by change aversion rather than evidence-based leadership, the consequences can be devastating for the communities these institutions serve.
The healthcare environment is characterized by constant evolution in treatments, technologies, and best practices. Administrators who cannot adapt to these changes inevitably create bottlenecks that prevent their organizations from meeting contemporary standards of care.
Research indicates that nearly two-thirds of change initiatives in healthcare fail due to poor planning, unmotivated staff, ineffective communication, and resistance to change. When this resistance originates from leadership, it becomes institutionalized, creating a culture that prioritizes comfort over competence and tradition over innovation.
Administrators who resist change often exhibit what psychologists call status quo bias—a preference for maintaining current conditions despite evidence that change is necessary. This resistance frequently stems from multiple underlying fears: fear of losing control, fear of increased workload during transitions, fear of revealing competence gaps, or fear of uncertain outcomes. In healthcare settings, where decisions can literally be matters of life and death, this resistance becomes particularly entrenched because the perceived stakes of failure are so high.
The administrator who is afraid of change often operates from a scarcity mindset, believing that resources are too limited to risk on new approaches as new recruits, rather than recognizing that strategic investments in qualified staff actually create capacity and improve efficiency over time.
The manifestation of this resistance follows predictable patterns. According to change management theory, resistance can be active or passive, overt or covert, and individual or organization. An administrator might pay lip service to change while subtly undermining them through inadequate resource allocation, excessive criticism, or deliberate delays in implementation. This behavior is often rationalized with concerns about “disrupting what works”; or “maintaining stability”; during challenging times, but ultimately serves to protect the administrator’s comfort zone at the expense of patient care and organizational health.
The administrator’s fear of change is shaped by the culture of the institution. In a state hospital where resources are already constrained, this fear can become institutionalized, creating a culture that prioritizes short-term convenience over long-term competence. When leadership demonstrates change aversion, this attitude permeates throughout the organization, making it difficult to implement evidence-based practices or innovate in care delivery. The organization becomes increasingly insular and rigid, losing its capacity to adapt to evolving healthcare demands and community needs, similar to what has been happening at the Bor State Hospital.
The cultural impact of change-resistant leadership is particularly evident in staffing practices.
Rather than seeking out the most qualified candidates who might bring new ideas and approaches, the change-averse administrator tends to favor staff who are unlikely to challenge protocols or advocate innovation. This creates a self-reinforcing cycle where the organization becomes increasingly stagnant and less capable of attracting top talent, further entrenching outdated practices and compromising the quality of care.
How change aversion manifests in staffing decisions:
1 An administrator afraid of change often makes staffing decisions based on the wrong criteria. Instead of seeking the most qualified candidates, they prioritize applicants who will accept lower wages, demonstrate unquestioning compliance, or present no threat to established routines. This approach leads to the systematic hiring of underqualified staff who lack the expertise or confidence to advocate better practices or identify systemic problems. Research on understaffing distinguishes between “personnel understaffing” and “expertise understaffing” (staff lacking necessary knowledge and skills)—and change-averse administrators often create both problems simultaneously.
The preference for underqualified staff is frequently rationalized through financial arguments, with administrators claiming that hiring less expensive, less qualified employees is necessary due to budget constraints. However, this false economy ignores the substantial hidden costs of underqualification: increased error rates, decreased efficiency, higher staff turnover, and greater supervisory demands on already stretched qualified staff. In healthcare settings, these hidden costs often far exceed the supposed savings from reduced salary expenses .
2 Change-averse administrators often reject evidence-based staffing models and established nurse-to-patient ratios that have been proven to enhance patient safety. They dismiss these as “theoretical”; or “impractical”; for their specific context, despite the overwhelming evidence. This resistance is particularly damaging in healthcare, where staffing decisions have direct consequences for patient safety and care quality.
The rejection of evidence-based approaches extends to the avoidance of innovative staffing solutions such as flexible team structures, interdisciplinary care models, or technology-enabled care delivery. Even when presented with successful examples from similar institutions, the change-averse administrator will find reasons why “that wouldn’t work here,” effectively insulating the organization from valuable learning and improvement opportunities.
The impact on healthcare quality and patient safety:
1 The employment of underqualified staff creates immediate risks to patient safety. Studies have shown that personnel understaffing and expertise understaffing jointly contribute to near misses and adverse events through different mechanisms. Personnel understaffing leads to greater use of safety workarounds (shortcuts to bypass obstacles), while expertise understaffing results in higher levels of cognitive failures (lapses in memory, perception, or attention). When combined, these factors create dangerous conditions where medical errors are much more likely to occur.
Below illustrates how underqualified staffing contributes to specific patient safety:
- Safety Issue: The impact of underqualified staffing is increased safety risks
- Medication Administration: Lack of pharmacological knowledge; wrong dosage, drug interactions, adverse reactions.
- Clinical Assessment: Inadequate assessment skills; delayed diagnosis, missed diagnosis, improper treatment.
- Infection Control: Poor technique and compliance; healthcare-associated infections, outbreak spread.
- Emergency Response: Inability to recognize deterioration; delayed intervention, preventable deaths.
- Documentation: Poor communication skills; incomplete records, information loss, legal exposure.
2 Organizational deterioration and systemic impacts
Beyond immediate patient risks, the practice of hiring underqualified staff creates systemic problems that further degrade healthcare quality. Qualified staff experience increased burnout and frustration as they struggle to compensate for underqualified colleagues while maintaining patient safety standards. This creates a vicious cycle where experienced staff leave due to poor work conditions, further increasing the organization’s reliance on less qualified personnel .
The organization also develops a negative reputation among healthcare professionals, making it increasingly difficult to attract and retain qualified staff. As the proportion of underqualified staff increases, the institution becomes less capable of providing specialized services, leading to reduced referrals and further erosion of the hospital’s standing in the healthcare ecosystem.
Ultimately, the community served by the district hospital receives substandard care across multiple dimensions, with poorer health outcomes and decreased trust in healthcare institutions
Overcoming Resistance: Strategies for change and accountability:
1 Addressing the problem of change-averse administration requires approaches that target both individual leaders and organizational systems. At the individual level, administrators must develop management competencies through targeted leadership development.
Proven change models like Kotter’s 8-Step Process for Leading Change provide structured approaches: creating urgency, forming guiding coalitions, creating vision, communicating effectively, removing barriers, generating short-term wins, building on changes, and anchoring changes in organizational culture.
At the organizational level, healthcare institutions need to establish systems of accountability that prevent any administrator from compromising care quality through poor staffing decisions. This includes implementing transparent staffing metrics, establishing clinical governance committees with real authority, and creating whistleblower protections for staff who voice concerns about underqualification or unsafe practices.
2 State hospitals must transition from arbitrary staffing decisions to evidence-based approaches that prioritize patient safety and care quality. These include:
Establishing appropriate nurse-to-patient ratios based on patient acuity and care requirements
Implementing competency-based hiring practices that prioritize qualifications over convenience
Creating clinical ladder programs that support ongoing professional development and career advancement
Developing mentorship systems where experienced staff support skill development of newer colleagues
Investing in simulation training to accelerate competency development in safe learning environments
Research has consistently demonstrated that appropriate staffing levels with qualified professionals is associated with lower mortality, reduced hospital-acquired infections, decreased medication errors, and shorter lengths of stay. By making evidence-based staffing a non-negotiable priority, hospitals can break the cycle of underqualification and compromised care.
Conclusion:
The consequences of change-resistant administration in healthcare extend far beyond institutional inefficiency—they represent a fundamental ethical failure to serve patients with the highest standard of care possible. When administrators prioritize their comfort with the status quo over their responsibility to provide qualified staffing, they violate the fiduciary duty that comes with healthcare leadership. This is particularly egregious in state hospitals that serve vulnerable populations with limited healthcare alternatives.
Healthcare organizations must recognize that change competence is a core requirement for anyone entrusted with administrative responsibilities. This requires careful attention to leadership selection, development, and accountability systems. Boards and oversight bodies must be willing to make difficult personnel decisions when administrators demonstrate persistent change resistance that compromises care quality.
Ultimately, the goal of change is the creation of learning healthcare organizations that continuously adapt to better serve their communities. This requires leaders who embrace evidence-based practice, value staff expertise, and prioritize patient safety. When administrators make qualified staffing a non-negotiable priority, they unlock their organization’s potential to deliver exceptional care—fulfilling the sacred promise that every patient receives the quality treatment they deserve.
The writer, Dr. Majok Philips Matiop, is the Medical Director of Bor State Hospital. He can be reached via email: majok421@gmail.com
The views expressed in ‘opinion’ articles published by Radio Tamazuj are solely those of the writer. The veracity of any claims made is the responsibility of the author, not Radio Tamazuj.