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Change Without Tears: 5 Steps to Managing Change (With a Real World Example)

It’s taken me a long time to realize that I’m part of a seriously small group that likes, or at least tolerates change well. People universally HATE change and will do most anything to avoid it. So what is a manager to do when charged with making change happen, or when leading your own change initiative?

Know the Change

Map out the change and do your best to understand every possible implication of the change. Have a trusted colleague or mentor review the map with you and see if you’ve neglected to consider any angle. For instance, if your plan is to offer Saturday clinic hours, make sure you’ve considered:

    • A budget for the change – are all the stakeholders in agreement on the money that will be spent to make the change? Is this a pilot for a specific time period or will the Saturday hours be continued regardless of the patient volume?
    • How will it be decided which staff will work Saturdays? Will working Saturdays be optional or mandatory? Will staff be allowed to earn overtime, or will they have to adjust their weekday schedule? Will there be a pay differential for Saturday hours? Will there be lots of staff wanting to work Saturdays or will there be no staff wanting to work Saturdays? Because they are so personal, staffing and payroll will always be the stickiest parts of making change happen, so assign them top priority!
    • How will it be decided which physicians or mid-level providers will work on Saturdays? Have issues with pay, call, and time off been resolved?
    • A marketing plan for the new Saturday hours. Letting people know that you will be open Saturdays is critical to the success of the plan.
    • Will all services be offered on Saturdays, or will it be modeled after on an urgent care? If it is an urgent care model, will it be billed as an urgent care visit and will co-pays be collected for urgent care services? How will an urgent care model be communicated to patients so they are not surprised when there are different terms of service than they usually encounter?
    • What, if any, changes will need to be made to forms, the computer system, HVAC, security, janitorial, lights, payroll system, etc. What workflows might need to be changed because the practice is not used to operating on Saturdays? Role play a patient coming for a Saturday appointment and map out all the possibilities.

Frame the Change Message

Let everyone know why the change is being considered/happening. Craft the change message into something repeatable. Everyone must understand the reason and must be able to attach the reason to a change message. It could be “We’re growing!” or “More service for our patients” or “We will thrive.” Whatever one or two messages you choose, repeat them in your Rule of Seven (see below) and throughout your change process. Explain that the change is coming because:

    • More patients want services than time is available.
    • ┬áMore patients want services than exam rooms are available.
    • A 1/2 time provider wants to go to full-time.
    • The practice wants to add a 1/2 time provider.
    • The practice wants to increase revenue to counter expenses.
    • The practice wants to add new services.
    • The Urgent Care down the street is seeing your patients on Saturdays when you could be.
    • Your ACO requires that you have Saturday hours to help keep patients out of the ER.

Use the Rule of Seven

The old adage is that your message has to be delivered 7 times before the listener is willing to take action or buy into your message. What could those 7 ways be? Here are some examples.

      • An announcement via newsletter, email or as a small part of a staff meeting that the board, administration or physicians are considering expanding hours.
      • An announcement that everyone (physicians, mid-level providers, staff) will be receiving an invitation to take a survey about their ideas for expanded hours.
      • A confidential electronic survey (try www.surveymonkey.com) asking for their feedback on expanding office hours and what their suggestions are.
      • A staff meeting with a physician or upper level management in attendance to discuss the results of the survey and how the results fit in with financial projections for the change and to start the change in a specific direction.
      • Department meetings to brainstorm how the change could affect teams in the office and how change could be positively addressed. Email ideas from each of the teams to everyone.
      • A weekly email update on the new initiative.
      • Your idea here: ________________________

Use a Change Timeline

Create a timeline by working backward from the desired launch for the change, or forward if the change requires a remodel or other change relying on external factors. Attach responsibilities to the timeline so everyone is involved and everyone knows their job.

Communicate Early and Communicate Often

Do you know what happens when you don’t tell employees what’s going on? They speculate. And speculation can drag your practice down and focus employees on something beside taking care of patients. It’s easy to think that because you feel positive about the change, everyone else will too, but that’s typically not the case.

 

Would a practice really have to go through all this just to add some office hours on Saturdays? Couldn’t this be done faster and with a lot less fanfare? Absolutely! It could also fail, which I have seen happen twice during my career. Twice I have seen practices attempt to add Saturday hours and have the initiative fail. They failed because of improper planning and poor change management. They both needed those Saturday hours to bolster financial performance, but neither made it.

Whether your change is large or small, use the five steps to manage change. Life in healthcare is all about change and your ability to manage change could be a career-maker or breaker.