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So, you’ve decided to make some changes.  What’s the best way to be effective while doing so?  A recent experience with administration trying to change physician workflow (with regrettable results) has me thinking about the best way to make changes (and not this kind of change).  Change management is a big subject, but if you’re a leader in your organization, it is critical.  We all see things that we’d like to improve, but without managing the change process, it will set you up to fail.  While the change process takes place at multiple levels in your organization, today we’re going to focus on your team.  How do you roll out a new process or workflow without inciting a revolt?

In general, physicians tend to be a conservative lot (we’re talking about medicine here, not politics).  There’s a saying in medicine – don’t be the first to use a new treatment, and don’t be the last one still using it.  We take our duty to our patients very seriously, and we don’t want to trust their lives and health to something new and untested.  This may be part of why physicians tend to be notoriously slow to adopt new treatments (and in fact is probably a source of harm to patients as it can take years before physicians adopt even well-tested/proven therapies).  While there is some dispute about this figure, there is an oft-cited number of 17 years to go from bench to practice.  Now as the study above demonstrates, this number is not necessarily accurate, and may be measuring different things in different lag studies, but it is clear that there is a delay in adoption of new practices.  Some examples of this are discussed here by Ebell, Shaughnessy, and Slawson. You may run into this same obstacle when you try to change something in your practice.

Physicians have often been the victims of new things designed to “help” them. People with minimal understanding of the workflows often try to change the way the physicians work, not realizing the significant difficulty this adds to their already difficult day.  With their prior experience with these changes, physicians are often reluctant to adopt new procedures or workflows that appear to disrupt their usual routines.  In their mind, these changes are almost universally negative.  Understanding this mindset is key to change management with physicians.

  • Transparency
  • Buy-in
  • Solicit input
  • Allot staff/time to manage change – pay the price
  • Cycle feedback

The first thing you need to do is be completely transparent with your physicians.  Make sure your team really understands what the problem is, and therefore why there has to be a change.  Next, you need to get their buy-in.  When they really understand the problem, and believe that it needs to be fixed, they’ll be active participants in the solution.

Here is where you really want to solicit their input.  By doing this, you’ll achieve two purposes.  By helping craft the solution, they’ll have a sense of ownership of the problem and the solution.  This will make them more willing to participate in the change process.  In addition, these are the people who truly understand the issue, the current workflow, the changes needed, the potential impacts of these changes, and so forth.

At this point, you need to do something to demonstrate your commitment to the change process – you actually have to allocate resources to help make the change happen. In addition to whatever staff you might need to implement the change (eg IT people for a software project), you need to “buy” the time of the providers.  If this new process is going to slow down your providers temporarily, bring in more providers so everyone can have a lighter load as they adjust to the new process.   If this change is important to your organization, you can demonstrate that by not making your providers the only one who bear the burdens.

Finally, you need to solicit feedback on the process.  Is the change addressing the problem the way you planned?  Are the providers able to incorporate the new workflows successfully into their day?  Are there changes that need to be made to the process to make it better address the issue/fit better into the provider workflow?  This final step is critical to ensuring that your change sticks.

If you have a story of change management – either good or bad – email me.  I’d love to hear the story.

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