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Managing Change at Your Medical Practice

Managing Change at Your Medical Practice

Oncologist Alex Nguyen is leading his practice through one of the most difficult changes any could encounter: The transition to an EHR. It is a daunting project. Nguyen's practice, made up of 14 physicians, eight offices, and about 150 staff, is the largest community-based oncology and hematology practice in Houston.

But it's not just the number of people involved in the project that makes leading the transition challenging. It's also the scope. In addition to implementing the EHR, Nguyen and his colleagues are participating in CMS' EHR Incentive Program. "Meaningful use is an evolving idea and evolving concept, so every year there seems to be new things that you have to be able to do to demonstrate that you're using the EHR in a meaningful way," says Nguyen. "There's continued changes and learning that has to occur in order to achieve these goals for meaningful use."

To help his practice adapt, Nguyen meets with his fellow physicians every six weeks, and with his staff quarterly. And, since his practice is too large for him to interact closely with everyone, he works with a "core group" of EHR transition leaders from various departments. "We discuss kind of a plan on what to do and how to educate the rest of the staff," says Nguyen.

While the transition to an EHR and participating in the incentive program are common reasons for change in practices, they are certainly not the only ones. From complying with new HIPAA requirements to participating in health reform initiatives, practices are encountering major shifts in the way they do business — and physicians play a large role in determining whether their practices navigate the changes successfully. "It's very simple and straightforward, that it is your job as a leader to make it work," says practice management consultant Owen Dahl, of Owen Dahl Consulting.

To help identify how you can best manage change at your practice, we asked Dahl, and other practice consultants, to weigh in. Here's how they said physicians can help their staff members, fellow physicians, and managers/administrators thrive amidst change.

Helping your manager navigate change

Most physicians will work with their manager or administrator when initiating or transitioning through a major change. While the distribution of change management responsibilities between manager and physician might vary practice to practice, the physician and manager should agree on the project timeline, milestones, and purpose; and the physician should provide the manager with his full support, says Jack Valancy, president of practice management and physician consulting firm Jack Valancy Consulting. "Make sure the manager has sufficient resources to get the job done, make sure the manager has sufficient time to get the job done," he says. And, if the manager is taking on several new responsibilities, help him delegate tasks to other staff. "In terms of resources — managers, they only have so much capacity, so you do want to be careful not to overwhelm," says Valancy.

Serving as a support system to your manager also requires supporting her role and authority, says Dahl. "When an employee comes to you as the physician and says, 'I don't like this change,' it's important for the physician to sit down and talk with that employee, or to refer that employee back to the administrator, and not pull the rug out from underneath the administrator,'" he says. "You can't say well, 'Gee, I don't agree with what [the administrator is doing] so therefore it must be wrong.' You just empowered [the staff member] to fight the change. Don't be a negative yourself in terms of the process."

Judith Treharne, of Halley Consulting Group, a practice-management consulting firm, recommends forming a "physician governance council" so that physicians and, if applicable, advanced practitioners, meet regularly with the manager to discuss project timelines, goals, and ensure everyone is on the same page. "When you keep the physicians involved in that change process, it means that the manager then has much more influence in supporting the change with the staff in the practice," she says.


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