Kathleen Adams

, we identified the problems practices face when change management is an afterthought during times of adjustment or following practice mergers and acquisitions. Today, we discuss successfully utilizing change management techniques in your practice.

Survey the Leadership and Assess Support Levels

Often, there are inaccurate assumptions that the leadership of an organization is on the same page with the changes that will be made it the practice. Assume nothing. If the leadership cannot agree on the vision and plan, the changes and opportunities are destined to fail. All the resources and financial strength in the world will not move the transition forward without leadership embracing the new approaches first to challenge and to motivate the rest of the practice.

No one likes change. It is unsettling at all levels, but it is communication from the leadership and their mutual, unwavering support for the changes at hand that will either calm the waters or create a storm.

The leadership must speak with one voice and model the desired behaviors. The voice and messaging must be publicly consistent 100 percent of the time.

Executive teams that work well together are best positioned for success. They are aligned and committed to the direction of change, understand the culture and behaviors the changes intend to introduce, and can model those changes themselves.

Identifying change agents at all levels throughout the practice is often overlooked, when it is one of the most important areas to implement. These change agents are rank and file with managers and supervisors supporting their efforts. The day-to-day operational people are incredibly important to help change “cascade” through the organization.

These agents are trained to understand and accept the vision of the practice and have a defined responsibility for part of the project or group of individuals. They must be provided with the tools to execute their specific tasks and motivated to make change happen.

Know why the change is necessary or important 

Change is unsettling, and employees will question the need for changes and want information before allowing themselves to commit to something that is uncomfortable for them. They will look to the leadership for answers and need to believe that the leadership is confident the change makes sense. More than just telling the staff about the changes, share with them the rationale behind it. People embrace what they understand; they repel what they don’t believe in.

• Present the problem in its current state and concerns for how not implementing change will affect the practice.

• Second, demonstrate the solid path the practice will be on with the new plans; communicate the vision and the leadership’s ability to get there.

• Finally, recognize there needs to be a steady implementation that will keep the plans on track.

Explain the process of decision making and roll out at a high level. Target and tailor the messaging for specific departments or roles within the practice with the goal for staff to feel their specific contributions are important and are not an afterthought.

Leadership at all levels from the executive board to the front-office supervisor must embrace positivity and exude an air of calm and capability during the transformation. This is more than lip-service buy-in. It demands ownership by leaders accepting responsibility for making change happen in all the areas they influence or control.

Ownership is often best created by involving those who will directly perform the tasks that the change is associated with. Leadership identifying the problem or perhaps, the desired outcome, and encouraging thought sessions by the change agent and their team to exchange ideas and craft the roadmap produces excitement and inclusion that is necessary to move the project forward. Positively working through change is often reinforced by incentives and rewards. These can be financial or through recognition opportunities that encourage continued team work.

Executives and change agents often misinterpret the level of understanding others may have of the issues or new practice direction. The best rule of thumb: When you believe there has been sufficient communication about issues and direction, triple it.

The most successful change programs consistently reinforce core messages through a variety of communication sources that is both inspirational and practical. Find ways to make communications fun. Newsletters, e-blasts, and memos are fine, but find ways to be engaging and entertaining in some way too. Send a “Question of the Day” email about a new procedure or change that everyone can answer individually. Those with correct answers go into a drawing for a prize or award points for each correct answer and tally them up for prizes each week. The rewards do not have to be financially complex, but it keeps staff informed while reinforcing the messaging in a way that is entertaining.

Effectively managing change requires continual reassessment by asking questions and eliciting feedback at all levels of the organization. Being willing to go back to the drawing board without apologies is a key component to long term success. Use data and a solid decision-making process to make the small adjustments when needed to keep driving the overall vision forward.

Change is not only about the practice moving forward; it is incredibly personal to your largest and most important resource: your staff. Many employees equate their contributions and success at work to who they are as people. They need to know how their work will change, what is expected of them during and after the change program, how they will be measured, and what success or failure will mean for them and those around them.

Team leaders should be as honest and explicit as possible, even when they are uncertain. If there is a likelihood that the staffing will be reduced by 10 percent, be honest and communicate that from the start using the tools described. Involve staff at all levels in the change process and utilize highly visible rewards, such as promotion, recognition, and bonuses, whenever possible as a reinforcement for embracing change.

There needs to be a balance between the business needs and the “soft” side of change management. Using these techniques combined with understanding there is a need to embrace the human need for support and communication through times of change is what will set up longevity with your staff long after the changes to your practice have been established.

Kathleen Adams is president and founder of MD Practice Partner, a national independent consulting firm that helps launch, develop and grow private medical practices. For more info visit: 

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In part two of this series, learn strategies to effectively enact change at your practice.

Utilizing Change Management in Your Medical Practice

As a practice advisor for over 15 years, I know the only constant in healthcare is change. I also know that successful navigation of these changes can make or break your practice, or at the very least, your sanity. Be it a practice that has recognized a need to adjust over time, or those working through mergers and acquisitions, change management has never been more important.


Change management is defined as the "discipline that guides how we prepare, equip and support individuals to successfully adopt change to drive organizational success and outcomes."


When a practice undertakes projects or opportunities, change is inevitable. It stands to reason these changes will involve organizational structure and processes, but it is about your staff transitioning their personal responsibilities and embracing the changes.  If your staff is unsuccessful in their transitions, the initiative will fail. If employees embrace and adopt changes, it will deliver the expected results.


Recently, I worked with a practice that felt by communicating with the staff through staff meetings and some one-on-one follow up, they could work through the changes that came with merging with several other practices in the area. 


Sadly, it seems to be the same story repeatedly when leadership is focused on the desired result but fails to understand the importance of managing the process to get there. Regardless of the size and scope of the changes, humans don't like it. Here is an opportunity to peek into the crystal ball when change management is an afterthought.


"What will happen to me?"  Make no mistake - that is all they will be thinking, all the time. They will not focus on their responsibilities. They will gossip regularly, looking for some sliver of information from another co-worker or at least someone to bond with over mutual fears. Even the best and the brightest are stressed and everyone knows that no one is really "safe."

"But we had a meeting and told them all of the great plans…"


The meeting reinforced the rumors they have talked about for months- things are changing. If there are new administrative faces at the meeting, the staff will not believe the rhetoric from the new leadership.  New leaders are not trusted, and the old leadership failed them. In some ways, they may even think their old leaders were dishonest with them and now find themselves feeling duped. Even the ones that feel secure in their position are not likely to believe that there is anything positive in this change for them. Extrapolate this over several newly acquired practices, and you have an awful lot of people who are demoralized, nervous and praying to just get through their days under the radar.

"Change is hard, but they will be fine…"


Once the staff is nervous and talking to each other about their concerns, the rumors, infighting and back-stabbing begins.Errors are made, customer service fails due to the stress and everyone is out for themselves in a weird version of Medical Practice Hunger Games. Eventually, it is decided that to "win" I need to beat the new leadership to the punch and find a new job. Suddenly, most of your team is out there looking.  

"Honestly, we were going to have to let some of them go anyway"


If your practice is like most, your staff is comprised of a mixture of talent and work ethics: 30 percent rock stars, 40 percent worker-bees and 30 percent underperformers. It is generally accepted that with a merger there are some staff that would likely be redundant, and others that may be let go because of exorbitant salaries from a practice that let things get out of control, but the real problem is the ones you are okay with losing, aren't the ones looking.


The first ones that will find jobs are the practice rock stars. They are the ones that keep the practice going- they are your "go-to's" that know their jobs and just make it happen day in and day out with little need for direction. They are marketable. They are personable. They have experience and know how to discuss their strengths and they are the first ones that will be lost.  


The post-rock star practice is now left with the serviceable staff- they get through the day, they can follow direction but are not the movers and shakers. This group needs direction to get things done which is a strain on the administrative time and now, they are now the best you've got. Make no mistake, you will lose some of those too and eventually, the staff that should have been let go years ago by the practices you've acquired, outnumber the serviceable staff.


Keep in mind when the levee breaks with the first rock star's exit, others follow; quickly. Be prepared for a mass exodus. The only shot at survival is rapid hiring, which, sadly, tends to mean hiring bodies, not skilled workers. The best HR director will not be able to keep up with resumes, interviews, references to back fill all that was lost. You will not have the time to be picky. You will not have time to find the best trained or best customer service for the job. Training the new staff will be a herculean task and will likely be more of an overview than actual training. After all, with only two- weeks' notice from departing staff, you are in a serious time crunch and the overtime you are paying to keep things going is starting to add up. 


Once you get your new staff in place, you will notice things are falling through the cracks. Patient complaints are up, satisfaction is down and there are more HR meetings than usual. Suddenly, progress on the new entity is sluggish and more time is needed on day-to-day issues rather than business development. Some of those HR issues need to be resolved through terminations and people not being a "good fit". Back to the drawing board for recruitment, and suddenly the front door has been replaced by a never ceasing revolving door. Chances are, there were some strong hires in the mix or maybe even a Rock Star or two that hung in there out of loyalty or curiosity. If the day-to-day becomes increasingly unstable, they will leave too.

"Our providers will help us get through this…"


Once the revolving door starts and HR issues are commonplace, the doctors you spent so much time and money recruiting for are looking as well. They know when their contracts are up and are not wasting any time speaking to recruiters to line up the next job. New physicians have no skin in the game and are trying to establish themselves. Unstable practices with high turnover will mean patients will be uncomfortable too and will likely leave. A Physician with less patients, staff turning over regularly in a high-stress environment is not signing on for another term.


Stay tuned for part two of this series on how to prepare for change and set a course for success.

Leadership teams wonder why their best-laid plans have gone awry. Here's how employees feel.

Failing to Manage Change 

Traditionally, practices have focused on the front desk collecting co-payments and have left co-insurances and deductibles to patient billing after the claim has been processed. This creates a lengthy revenue cycle and less cash flow for the practice. With more responsibility being placed on the patients for these deductibles and co-insurances, practices can no longer survive with traditional billing processes. Many are starting to deploy new methods such as requiring patients to pay up-front for services when deductibles have not been met. Modifying collection practices is a systematic change for your business with many factors to consider and processes to work through. It is essential to plan and prepare to launch new policies.


Use data to determine if there is a need to modify your collection procedures. You may find there is no need to implement an entire new process for collections, but may want to consider new technologies to improve efficiencies or payment options to your patients.


Review your current policies and procedures. Does your process already include collecting deductibles and co-insurances? Perhaps there are polices in place that are not being enforced and simply require retraining staff and reinforcing the plan with your patients.


Review patient aging reports for A/R days and outstanding balances. If patients have balances that appear to be the entire cost of the visit, large balances or have a high number of days in A/R, chances are there is a significant amount going towards unmet deductibles.


If you feel changes are necessary, it's time to decide on an implementation date and which policies are you going to implement for your practice.


List out the steps for collecting at the time of service. Note what processes are already in place that will need to be altered, and which can remain.
Identify all the people who will be involved in the workflow and what they will need to manage their responsibilities.


Involve key staff in developing the new workflow; no one understands the job more than the people that are doing it each day. Having them become part of the implementation team will help them be more supportive of the program when it is rolled out.


If you are already verifying benefits prior to the visit, most of these systems will provide you with deductible information. Determine where this information obtained will be maintained in your management system.


If the desire is to collect co-insurances, obtain fee schedules for each plan and create a spreadsheet outlining your E&M Codes and top procedure codes.


Communicating the expectations to your patients ahead of time is an essential part of implementing new workflow and strategies.
Making payment policies part of your registration packet assures every patient will have been made aware of your office process from the start.
Rather than create matter-of-fact policies, craft a brief message that explains the reasoning behind the policy whenever possible.


For existing patients, typically a letter from the Medical Director explaining the need for change and any plans for assisting patients can go a long way in the patient's acceptance of new policies.


Prepare for the change by arming your staff with the tools they need to communicate the new plan; make sure they know where to find the information they need, are comfortable with answering questions from patients, and can navigate the policy for every-day workflow.


Provide scripting for the staff so messaging is consistent and is crafted with the tone you want to convey as they communicate with your patients.


Role play with your staff to alleviate their tensions in rolling out the new process. This makes learning fun, while showing them the best way to handle an uncomfortable situation or question from the patient. It also may uncover some areas that you haven't thought about addressing with the new polices.


Requesting payments upfront is likely to be an unpopular policy for patients, but a necessary one for your practice. Developing options to assist patients with these payments can do a great deal to bridge the gap to meet everyone's needs.


Payment plans only work when patients adhere to their responsibilities and the staff can manage the complexities of overseeing the plans. Credit cards on file, written agreements permitting specific dollar amounts or processing limits gives both the practice and the patient some control over the payment plans.


Consider using technology to assist you by implementing an electronic credit card on file program. 


There are several secure systems on the market that do not display the credit card information and instead, store key information in the cloud. This provides a level of comfort that personal information is inaccessible to anyone on staff.


Charges are made automatically for dates and amounts that have been agreed upon during the initial set up with the patient.
Systems can provide a multitude of services from one-time payments, automatic payment plans, payment limitations and automatically sending receipts to the patient's email.


Modifying traditional collection policies is becoming more of a necessity and is gaining more popularity in the changing world of healthcare. Taking the time to review your process is an essential piece of keeping adequate cash flow moving through your practice.

Stay on top of your collection practices using training, technology, and communication.

Author | Kathleen Adams

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