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Failing to Manage Change


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

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.

What is Change Management?

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.

This is what your staff is thinking

"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.

"No problem, we will hire and replace"

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. 

"We've filled all of our positions"

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.

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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