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Making Changes at Your Medical Practice, Overcoming Resistance


Without everyone's cooperation in your practice, change results can be compromised. Here are a few steps you can take to avoid sabotage.

In the coming year, physicians and managers can anticipate even tighter reigns on future reimbursement, and may realize they will be expected to accomplish more with fewer resources. One of the things they can do is streamline their operational processes - however, that means change, which is not always welcomed.

There are many people who don't like dealing with change.  It encroaches on the way they do things and brings uncertainty - not knowing if the outcome will really make things better for them. The truth is, without everyone's cooperation in your practice, change results can be compromised. Here are a few steps you can take to avoid "unwitting or calculated sabotage" as you navigate your way through operational changes at your practice.

1. Think strategically

Analyze the reason change is necessary. What is happening internally or externally that requires the change? What will happen if you don't make change? Just as importantly, it is essential to determine how your practice and the people in it will be affected by the change, and how they will deal with potential barriers that might threaten results. Beyond this, agree on your ultimate objective and decide how you will measure results. These are important strategic elements for monitoring progress and ensuring that the appropriate level of accountability exists.

2. Examine the barriers to change

Analyze everyone's needs and understand their perceptions. After all, staff will be asking "WIIFM:What's in it for me?" It's management's job to paint a picture of hope and improvement. The barriers begin with and are fueled by fear - fear of the unknown and fear that the results will not be good, in fact fear that (in the end) things might actually be worse. People feel a loss of control when faced with change; worry that they will not be heard; and concern that change will make their work more difficult to accomplish.

3. Find a champion

Creating enthusiasm for change and getting everyone on board is no small task. Your best way to accomplish this is to identify the person inside your practice who is most appropriate to "lead the charge" for change - to be your champion for this cause.

There are a few key requirements: First of all, this person must feel passionate about the changes you plan to implement and be willing to be a key player in guiding the change process. This individual will be instrumental to your success and needs to be someone that will be closely affected by the change. For example, if you are going to centralize scheduling and it requires all the physicians to agree, then seek the physician who is the mostly likely to have a vision for how he will benefit from the change - improved access for patients, fewer missed appointments, fewer complaints, and getting out of the office on time each night.

Your champion, guided by management's skill and talent, will need to sell the vision to everyone involved in the change process. When changes result in success for your champion, the other physicians will feel more confident and will come on board.

4. Introduce and manage change well

Approaching change and getting acceptance not only requires overcoming barriers, but also managing cultural and political challenges within the practice team.  Management must meet individually with staff that are most vocal about sabotaging efforts to implement operational changes. Open the doors of communication and discuss perceived resistance and issues that concern each of them. It may require some real negotiating finesse to overcome these hurdles, but without doing so, you can expect problems with introducing and managing change. It should to be a two-way dialogue, so that you have a clear understanding of how they feel and they understand what you expect of them.

When you are ready to implement change, call an orientation meeting. Prepare for the meeting with a plan that sells your vision. You want everyone to hear the message the same way, at the same time. Remember the grapevine has no mercy and can be easily misinterpreted or distorted. Also, communicate what kind of training and support staff will receive during the process. In the end it's making everyone feeling valued and reassured that their feedback will be heard.

Change is not about personal gain, it's about gain for the entire practice. Keep everyone focused on this, celebrate steps of progress along the way and show appreciation for a job well done.

Judy Capko is the founder of Capko & Morgan, a healthcare consulting firm. She is located in Thousand Oaks, Calif. Judy is the author of "Secrets of the Best-Run Practices," "Take Back Time," and coauthor of "The Patient-Centered Payoff." Capko is a national healthcare speaker may reached at

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