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.

Helping your staff navigate change

Staff members look to you as their leader, so your attitude is critical during a major transition, says Treharne. "Sponsor" the change by clearly communicating its purpose to staff, providing feedback on progress, and, if you are in a multi-physician practice, holding fellow physicians accountable for supporting the change, she says. "That sponsorship role lets the rest of the practice know, be it other physicians, advanced practice practitioners, or staff, that there's physician commitment to the change."

Make sure also, that all of the physicians within the practice are providing a consistent message regarding how the project ties to their vision of your practice's future. "If people feel like the change is actually moving them forward, then they can much more effectively embed those new skills into the work that they do," says Treharne. "If they don't understand why the change is occurring or [they don't] see the positive opportunities in the change, it's much harder for people to be motivated."

To further foster staff engagement, solicit their feedback regularly, says Dahl. That way staff will feel like they are part of the process and the ultimate result. Nguyen agrees. In fact, he says taking staff feedback seriously is one of his biggest tips for other physicians. "You can't accommodate everyone, but you've got to be open to listen and try to accommodate what other physicians and staff would like to try to implement in the practice."

In addition to fostering engagement, celebrate it. When you reach key milestones provide staff with special perks, such as a pizza party or movie passes, says Dahl. This will let them know that you appreciate their hard work, and it will cultivate a sense of teamwork.

While change can be exciting, it can also be scary, so provide staff with as much information as possible regarding how it will affect their roles. "... Without information, people start speculating and then rumors get started, and then misinformation starts circulating," says Valancy. "Everyone's stress goes up and people's effectiveness decreases, so plenty of information is going to keep things from taking a bad turn."

Helping your partners navigate change

Clearly physicians play a key role in getting their staff onboard with change and in supporting their manager through a change. But all your hard work can come crashing down if there is dissension among physician leaders. Staff may pick up on the tension, and the manager may be torn in different directions.

Of course, physicians may not always fully agree with the change, or with how it should be implemented. So it's important to have open discussions regarding concerns, says Valancy. "What we want to try and do is to get people involved in the process," he says. "A lot of times people complain because a lot of those complaints rise out of a sense of helplessness, that these are forces beyond their control and they are being forced to do things that they just know are going to [have] a bad outcome." When concerns arise from fellow physicians and staff members, listen closely and engage the concerned party in identifying a solution, he says. "... If people are implementing a solution that they had a part in designing, they're going to have a higher commitment to its success, than if a solution, or way of doing things, is imposed upon them."

Changing times, changing roles

With so many changes happening in healthcare today, physicians need to take a more active role in staying current and updated. The more knowledgeable they are, the better equipped they will be to help their practices successfully navigate the changing waters, says oncologist Alex Nguyen, who is leading his practice through the EHR incentive program.

"There are doctors who just see patients and they're in that shell, and when you're in a private community practice you've got to do more than that," he says. "You've got to have your feelers out, go to meetings, do some networking, whatever you have to do to be kept abreast on the changes."

Aubrey Westgate is senior editor for Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the October 2014 issue of Physicians Practice.