Change management is the process of leadership through transitions. Most pediatric practices experienced a crash course in change management through the many shifts in patient and practice needs during the early days of the COVID-19 pandemic. How can pediatricians and practice administrators take the lessons learned from this period and continue to grow their practice’s leadership styles, revenue cycles, and patient care strategies?
Change management, according to Forbes, is “the general term used to describe the approaches that businesses take when making both short and long-term organizational change, both of which are often necessary for businesses that want to survive and be successful.” It is a broad term for many different strategies to arrive at familiar goals, such as optimizing resources, improving business processes, and reallocating funds.
Practice managers and administrators should be familiar with change management. Advancements in healthcare policy, technology, and scientific research contribute to near-constant changes in how pediatricians deliver care to patients and families. The way you deliver vaccines might not change in the next two years, but the way you manage, track, store, and talk about them likely will, and the responsibility of leaders is to guide staff and families through the changes with clarity.
Change management is a skill many physician-leaders already have.. What the enormous challenges of the COVID-19 pandemic taught many of us is that large-scale changes are necessary to keep practices afloat and able to offer healthcare as families’ needs evolve. This could mean adopting new technologies like EHRs or telemedicine, firing or hiring a partner, leaving a practice to start over, selling or buying a practice in a new place, or beginning a retirement plan.
In this post, we’ll cover the change management skills needed for the larger changes your practice may face: the ability to stay flexible, gain the support of staff and patients, execute your plans, and lead a pediatric practice through the challenges necessary for growth and success.
“Pediatricians routinely counsel families on how to manage change in their lives, so it's fascinating to watch how physicians often struggle with change themselves. I often encourage pediatricians to ask themselves: 'What would you say to a parent in your situation?'"
PCC’s Director of Pediatric Solutions, Chip Hart
Independent pediatricians’ leadership styles are unique, but most will benefit from selecting a change management strategy. A good management strategy sets clear expectations for the road ahead, builds in time to gain feedback, and is flexible enough to be useful for goals whose needs shift over time.
Popular change management strategies include the ADKAR model, Bridges' Transition Model, Kotter's 8-Step Process, and McKinsey 7S. You can find out more about these models in the links above. For the purposes of this post, we’ll stick to the Plan, Do, Study, Act model familiar to anyone who has completed a Bright Futures Quality Improvement project. These models all share common steps: identify a need for change, design and implement change, study the results, and adjust actions according to what you learned.
The most important skill for change managers is communication. Effective change cannot happen without engaging with the people who will be affected by your chosen goal and who must carry out the work. This communication must include engagement with staff, patients, parents, and anyone else who has a say in how medicine is delivered at your pediatric office.
Before getting started, you should already have an idea of two things. First, identify the need your change management plan aims to address, and second, who will manage this change process. For most practices, large-scale change is usually best addressed by the physician-owner(s). Still, you may wish to invite a business consultant, your office manager, billing staff, or other experts into the room to discuss and help inform your plans.
What matters in the planning stage is identifying the needs of your practice as a business, studying the requirements for change, and proposing a plan to improve outcomes. Let’s take the example of adopting a brand-new practice management software. The needs of your business might be analytics tools for year-over-year improvements, the requirements include costs, training time, and staff participation, and the plan could be to attend 3 product demonstrations and select a vendor by the end of the next quarter.
The COVID-19 pandemic required quick actions and reactions to new policies and guidelines without much planning, so, understandably, some practices might attempt to compensate with over-planning for their next big change. Thankfully, your plan does not need to be perfect to be successful.
A post-COVID-19 Forbes article recommends starting change with not just one plan, but many, to account for every possible outcome and ensure success by pre-empting challenges. The Harvard Business Review offers a contrasting argument that both strict plans with little input from others and looser, more collaborative plans have merits for different challenges. The benefit of the Plan, Do, Study, Act model is that you have a chance to adjust for the unexpected later on.
As mentioned earlier, successful execution of your plan does not require a perfect plan. Many factors contribute to the success or failure of a change management venture, but for small businesses and independent practices, in particular, staff and patient participation is an important one.
When executing your plans for change, build in time to consistently solicit feedback from the people doing the work and who are affected by it. Change can be intimidating, so it’s important to prepare in advance for repeated answers to tough questions such as, “Will I keep my job if you move the practice to another state?” “Who will care for my special needs kids if you retire?” or “How can I prepare to use a new EHR when I’ve spent my career charting on paper?”
These conversations are valuable – they can reduce friction and resistance to change, and enable growth in ways that help patients and staff understand and accept the changes that aim to improve their employee and patient experience. In the current healthcare climate, many pediatricians and healthcare professionals have succeeded in undergoing huge life and career changes. Independent practice owners can use this experience to recognize the opportunities for their staff and practice and guide the process.
When the first big steps of change are over, it’s already time to improve. Depending on your goals, there may or may not be a clear deadline when you know that the project is over and the changes have been successfully implemented or not.
If you’ve switched to a new practice management software, you might imagine that after a certain milestone, like implementation, you’re done! Indeed, change is worth celebrating, and it’s great to acknowledge hard work. However, when you’re managing people instead of processes, it’s necessary to check in with yourself and your team consistently to get a true sense of success. If your PM software improves your revenue cycle but your billers are miserable and staff turnover increases, it’s time to learn how to get employees on board with change.
This stage is where more changes can be implemented to adjust to how your office works and practices medicine. Ultimately, you cannot force your team to be honest or transparent about how they feel after a big change in workflows or tools. What you can do is to lead with empathy, honesty, and a willingness to listen.
Guiding staff and partners through change is one of an independent pediatrician's most challenging and rewarding tasks. Ideally, you’ll have worked hard to build your practice’s culture to match your goals for your next big change. If you’re wondering how to reframe your current culture or how to build the foundations of great teamwork from scratch, you’ll want to check out our webinar with PedsOne pediatric billing founder Tim Rushford. In this webinar, he covers how a simple interview can be an “inner-view” at your practice’s core values, and what it takes to build a great team.