How to sell staffers on change, big and small

Change. Nobody likes it, but managing it has become an even more important issue for medical practices in the age of health system reform.

“Even people who don’t like the status quo still don’t like change,” said Michael Abrams, a health care consultant and managing partner with Numerof & Associates in St. Louis. “But you need staffers to buy in to get it done.”

The potential chaos of making a change, however, does not have to irritate employees, reduce productivity or increase turnover. Consultants who work with practices say change can occur with little disruption, whether it’s a big shift such as converting to a patient-centered medical home or something as small as switching the brand of coffee served in the break room.

Making a change with minimal disruption requires extensive communication at the beginning, middle and end of the process.

Opportunities for employees to influence how the change plays out should be identified. And staffers should be able to voice their concerns.

“You cannot assume that because you understand and embrace the change that other people are going to do the same,” said Marian Thier, a business coach based in Boulder, Colo., who works with medical practices. “You have to bring in people. The worst thing for a practice is if everyone shuts down because they don’t understand what is going on and they’re scared.”

After practice leaders pick a potential direction, the first step is to start communicating with employees as early as possible, human resource experts say. The discussions can take place in face-to-face meetings or by email and should include the rationale for the change.

Communication is critical because what seems like a relatively minor switch to some, such as the brand of coffee, may be extremely important to others. Understanding the reasons for change can make it go over more easily.

For something as complicated as shifting to a patient-centered medical home, communication should go beyond the rationale and include how it will benefit patients and affect staffers. The medical home model can be a better way for some practices to provide care. It also can lead to bonuses from insurers.

Practices should ask how will change affect the people at the front desk? What will be different about the work of the nurses? What kind of questions will staffers have to answer from patients?

“You need to develop a communication strategy,” Thier said. “What is the change? Why are we going to do it? You need to state who and what it will entail, how we will implement it, what it might mean to you and the difference it will make to patients. I tell practices to understand all of the ramifications to every stakeholder and over-communicate.”

Practices also may want to identify employees who are well-respected among staff members and can help colleagues embrace change.

“You need to know who is trusted,” said Christina Stovall, director of the human resource service center at Odyssey OneSource in Euless, Texas, who consults for medical practices. “They can be your champions.”

Seeking employee feedback

The next step is to consider how employees can contribute to a needed change. Allowing them to provide input may reduce the chance of simmering resentments that can negatively affect productivity.

For example, a practice may need to cut costs. Cheaper coffee may seem an easy place to start. Can a staffer for whom coffee is an important part of his or her day help make the decision?

“A change in the coffee can be really important to some people,” Stovall said. “Getting them involved is crucial.”

If a practice is becoming a patient-centered medical home, staffers can provide insights that may improve the chance of achieving the model’s core characteristics of increased access and care coordination.

“This doesn’t mean you ask for consensus,” said Peggy L. Naas, MD, vice president of physician strategies with VHA, a network of nonprofit health entities. “There are some changes that have to happen, but you can allow input when appropriate.”

The third step is to hear out employees. Suggestions or feedback may not alter the change process, but consultants say those who feel they have at least been listened to are more likely to accept change than resist it or hunt for a new job.

“It’s important to have an open door, hear their perspectives and address their concerns,” Stovall said. “Let them voice any fears that they may have.”

Consultants say practices should communicate to staffers the effect of a change after it has been implemented.