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Seven principles for being an effective change agent
Physicians have to know how to impose change in a business setting.
“The success of any kind of social epidemic is heavily dependent on the involvement of people with a particular and rare set of social gifts.”
– Malcolm Gladwell
“The only way to make sense out of change is to plunge into it, move with it, and join the dance.”
– Alan Watts
“To improve is to change; to be perfect is to change often.”
– Winston Churchill
John B. Pinto
All change, even change for the better, is stressful. As a practice leader, you should be constantly working in two dimensions, to foster new ideas that will improve your company and also to foster an environment in which change is embraced and not feared.
Eye surgeons are medical change agents at several levels. They reverse the course of disease, revise delicate tissues and certainly change thousands of lives for the better in the course of a 30-year career. The most innovative surgeons are peer-to-peer change agents as well, teaching their colleagues a better way.
But surgeons, if they are to work in effective, ethical and prosperous practices, also have to be institutional change agents.
When a new client calls me, it is rarely because everything is going just fine. Either the practice has failed to change (for example, spending has gotten out of control) or changes have been made with unintended adverse consequences (and in an effort to control costs, key staff have revolted).
Being a medical change agent is pretty straightforward. First your professors vouch for your competency, and standardized board exams prove that your professors were right. Then the state confers a license on you. Then various insurers, satisfied with your credentials, set you free to do your work on patients who (mostly) go with whatever you advise. Most of the time, patients are better off for the changes you impose on them.
This is less the case in business for a variety of reasons. Business is only partially scientific, and many commercial experiments fail. Although you may be an owner of your practice and sign everyone’s paychecks, your control over what Sally does in room two or what Medicare does with your fees next year is limited.
Because of these limitations, it is helpful to be a student of how to more effectively impose change in a business setting. Here are seven principles. Reading between the lines, you will see a lot of similarities with your role as a medical change agent.
Communication and collaboration are key.
Unlike medicine, in which decisions are made solely between doctor and patient (and perhaps a patient’s family), business decisions are multiplexed. A shift to electronic health records obliges buy-in and involvement from providers and lay staff, as well as the input of numerous experts and vendors. Rather than a brief conversation and chart note, everyone who will touch the new EHR system has to be in the loop. Do not try to impose change until you have asked, “Has everyone who touches this issue been engaged?”
Trust is the foundation for acceptance of your ideas.
Ms. Schwartz in your chair has just given her consent for cataract surgery, the first surgery she has ever had. Why? Because she trusts you. Even though she had only known you for a few minutes, your demeanor, the diplomas, the kindness of your staff and the successful-looking office all get her quickly to “yes.” How does that compare with your effectiveness in the board room or meeting with your management team? Ideally, the trust your partners and staff have in you would be much higher than Ms. Schwartz’s because they have known you for so much longer. If their trust is actually lower, ask yourself (and them) why, and then take steps to rebuild trust.
Remember that most change is incremental.
Great leaps in business innovation are sexy and exciting. But in truth, most business process improvements, like most clinical advances, are derivative, incremental and simply copy the best ideas of others in the profession. There is no disgrace in this. Most truly new business ideas, like most truly new medical ideas, to be frank, turn out to be a bust. You can be a powerful, effective change agent by simply adopting the success factors of the best ophthalmology practices you can find.
Be sensitive to the resistance of others.
You stay up all night figuring out a new way to run techs in the clinic. At 5 a.m., you have a eureka moment. On the drive in to work, you rehearse what you are going to tell your administrator and head tech at the 9 a.m. meeting. At 9:05 a.m., you have the floor and say, “From now on, all of my techs are going to be hired with an LPN degree or higher, and I need two scribes to be able to keep up.” Your administrator gives you “the look.” Your head tech starts to protest, then looking at the administrator, shrugs her shoulders and moves onto the next agenda item. What just happened? You forgot to anticipate the innate resistance that most people have, even to the best of new ideas. Sometimes stealth is indicated. In boardroom terms, it is called “pre-eliminating the blackball.” Seek out a one-on-one meeting with the person you think will be least in favor of your new idea. Describe it in neutral terms, not as a cheerleader yet, and invite feedback. Then go back to the drawing board, addressing each point of resistance. Return to the same person for a second round, repeating until he or she is ready to go into the meeting and support your idea.
Be persistent.
This applies in two senses. First, persist internally, driving yourself to improve on your original idea for change before just blurting it out. Keep your thinking out ahead of the words you say aloud. Second, once you have perfected your great idea as far as you can, be persistent in selling it to others, focusing on those people who are the most critical and resistant in your organization. Most physicians, who by their nature seek approval and validation from others, do the opposite. They go to people they know will applaud any idea they have. Start with your hardest critics first.
Cultivate a culture that embraces change.
In the current medical-economic environment, and certainly the environment out ahead of us, we all need to be change-loving. As a practice owner, are you creating an environment in which people are open to change? Do you personally demonstrate a willingness to try the new ideas that others have? Do you adequately and publically reward great suggestions from staff?
Take responsibility.
You are all too aware that every medical decision, every surgical case, is on your head. The same sober caution — with some allowance for the fact that business malpractice suits are rare, and nobody goes blind or dies when there is a commercial error — should be applied when you are driving forward a business initiative. Ask, “Have we gathered enough information to take this initiative? What’s our exit strategy if we’ve made an error?” By taking this approach with every new idea, you will build the confidence of your team to take on the scarier changes out ahead for all of us.