Change Without Tears: Five Steps to Managing Change

Written by on March 2, 2012 in Features, Practice tips - No comments

By Mary Pat Whaley, FACMPE

It’s taken me a long time to realize that I’m part of a small group people that like – or at least tolerate – change. Change is hated universally and most people will do anything to avoid it. So what is a manager to do when charged with making changes, or when leading your own change initiative? The following are five steps that will help make sure the change transpires smoothly. For instance, let’s say your plan is to offer Saturday clinic hours, make sure you’ve considered:

1. Understand the Change

Be aware of every possible implication that the change could bring. Map out the process, find a trusted colleague or mentor to review the plan with you. Make sure you haven’t neglected to consider any angle. Before going through with the implementation process makes sure that your plan has:

A budget for the change

  • Are all of the stakeholders in agreement on the money that will be spent to make the change?
  • Is this change a pilot for only a specific time period or will the new Saturday hours be continued regardless of the patient volume?

Addressed staffing and personnel issues

  • How will it be decided which staff will work Saturdays?
  • Will working Saturdays be optional or mandatory?
  • Will staff be allowed to earn overtime, or will they have to adjust their weekday schedule?
  • Will there be lots of staff wanting to work Saturdays or will there be no staff wanting to work Saturdays?
  • Have issues with pay, call and time off been resolved?

Because they are so personal, staffing and payroll will always be the stickiest parts of making change happen, so assign them top priority!

A specifically defined model

  • Will all services be offered on Saturdays, or will it be modeled after on an urgent care?
  • If it is an urgent care model, will it be billed as an urgent care visit and will co-pays be collected for urgent care services?
  • How will an urgent care model be communicated to patients so they are not surprised

Role play a patient coming for a Saturday appointment and map out all the possibilities.

2. Frame the Change Message

Let everyone know why the change is being considered/happening. Craft your change message into something repeatable. Everyone must understand the reason why the change is occurring and must be able to attach the reason to a change message. Whatever messages you choose, repeat them in your “Rule of Seven” (see below) and throughout your change process. Explain that the change is coming because:

  • More patients want services than time is available.
  • More patients want services than exam rooms are available.
  • A half-time provider wants to go full-time.
  • The practice wants to add a half-time provider.
  • The practice wants to increase revenue to counter expenses.
  • The practice wants to add new services.
  • The Urgent Care down the street is seeing your patients on Saturdays when you could be.
  • Your Accountable Care Organization (ACO) requires that you have Saturday hours to help keep patients out of the ER.

3. Use the Rule of Seven

The old adage is that your message has to be delivered seven times before a listener is willing to take action or buy into your message. What could those seven ways be? Here are some examples.

  • An announcement via newsletter, email or as a small part of a staff meeting that the board, administration or physicians are considering expanding hours.
  • An announcement that everyone (physicians, mid-level providers, staff) will be receiving an invitation to take a survey about their ideas for expanded hours.
  • A confidential electronic survey (try asking for their feedback on expanding office hours and what their suggestions are.
  • A staff meeting with a physician or upper-level management in attendance to discuss the results of the survey and how the results fit in with financial projections for the change and to start the change in a specific direction.
  • Department meetings to brainstorm how the change could affect teams in the office and how change could be positively addressed. Email ideas from each of the teams to everyone.
  • A weekly email update on the new initiative.

4. Use a Change Timeline

Create a timeline by working backward from the desired launch for the change, or forward if the change requires a remodel or other change relying on external factors. Attach responsibilities to the timeline so everyone is involved and everyone knows their job.

5. Communicate Early and Often

When you don’t tell employees what’s going on, they speculate, and speculation can drag your practice down and focus employees on something besides taking care of patients. It’s easy to think that because you feel positive about the change, everyone else will too, but that’s typically not the case.

Would a practice really have to go through all this just to add some office hours on Saturdays? Couldn’t this be done faster and with a lot less fanfare? Absolutely! It could also fail, which I have seen happen twice during my career. I have seen two practices attempt to add Saturday hours and have the initiative fail because of improper planning and poor change management. Whether your change is large or small, use these five steps to manage change. Life in health care is all about change and your ability to manage change could be a career-maker or breaker.

Read more of Mary Pat Whaley’s helpful practice management insight on her blog,

Mary Pat Whaley, FACMPE
is board certified in health care management and a Fellow in the American College of Medical Practice Executives. She has worked in health care and health care management for 25 years. She can be contacted at

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