EyeNet Magazine

Practice Perfect: Information Technology
How to Lead Your Team Through Practice Change
By Russel J. Igoe, ABOM, NCLC

Remember when your vendor delivered the wrong brand of coffee? While this unexpected change was a minor nuisance for some people, others kicked up a major stink. So how will staff react when they hear that more profound changes are afoot? Suppose, for instance, your physicians have decided to adopt electronic medical records. This requires an overhaul of practice procedures, extensive training of staff and changes to job responsibilities—and it’s your job to make sure it all happens swiftly and smoothly. Will people accept or resist those changes? The way you communicate could make all the difference.

Six Ways to Talk About Change

Different individuals may react to the same change of circumstance in different ways, and you should tailor your communications accordingly, but there are some rules of thumb that apply across the board.

Give advance notice of the change—and don’t let staff learn bad news via the water cooler. It’s only fair to let people know about change ahead of time. Even if members of staff don’t have any influence on the decision, the advance notice helps them get used to the idea of change. And while your biller won’t be happy if she loses her window desk due to an office redesign, she’ll be even less happy if she learns about that loss through the rumor mill. She’ll find it easier to come to terms with the new office arrangement if you tell her the news before you tell her coworkers.

Before announcing what the change will be, explain why change is needed. Suppose you say, “OK gang, I’m giving you new procedures . . .” If this announcement comes out of the blue, don’t be surprised if there’s a discrepancy between your perception of the conversation and theirs. You’ll think you’re saying, “. . . you need to do X, Y and Z,” but what they’ll hear is, “. . . drink the Kool-Aid.”

Staff will be more receptive to change if you first do the groundwork of selling the need for change.

Paint a picture of where the practice is headed. Once you’ve sold the need for change, you need to focus on your plan for the future. Tell staff where the practice will be tomorrow, next week and six months from now. By reminding people about the final goals of the current, temporary upheaval, you can help them to keep plugging forward rather than looking back. And by painting a picture of what the practice will be like after the changes have gone into effect, you will be helping members of staff to visualize how they will each fit into that future workplace. This will reduce the uncertainty that is a key cause of stress.

Be Prepared for Problems


Before there can be a new beginning, something familiar must come to an end. This is why reactions to change have been compared to the grieving process, with people suffering feelings of loss and a fear of the future. While your communication strategy can reduce staff stress, you should still be ready for these common problems:

  • Weaknesses may become more pronounced. If, for instance, your practice has problems with customer service, this is likely to get much worse when people are coping with change.
  • Your practice may become polarized. Since people adapt to change at different speeds, they might polarize into the old school staff and the let’s go group. Make sure these groups intermingle.
  • Staff may phone in sick as a way to avoid workplace stress.

Identify Those Who Can Help (or Hinder) Change

THE PHYSICIANS. It is critical to have physicians involved right from the beginning. They don’t necessarily have to be deeply involved at every stage, but if you tell them, “We’re trying to solve this problem, and we’re thinking of doing X, Y and Z,” that gives them an opportunity to say, “X and Y are fine, but Z won’t work.” You can then do further homework and come back to them with a modified plan.

THE GUIDING COALITION. You need people who are willing to stand up and say, “We’re going to make this change happen, here’s where we’re going.” Whether it includes physicians or managers, they must be firm in guiding the planned changes.

THE ENTHUSIASTS IN THE SUPPORT STAFF. In a team environment, members of the support staff can play a key role in promoting change, even when they’re not in a formal position to do that. Indeed, if it’s not their job to be an advocate for change, their arguments can be all the more convincing. If the same arguments were coming from somebody in a management position, people may think, “Well she’s the manager, so of course she’s going to say that.”

THE RESISTER. When people are resisting change, bring them to the table and say, “Look, I know you have some problems with this particular change. Tell me what your issue is.” Keep asking questions until you uncover the core reason(s) for their resistance. Sometimes you may end up having some hard conversations with people about what they’re getting out of work, why they’re coming to work and where they see themselves in the future. Don’t be afraid to bring these difficult issues to the surface.

THE 80:20 RULE. You can expect to spend 80 percent of your energy helping 20 percent of the people through the changes.

Celebrate every step of progress. After all, each little “victory” gets your practice one step closer to where you want it to be. If there are benchmarks that will help you to track progress, pick a few key measures—preferably ones that are highly visible—and keep score. People need to know how the practice is doing.

Acknowledge losses, offer sympathy and let staff vent. Some people will approach you and spend 10 minutes telling you about their frustrations, and they don’t want you to do anything at all other than listen. The fact that you’re available to do that can be important.

Keep the message consistent, simple and repeat it often, but don’t sound like a broken record. When practice leaders communicate to staff about the change process, it is important that they all give a consistent message. And increasing communication with staff is also critical during times of change. If you think you’re doing enough communication, try doubling it (and that doesn’t mean sending twice as many e-mails—go out and talk with people). However, the challenge is to find different ways to say the same thing, for if you start to sound like a broken record then staff will start to tune you out.


Mr. Igoe is director of eye care services at Group Health in Seattle. He works with 13 physicians, 38 optometrists and about 160 support staff at 12 different locations.


The AAOE has invited Mr. Igoe to present two Instruction Courses and a Roundtable at this year’s Annual Meeting.

  • Effective Change Communication—Course #551 (Tuesday, Nov. 13, 9 to 10 a.m.)
  • Engaging and Motivating Your Team Members—Course #480 (Monday, Nov. 12, 4:30 to 5:30 p.m.) and Roundtable #RT16 (Monday, Nov. 12, 12:45 to 1:45 p.m.)

Ticket sales opens on June 20 for Academy and AAOE members.

For more information, visit www.aao.org/annual_meeting.

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