Engaging Physicians in the Change Process
Over the past ten years, I have had many opportunities to assist fellow clinicians in making the transition to an Electronic Health Record (EHR). And prior to that, I helped nurses, doctors and other clinicians implement countless changes throughout the healthcare system.
Being a clinician myself, I have great insight into how to connect with my peers as they learn new technology, processes and procedures. However acting in the role of change management consultant on these complex initiatives has given me an even deeper understanding of how to help my fellow clinicians successfully adopt change.
Introducing change to physicians can be complex, frustrating and at times all consuming. What I learned early is how important it is for the change agent to know as much as possible about the physician culture and their specific healthcare environment.
Here’s what every change agent facilitating change in the healthcare environment needs to remember about physicians impacted by change:
Patient First/Change Last — I’m sure this doesn’t surprise you, but you will find that physicians are typically autonomous. Although it takes a team to provide care to patients, physicians have been trained to captain the ship, and only consult with others when absolutely required. They will always be primarily focused on their patients, their profession and their craft rather than the change or the organization. So don’t expect them to put the needs of the organization above the needs of those entrusted in their care. Each and every one of their patients need to come first. Their interest in change is low on their list of priorities.
Safety Trumps Change –There is a natural concern for patient safety and outcomes whenever changes are suggested, especially if it impacts the physician’s ability to direct care. The change must not negatively affect the care of patients. Only safety-related changes get priority.
Understand the Payment System — You need to know how the reimbursement structure works. Although we are seeing a swing away from “pay for production” to “pay for quality” type reimbursement, the change is far from complete. Efforts that impact the physicians’ pay structure can cause resistance to change just as it would with any other group of people. You will need to develop a rewards structure that mitigates the loss.
Physicians Value Relationships — Physicians are definitely oriented toward relationships. They have spent their career building these relationships with fellow providers and other healthcare personnel. As a change agent, you will need to work on building a relationship with them. Once that relationship is built, you will find individuals willing to help and champion the change.
Physicians Are Scientists –They will likely make their decisions based on data. They will use both quantitative data and qualitative data. That includes their own experiences. So provide them the data that they need to make the decision to support change.
A Change Agent Insight into Physicians
Approach and Tactics
1 – Academic detailing vs. training
Physicians are highly educated individuals. They may not respond well to being told that they need to be trained on something. Merely using the word training can turn off the physician. To them it sounds long, boring and like something they don’t have time for. Consider using academic detailing, a technique used by the pharmaceutical industry for years. I found this face to face individual or small group approach to be highly effective when preparing physicians for using an EHR. They will see immediate value in having a discussion with another physician or clinician.
2 – Peer comparison vs. performance assessment
Physicians typically respond to data and want to know where they stand in relationship to others, especially their peers. Avoid telling them how they’re doing based on your assessment. If you have an opportunity to use benchmark, professional standard, target or peer comparison data, by all means do it. However, be cautious. Know their healthcare environment and culture when deciding to use peer comparison data and mask the names of their peers.
3 – Credibility vs. credentials
Establish your credibility as a change management professional based on how you consult with physicians and present yourself. Avoid waiving your credentials and years of experience. Allow them to draw their own conclusions. If you have a good working relationship with the physicians, good for you. If not, you will need to first establish and then work hard to maintain your credibility. Some key things to keep in mind are:
- Respect MD time
- Aggressive agenda
- No Agenda, No Meeting
- Send materials for pre-meeting prep
- Be flexible with participation methods
- Work around their schedule
- Consider ways to not interrupt their patient care schedule
- Consider compensating them for their time
- Data, Data, Data
- Know exactly what you do know and what you don’t know
- Provide key articles from scientific journals
- Provide bibliography or references for further reading
In my opinion, working within healthcare to improve the care that is delivered to patients is rewarding work. For more than twenty years it has been near and dear to my heart. I hold my fellow clinicians in high regard for the important work that they do every day. I want to leave you with a few final thoughts for you in your role as change agent when working with physicians and hope that you find these helpful in supporting this key group of people as they face the constant wave of change.
- First, you need to recognize how much your change will impact physicians and allow them the opportunity to share their issues and concerns and give input into the change where possible.
- Second, understand that this change may have impacted their autonomy and production. Your change will possibly slow them down in the beginning. You will need to acknowledge this and put mitigation plans in place to lessen the dip in productivity while they are adjusting to the change.
- Third, physicians are used to knowing what they are doing and this can be a humbling experience for them. Put yourself in their shoes and treat them as you would want to be treated.
Sheila Fain is an experienced clinician who has led complex, high priority projects such as SAP, ERP and EHR implementations and organizational transformations. She possesses a blend of performance improvement, learning strategies and business skills to help organizations apply the Managed Change™ process to execute their strategies. Sheila will host this blog monthly, tackling the unique challenges patients and providers face as they manage health care changes.