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 By Neil B. Gailmard, OD, MBA, FAAO, Editor August 13, 2003 - Tip #82 
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How to introduce change in your practice

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Additional Information

There are entire books and complete courses within MBA programs on how to plan and introduce change in a business. While I can't begin to encapsulate such material in this weekly tip format, I can share some basic concepts that may help you introduce change in your practice.

Why change?

First, realize that all businesses (professional practices included) must change, or they will become out of date and decline. Change can occur in small increments or in a sweeping re-engineering, and both can be effective. Second, realize that change is difficult for employees because it may threaten their way of life at work. I find that looking at change from the employee's point of view is helpful, and it allows me to provide support and reassurance to help them get through the process.

There are many things that may require change in an optometric practice:
  • A new plan for increased delegation and pre-testing - resulting in more patients per hour
  • An increase in fee structure
  • New policies in the optical - such as warranties and remakes
  • Dropping or adding a managed care plan
  • A change in employee benefits
  • A new office computer system
  • Moving to electronic medical records
  • A change in administrative procedures - such as recall or billing
What not to do

The main thing to avoid in introducing change is exactly what many optometrists do - deliver an edict. This seems like the natural and most efficient way to get things done to a practice owner. You've come across a good idea and you want to try it - so you gather the staff and tell them what they will do from now on.

From the employee's point of view, you have just let them know that their opinion does not matter, even though they know quite a bit about the area of the practice you are changing. The employee mentality is to also think that if it's good for the doctor/ owner it must be bad for me. The employee may worry that he/she will have to...
  • Work harder or longer
  • Learn new tasks which will be difficult
  • Learn new tasks which may reveal personal weaknesses
  • Have something taken away
  • Perform an unpleasant task, such as give patients bad news
You can think of more if you just consider the specific change from the employee's point of view

Start with a discussion of the problem

The best way to integrate positive change is to have a meeting to openly discuss a business issue. A problem well stated is a problem half-solved, so state the problem and cite the evidence for why it is true. This could be that revenue is down, patient complaints are up, managed care is too time consuming, fixed fee plans are causing a need to see more patients per day, etc.

Ask for, and truly listen to, employee input about the problem. Staff members have a lot of knowledge and the different points of view truly can help management make good decisions. Employees actually want to make the practice better, if asked, and they know that is good for their own advancement too. The doctor can also provide his/her ideas for how to solve the problem, and gauge reactions and listen to potential obstacles. Take notes at this brain-storming meeting, and schedule another meeting.

After this groundwork, the doctor can present a plan for change. It should include a pledge of support and it may include a willingness to re-evaluate the new procedure after it has been in effect. Advise staff that you will hire additional employees if needed, and that higher-level work will be recognized with pay raises when it is time for employment reviews. Also, pledge to provide the time for training, the printed materials and forms if applicable, the new equipment if applicable, and the patience as everyone goes through the learning curve. Complement the staff on how good they already are, and how new skills will be good for their careers. View change as a way for staff to move up in your organization - which is much needed in optometric practices.

Is it worth all the trouble and expense? The professors in MBA programs sure think so. And I believe there is no better place to invest money and resources then your practice.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week

A Proud Supporter of

Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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