When you know that you need to build support for a change around clinic processes be strategic in your approach. Make sure people understand their role and what will change. Have a back-office champion to support the cause and make sure and substantiate progress with benchmarks and measures.Doctor Listening to Patient

An example of a difficult change is asking patients for payment on account or more insurance information during check-in. A patient may not be prepared or accustomed to being asked to pay. Front desk staff may not feel comfortable asking patients to fill out an insurance update card or ask questions that may seem personal. Staff may not understand why the information is important and know the impact of not collecting the information. The level of confidence in what you are asking for comes across in your tone of voice. A less than confident tone can lead to patients questioning the request. Patients may challenge the process change and staff can quickly buckle. Helping staff understand why they are being asked to change their check-in process, giving them examples of how to ask for the information, and responses to common questions will go a long way. Sending out an e-mail or asking staff to “just do it” will probably land you right back where you started.

Managers find that some people are fearful of change while other just like to keep things the way they are. It can be easier to hire and train a new employee than to take your most experienced staff and try to get them to do something different. Dealing with “head junk” around “we already tried this” and “this will never work” is a serious barrier to implementing change. Implementation is especially hard when staff don’t know what the outcome will be and may have to wait 30 days to see the benefits. Moreover, when staff don’t have trust in the process they can look for outs to implementation before the process has even been given a chance.

The best way to get staff on board is to first think of the change strategically. Don’t start with the process and new tools; start with the reason why change is necessary. Ask people how they are managing a process currently and what the challenges are. Identify what is the risk of just continuing to do what you are doing. Ask how things could be improved and how improvement can be measured. Working in a group setting helps make opinions public and give everyone an opportunity to voice what they have to say. This can help later if resistant staff negatively message while a new process is still taking hold. The conversation will also provide positive talking points directly from staff.

Employees want to know and understand their role and don’t always thrive under the ambiguity of change. Uncertainty leads to questioning and can spiral into fear and disengagement. Disengagement can happen on many levels when you implement a new process. After three weeks you are back to where you started and everyone claims it wasn’t clear or they didn’t know they were supposed to actually use the new process. The best way around this is daily check-ins with staff. Don’t just ask “how’s the new front desk process process going?” because this will get you a “just fine” almost every time. Ask employees to “show me how you are implementing this, walk me through it so I can understand.” Also, make sure staff know you are open to talk about questions and concerns they are having. These conversations can be an opportunity to reiterate the training and reference the written materials – “let’s see what it says in our written documentation about  your question.” When you glaze over issues or don’t tune in to what is really going on it sends a message of “I don’t really care” which is a license for staff go and bag the new and return to the old.

Getting your ear to the ground will help and there is no better way than to get a trusted staff person to feel confident enough to really lead a new process and also bring challenges and changes directly to you for consideration. Providing this staff person with objections that may arise and strategic talking points to respond is key to heading off issues at the ground level. Another helpful tool is actual data from past process failures, ongoing benchmarks for success, and progress updates. A trusted staff person should be a believer not only in the new process but in your leadership and the organization overall. Having a champion staff person that just cares about their department can create division among teams, while having someone who gets the bigger picture and supports the mission can bring everyone together.

As a leader you need to be salesman when it comes to implementation of new processes. Leaders may have been deep into developing a new process and think that everyone else somehow understands what has been discussed. Don’t assume understanding; start from the beginning by describing briefly where process deficiencies were hampering the organization, what the concept is for the new process, and what are the challenges you expect and indicators of success. Be clear on your expectations of each staff person and what will be different tomorrow and the next day.

It may take extra time and energy to work through initial process changes but this investment can pay off longer term. Staff will reset their expectations over time as positive change experiences replace the negative ones from the past. Being able to measure and see results also gets everyone on board for the clinic; not just for themselves or their department. Over time trust in leadership for seeing change through will grow and give staff confidence in changes to come.

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