When Change Is Bewildering 11 principles of preparing for change management take the fright out

When Change Is Bewildering 11 principles of preparing for `change management` take the fright out of dealing with a management consultant.

Jan 1st, 1999

When Change Is Bewildering 11 principles of preparing for `change management` take the fright out of dealing with a management consultant.

Suzanne Piersak, RDH, BS

Change and adapting to change is the new order of successful dental practices. In today`s ever-challenged and demanding dental environment, practices are facing crisis after crisis.

Dentists are enlisting the expertise of consultants to enable the expected raises in take-home incomes challenged by today`s business experience. A raise in fees doesn`t necessarily mean the practice owner is realizing a raised income. The demands of DMOs, savvy patients, insurance- dependent patients, demanding employees, forever increasing regulations, overnight technological changes, and encroaching larger dental corporations provide incentives for practices to change. They provide incentives to learn how to do things better in order to realize increased profits. Practice survival depends on it.

Consultant expertise doesn`t come cheap. Knowing what some of the major pitfalls, obstacles, and reasons your practice may fail places you in a position to be an effective part in the change process. Falling back into the practice`s familiar "same old, same old" after the external expert or consultant leaves is not at all unusual. People want the comfortable, predictable environment, even when the new process is logically better and more efficient. Understanding some of the basic change mechanics helps facilitate the change process. Preventing the natural phenomenon of slipping back to the comfortable "old shoe" of the past makes investments of time, effort, and cost for the consultant pay off. Past experiences of failed change may give you a case of deja vu as you replay the consultant experience. You may relate to one of the following forces contributing to a failed attempt to improve your work practices.

1) Smooth Operators Practices experience malpractice after trusted external experts damage relationships, gamble away assets, and prescribe "magic plans" without complete analysis and assessments. As treatment plans are individualized for our patients, so must change interventions be individualized according to each unique dental organization.

Damage done, the management consultant may remain a strong influence due to a practice`s ignorance and a trust in the relationship. We have witnessed, for example, the scenario of new patients who either leave the long-term care of a retiring dentist or move away from their trusted dentist and present with conditions of neglectful care. Finding decay under crowns, advanced periodontal disease, overhangs, and poor crown margins during the patient`s dental examination demonstrates that a trusting relationship isn`t everything.

2) Past Failures Consultants working their "magic formulas" may not have a theoretical and practical application required to facilitate the change management process. Until the consultant field becomes regulated, our protective recourse is knowledge of inept change management.

As dental professionals, we see the same response in dental patients paralyzed by past experiences. They are afraid and resistant to seek care to heal their pain and disease. Sadly, when patients wait until it is too late to save their teeth, the losses are permanent. It is the same for many practices which have lost invaluable assets due to past experiences with inept practice management consultants. The failed experiences often prevent and paralyze a practice from seeking the expertise crucial for success.

Exiting consultants leave chaotic outcomes and enable a slow - sometimes rapid - regression back to "the same old, same old." Practice owners and staffs become cynical of any and all consultants.

3) Failure To Transfer Learned Skills Some practices flourish through skilled change management. However, other consultants apply a "magic formula" and then leave a practice powerless. They lack the skills required for damage control when the domino effect of most "quick fixes" and even long-term "fixes" begin. Changing any system, person, or action means another part of the system, person, or action will require attention.

Effective consultants empower practice members with the skills required to facilitate independent practice health. The consultant who never exits may never intend to produce self-sufficiency. "Magic formulas" may ignore the task of transferring training and skills so the practice can begin the transition to effective self-management.

The bottom line here is that a consultant will become a drain to the practice`s resources! Developing skills to stand alone and targeting the exit date are specifications to make with external experts.

4) Inadequate Assessment In practices severely damaged by consultants, we witness our co-workers, bosses, and, yes, even the patients suffering at the hands of unskilled practice management consultants. Many consultants also, for example, ignore the crucial and valuable input of the "significant others" - the staff - who care deeply about their patients and their practice.

Skilled experts have a rich background in facilitating and managing the resistant factors that accompany change interventions. A facilitator with high ethical standards also will work under a premise of "do no harm." A careful investigation of practice management consultants will assess their skills and knowledge of change management.

Cathleen Smith Hutchinson, a change and strategist consultant, defines "performance technologists" in Performance Improvement Quarterly as the new breed of consultants. These professionals address performance gaps at the individual, group, and organizational level. They view each level as an integrated system.

Practices must become like the savvy dental patient who has developed into a knowledgeable dental consumer. Practices must evaluate potential consultants with the same degree of intelligence. This is especially true since the hiring of an expert poses a risk to the practice`s time and dollar investments.

5) Inadequate Buy In Often, all ownership of the change intervention is taken away from the staff. This act builds a solid wall for change resistance. No wonder practice management consultants position their power by deciding practice members are replaceable parts. It is their protection for incompetent skills of analysis and feedback. When employees are brought into the picture, it is with directives to "do this, act like that, and to jump on board as a team player."

Employees disregarded in the assessment, feedback, and analysis will most likely not buy into the change process.

The skilled dental hygienist uses both objective data (concrete observable findings) and subjective data (symptoms and individual life situations) to implement cooperative treatment plans with the dentist`s and patient`s involvement. Likewise, a change expert will facilitate the needs analysis through objective data (hard numbers) and subjective data (the human factors) to implement interventions, working cooperatively with the practice owners and employees.

Outcomes of resistance and disagreement lead consultants to the explanation that employees who won`t "jump on board" will just not fit the "magic picture." And, of course, they will find those "complaints from a few patients." With training in a specific area, the experienced employee may never have had a complaint. Instead, the "external" expert advises dismissal of the change resistor.

These consultants have not mastered the buy-in and advocacy skills listed as a major competency for human performance roles by the American Academy for Training and Development.

6) Internal Human Resource Expertise Standing back silently and taking for granted that a consultant will acknowledge your unique skills and expertise is a lesson for the naive. Ignoring "internal" expertise may disguise actions that communicate that you may be the employee who is a predetermined replaceable part. A truly skilled change consultant would be able to diagnose where systematic problems lie and facilitate vital information that communicates the real bottom-line assets to a practice.

As an employee, you do know the systems, you have established caring relationships with your patients, you hold vital information about problems and the assets, and you are an asset because of it. Consultants who never talk directly with key employees cannot assess the true picture. Employees provide subjective data and are a crucial part of a complete assessment.

7) Unwillingness To Model Behavior Ironically, in most cases, the practice owners never really carry their own weight. The bottom-line experience is that the practice owner is as resistant as the rest of the staff to the "magic formula." John Kotter states in the Harvard Business Review article, "Why Transformation Efforts Fail," that, "worst of all are the bosses who refuse to change" and never really "walk the talk." Real coaching and leadership training are absent. It is imperative that leaders model the actions required to facilitate change acceptance.

8) Rejecting Significant Others Problems often begin with the release of employees. This is overt when firing employees or covert when sending employees strong clues that they are not part of the practice`s needs. This may begin a path of self-destruction for the employee and a downward spiral for the practice. A complete assessment of systems, processes, and individual performance, as well as effective change management, may have kept all the stakeholders involved rewarded.

Business management experts who rely heavily on the hard data often delegate employees to being replaceable parts in the system. They may have mishandled interactions with staff and replaced communication opportunities with threats. Employees who feel threatened will often unknowingly, and even knowingly, sabotage the change and become a targeted "weakness." They feel rejected and lose significance to the organization.

When the bottom line is a key component to change, it should never be forgotten that connecting and caring relationships are key to successful models implemented in business and industry today.

9) Work Culture Changing a culture is the most challenging of all change attempts. Every work environment has its own work "culture." It is the culture that defines the how work gets done and how decisions are made. In the book, Organizational Development and Change, Cummings and Whorly define culture as the shared patterns, values, beliefs, and expectations of employees and practice owners.

The work culture defines the spoken and unspoken norms that interweave the relationships and communication patterns of where we work. It is the deep-seated cultures and norms that, in the long range, have to transform into cultures able to survive and succeed.

Experts entering your practice need to acknowledge the old work cultures and enable environments to support the new work cultures. They understand the complex requirements needed to change the culture of an organization.

10) Change Readiness Before your practice can change, it must be ready to change. Think of the patient who smokes. As much as family, friends, and caregivers would like to believe their need for the loved one to quit smoking should be enough, it isn`t. Only when the smoker is ready to quit will any chance of becoming a nonsmoker exist. Threat of death is a heartbreaking situation that sometimes isn`t even enough. Information helps to prepare for change. Acknowledging and accepting that there is a need to change is a prerequisite. This is change readiness.

11) Lack of Effective Communication Dental practices that lack communications skills and forums to facilitate a "team" effort are much like teeth in a periodontal Class IV state with contributing factors of smoking, poor occlusion, and poor oral hygiene. Both the teeth and the dental team have a poor prognosis.

Establishing effective communication processes are crucial prior to any "magic plans" or any intervention. It is a critical component to the change readiness state. Change will produce conflicts, and organizations unable to resolve conflicts through effective communication will not be able to change.

This article is dedicated to fellow peers who have been hurt by the consultant viewing them as replaceable parts. It is dedicated to the wasted loss of established relationships between caring professionals and their patients. It is dedicated to practices damaged by practice management consultants who lack skills essential for effective change management. May knowledge and experience prevent repeat performances in the lives of those affected by practice management malpractice.

Suzanne Piersak, RDH, BS, is a clinician and founder of Dental Teamcare, a company dedicated to aligning "practice care" with "patient care." She has 20 years of clinical experience and a degree in human resource development. Her e-mail address is dair0005@tc.umn.edu.

References available upon request.

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