Empower Your Practice

Journal for Practice Managers

Healthcare Organizations: How to Implement Change Successfully

Healthcare managers regularly face various tasks related to the optimization of thermal processes. Representatives of the healthcare system note positive changes in these areas as a result of the introduction of advanced technologies. Examples of digitalization include telemedicine consultations, online booking modules, automation of accounting systems, electronic health records.

Conflict-free implementation of changes in the conditions of cooperation of staff members is the exception rather than the rule. Changes are viewed differently by the top management of clinics (for them, these are added responsibilities) and by its employees (for them, changes are fraught with danger). Personnel may resist changes of varying strength and intensity.

Let's consider the psychological and legal basis for the introduction of any changes, and also find out how to reduce stress and resistance in your management system.

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Change Management in a Medical Organization

Change permeates our whole lives, every day. Therefore, it is necessary to be aware of these changes. In most cases, the head of medical institutions must make sure all changes are for the better, as they are not painless. Usually, every healthcare provider passes through six steps of the change process:

6 steps of the change process

What causes the need for changes:

  1. Speed of changes, flexibility of changes, efficiency of changes.
  2. Prerequisites and conditions for changes.

From the inside and outside, the dynamics of the external environment and the internal environment determine organizational change in medicine. These are changes in science and medical technologies.

As an example, blood was collected in laboratories openly until recently. All methods are now closed and vacuum-based.

This was facilitated by the internal and external environment, when specialists discovered that the closed method is more accurate in terms of diagnostics. And it was a real quality improvement.

  1. It is necessary to anticipate the needs of the client as part of the quality system of patient care. Don't forget to also address increased requirements, and in particular, the needs of patients of medical institutions to learn more about legal and healthcare literacy. This is also an incentive for medical institutions to strive for certain changes, to improve their own literacy.
  2. Increase in personnel requirements. People with a different level of preparedness come to participate in healthcare delivery. They are seeking other changes. They want to work on upgrading equipment, which requires the improvement of some technologies, and the purchase of updated instruments.

Conditions for Effective Change

Organizational changes need to be carried out quickly, as the overall pace of change at the present stage of development is higher than ever.

Care organizations seeking to ensure long-term growth and stability should prepare their employees for frequent changes. Such organizations should set clear goals, as well as form a culture that will facilitate individual and group adaptation to changes. The price of error is especially high here.

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ADKAR model

The ability to effectively manage factors that either hinder or contribute to adaptation to changes becomes a key component of the success of any manager.

As part of the role of implementing changes, the manager must identify the problem that requires the introduction of a change. He or she must then assess the environment for its implementation, identify alternative options for managing the change and its consequences.

This process is represented in an ADKAR change management model that has proven to be very effective.

ADKAR change management model

To successfully manage changes in a healthcare setting, managers need:

  • Clearly represent the long-term goals of his organizational culture and the impact of changes on achieving these goals
  • To be able to communicate effectively with staff
  • Explain to the staff the prospects for change. Compare the present with the desired future state and determine what needs to be done to transit from the first state to the second
  • To establish and use mechanisms for regular monitoring of progress achieved
  • To help staff adapt to the changing situation and encourage their effective work
  • To organize continuous staff training
  • To exercise leadership
  • To know the requirements of patients and plan their quality service (quality management)
  • To monitor constantly the external environment of the organization and identify factors affecting its work.

5 Change management strategies

Team members prepare numerous reports, conduct consultations, analyze the metrics beforehand, determine whether to implement a change, and outline the evidence-based plan.

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There are several change methodologies that managers could use in their work.

#1. Directive strategy

The right of senior management to make change effort

When using this approach, managers use authority to "impose" change with the least involvement of other people.

The advantage of this approach is that it can be done quickly. However, the disadvantage is that the manager ignores the views or feelings of people affected by the change.

As a result, valuable information may be lost, and the probability of resistance increases. This resistance can reduce the speed of implementation of the change or even disrupt it.

It is the directive strategy that is currently most often used by the management of medical organizations.

#2. Expert strategy

Change management as a problem solution

This approach is often used when a change is the result of a "technical" problem that requires expert solutions. For example, the introduction of a new PMS into the activities of a medical organization.

Expert strategies have two main advantages.

Firstly, they allow you to use the experience of experts, directing it to the issue of change.

Secondly, the change initiative can be implemented quickly, because a relatively small group of experts is dealing with the problem.

A potential drawback is that people affected by the change may view the concern as more than just a technical one.

#3. Negotiation strategy

A collaborative decision

This approach includes a willingness to negotiate with other groups, recognizing that clarifications and concessions may have to be made.

It does not eliminate the manager from initiating and managing changes, but is based on the fact that people who are subject to change have the right to vote and have the ability to resist change if they do not agree with it.

The advantage of this is that those affected by the change have the chance to speak out and become change leaders. It reduces the likelihood of resistance. The disadvantage is that the implementation of the change may take much longer, and the results may become less predictable.

#4. Educational strategy

Successful change means winning minds and hearts

This approach involves changing values and beliefs so that people support change.

The emphasis in this case is on attracting supporters through a variety of actions, such as persuasion, education, training and selection. Organizational development consultants can be engaged to assist in the implementation of leading change.

The advantage of this approach, if it is successfully applied, is that people will react positively to the change and support it. The disadvantage is that the strategy may take longer and require more resources than the previous three.

#5. Complicity strategy

Everyone is involved in making a change model

This approach will include the participation of everyone affected by the change process.


  • Due to the large number of people involved in the change, it is more likely that the essence of the change will be perceived more fully
  • The active involvement of people is likely to increase their enthusiasm and commitment to the process of change. There are no facilitators, only participants
  • Healthcare professionals have the opportunity to use the competency and skills of numerous people
  • For people capable of learning in the process of change, there are increased opportunities.

The main disadvantages are:

  • The change is likely to be longer and more difficult to manage and will require a large amount of resources
  • Its results may be less predictable and more diverse.

The different strategies are not mutually exclusive. They can usually be used in combination.

Risks When Introducing Changes

In most situations, we don't introduce changes to our health services when everything is fine at first glance. Therefore, the right moment is when at the stage of development we reach the optimal level where we need to plan some changes, because after that there will be a decline.

Sometimes, at a stage of growth, the stakeholders of medical institutions do not wish to introduce any changes, because they fear losing time, profits, patients, and staff. Many organizations are afraid to lose their status quo.

When introducing changes, there are always various kinds of resistance that are encountered along the way. First, this is the resistance of personnel, third-party organizations, and higher-level organizations. The deadlines for implementing changes are often quite compressed, and the prospects for obtaining positive results are blurred.

These risks must be overcome. This is because the successful implementation of changes contributes to improving the quality of patient care, safety, as well as satisfaction with the work of the clinicians themselves.

Overcoming Resistance To Change

People resist change for many reasons. The ability of a manager to cope with certain forms of opposition and resistance to change depends on his understanding and assessment of the causes of their occurrence. Additionally, their significance and importance play a role in this.

Causes of change resistance

For a manager to successfully take improvement initiatives, it is necessary to know how to overcome opposition and resistance.

There is a wide range of methods or tactics that managers can apply to prevent negative reactions from staff:

  • Avoid unnecessary changes
  • Education and information for staff
  • Participation and involvement
  • Support and development
  • Negotiations and agreements
  • Building coalitions and alliances
  • Manipulation
  • Explicit and implicit coercion.

It is also necessary to keep in mind the impact of changes on those affected by them.

All these factors, strategies and risks should be taken into account by the change agent when managing a change.

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