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Does Managing During Turmoil Have to Be Traumatic?
Nancy Burden
Publish Date: October 10, 2007   |  Tags:   Staffing

Nancy Burden, RN, MS, CAPA Change is natural and good. But nothing is as upsetting to your people as change. And nothing has greater potential to cause failures, loss of production or falling quality. Reaction to change is unpredictable and irrational, but manageable - if done right.

I know of what I speak. My team and I at the Trinity Surgery Center in New Port Richey, Fla., underwent a long (17-month) transition in ownership structure - from private ownership by a health system to a joint venture with physician-investors. These are the five keys that helped us keep our staff morale strong and our practice running smoothly during the transition. Think of these tips the next time the winds of change blow though your facility.

1. Keep your staff in the loop
When change is afoot, no news is definitely not good news. Within reasonable limits, don't keep your staff in the dark about what goes on in the boardroom. The staff appreciates updates about important executive decisions as well as those that are delayed. One word of caution: Leave delicate matters for the privacy of meetings - they don't belong in the staff lounge.

Our 20 staff members understandably were worried about their careers and the future of the facility. We established a question-and-answer format to give the staff a mechanism to raise questions and make suggestions. I received a lot of questions asking who was investing in the ASC and requests for progress reports on the development of facility bylaws. We also fielded practice-related queries about how the credentialing and OR privileging processes would work, and what companies we would retain and replace as vendors.

To reinforce that we took these questions seriously, the vice president of our health system made himself available to the staff by phone and at site meetings. If questions required specialized knowledge, we brought in experts such as the director of team resources and financial planners. Often, we couldn't answer specific questions for months at a time, because the issues had yet to be finalized. When this occurred, we made a point to keep track of those points and get back to the staff when we had the answers.

2. Be honest and open
No one enjoys being the bearer of bad news. But if there is unpleasant news to deliver, the administrator should bring it to the staff. For example, our staff waited anxiously to find out whether our health system would continue to employ them and "lease" their services back to the ASC or if their employment would be in the hands of the ASC. As soon as we knew that they couldn't continue to remain employees of the existing health system, we explained this and the reasons to the staff. It wasn't a decision they wanted to hear, but we provided the information to them as soon as possible so that this unresolved issue wouldn't persist and affect the day-to-day practice.

As much as people dislike bad news, uncertainty is even worse. Some administrators prefer to speculate rather than say "I don't know" when the staff asks tough questions that deserve definitive answers. Unfortunately, definite answers aren't always possible. Avoid guessing when you truly don't know. If you feel you must weigh in with your own read, clearly express that these are your thoughts on the topic and may or may not happen.

3. Encourage the staff to speak their minds
Don't guess what the staff members most want to know; ask them directly. From personal experience, I can virtually guarantee that salary and benefits are No. 1 and No. 2 on most workers' lists of concerns. Be prepared to tackle this question and update the staff. Our newly formed board of managers for the joint venture addressed this issue as soon as feasible.

Listening to the staff's salary and benefits concerns also spurred the board to create staff-retention strategies. In the end, it was effective. All staff (except our scheduler, who was a 28-year veteran of the health system) remained in the new business, in part because the board demonstrated support for the current staff by approving a generous compensation structure.

Other common concerns raised by staff center around how their daily work will change and "How many physician 'bosses' will I have?" Any information you can provide to the staff that practice life will change very little is reassuring, but the ultimate proof will come only after the new joint venture is in business. You may also need to coach the physician-owners on the right and wrong ways to approach staff concerns.

4. Make the transition fun
One great way to keep staff morale high during the transition is to provide diversions that make creative juices flow and build team spirit. It's also a way to alleviate anxiety and keep the day-to-day work environment relaxed.

Our board let the staff choose a new logo. We organized a contest and voted on the final choice. Our contest generated lots of interest and discussion that made everyone feel involved in the process. We even created some good-natured politicking for favored logos. We had some grumbling from someone who held out for a tree in the logo, but she was swayed by the crowd.

Here's another interactive staff-owned process that everyone enjoyed: letting everyone choose scrubs they liked. We also posed the question, "What color physician scrubs would be the least likely to 'walk' at the end of the day?" Our staff voted, and now our surgeons are clad in "Barney purple" scrubs while they operate at the center. Not many walk, but when they do it's easy to spot them.

5. Stay enthusiastic
You may not recognize it, but the attitude of your staff is largely drawn from the vibe they get from management. It's crucial as the administrator to show your enthusiasm every day. As the months of hard work went by during our transition, I had days where keeping the practice running smoothly, the staff informed and interacting with the board all at once seemed especially difficult.

Don't neglect yourself
As you work to make the business and process changes necessary for any major shift, don't ignore own health and well-being. As a leader, you need to maintain an equilibrium between your work and your outside life. That's not an easy task, but it's a valuable goal.