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Leading Practice Change


Organizations that are adept at implementing change tend to develop more innovative, risk-tolerant cultures and have greater agility in implementing new strategic initiatives. A change-ready culture is a foundational element for practices that are interested in successfully implementing new services.

Physician owners and leaders, as well as practice managers, must see a need for and be open to change. To implement change, it is essential for practice leaders to empower their staff based on a shared vision that aligns with the organization's desired change, recognizing that each staff member has much to offer. To be successful—once change is implemented—it must then be managed.

Changing a practice's culture does not happen overnight. Leaders cannot simply define new values and goals and share them in the hope that everyone will get on board with a new strategy. Instead, leadership must do the following:

  • commit to a new vision for the organization's culture;
  • integrate decision-making that supports that desired culture;
  • empower managers to provide staff incentives that align with desired goals; and
  • implement processes and systems engineered to drive desired behavior. ​

The following materials provide you with tips to build a practice culture that is more adaptable to change:  


Changing Practice Culture: Implementation Stra​tegies​

    1. Establish a Learning and Growth Culture among the Staff

    For a group to adopt new behaviors that can translate into desired business objectives, a learning and growth culture must first be established. In a learning and growth culture, the individuals and teams consciously invest in growing and developing themselves.

    Learning and growth of staff not only benefits the individual, but also benefits and strengthens the entire practice. As such, practices should support and provide resources for individual staff to grow professionally and achieve outcomes that are important to them and to the practice. This type of investment communicates to staff that there is an expectation for growth and learning at all levels, and helps to build an atmosphere of curiosity and forward thinking.

    ​Additionally, practice leaders can demonstrate their commitment to this concept by investing in their own learning and growth, admitting when they don't know something, and utilizing errors or negative feedback as opportunities for learning and process improvement - as opposed to only for punitive or disciplinary measures. Building a learning and growth culture takes time and effort; however, it becomes the foundation on which everything else is built. 

    2. Review the practice’s mission, vision, and value statements with practice staff, and modify as needed.

    The practice's mission, vision, and value statements should convey the values of the practice, inspire and encourage employees, sound reasonable and plausible, and be as specific and relevant as possible in a concise sentence.

    The practice's commitment to ongoing improvement and high quality care should be inherent in these statements. Involving staff in review and revision of the mission, vision, and value statements will help to ensure a more comprehensive statement, and also increase investment and buy-in by staff. Additionally, consideration should be given to involving patients and families in this process.  


    3. Evaluate and assess the practice’s environment

    Obtain feedback from staff and patients/families on whether the practice's current environment is consistent with the mission, vision, and values statements. An anonymous survey tool can be used to encourage honest feedback; and consideration should be given to whether slightly different questions are needed for staff and patient/family audiences. Provide assurance that results will be used to identify areas where additional development and improvement might be necessary. Share a high-level summary of the survey results with survey respondents, and consider offering a small reward for participation (eg. luncheon, vacation day/additional hour's bonus, gift card, or whatever the team decides as a group for recognition).


    4. Identify what needs to be changed

    ​Review the survey results with staff and/or patients/families, and develop a prioritized list of the changes the practice will need to make in order to align with the mission, vision and value statements of the practice.


    5. Identify members of a staff team, including a team leader, that will plan and lead the change process

    ​Involve staff at all different levels to plan and lead the change process; however, care should be taken to keep the team relatively small and to select individuals who are well-respected and open-minded. A team leader should be identified, and will be responsible for facilitating staff team meetings and leading the implementation process. The staff team can review the prioritized list of changes, and brainstorm ways in which to address the gaps. Consider using the Plan-Do-Study-Act cycle to begin the change process in your practice. Step-by-step instructions can be found in the Quality Improvement in Pediatric Practice module. ​

    6. Communicate and implement the change

    ​When ready to implement change, call an orientation meeting. Prepare for the meeting with a plan that sells the vision, such as including data or a patient/family story. Everyone should hear the message the same way, at the same time. Remember the grapevine has no mercy and can be easily misinterpreted or distorted. It is recommended that changes not be implemented all at once; rather that changes are implemented more methodically, and integrated into daily procedures. Staff should receive the training and support to implement changes, and have a clearly outlined mechanism to provide feedback and receive feedback from patients/families (if appropriate) on what is/is not going well. In the end, it's making everyone feeling valued and reassured that their feedback will be heard. ​​


    7. Manage resistance

    There are many people who don't like dealing with change. It encroaches on the way they do things and brings uncertainty—not knowing if the outcome will really make things better for them. The truth is, without everyone's cooperation in your practice, change results can be compromised.


    8. Manage the Change

    Approaching change and obtaining acceptance not only requires overcoming barriers, but also managing cultural and political challenges within the practice team. It is crucial for leaders to meet individually with staff that are most vocal about sabotaging efforts to implement operational changes. Open the doors of communication and discuss perceived resistance and issues that concern each of them. It may require some real negotiating finesse to overcome these hurdles, but without doing so, the change process can be more challenging. It should be a two-way dialogue, so that there is a clear understanding of how they feel and what is expected of them.​​


    9. Regularly solicit feedback from staff and patients/families

    ​Transparent, genuine and consistent communication is needed about changes that have been implemented and the performance improvement journey, so all employees feel part of the process. Regularly scheduled sessions with two-way communication and extensive informal approaches are needed to emphasize expected behaviors and results. Use these sessions to clarify plans, answer questions, address rumors, and reduce drama.​

    10. Honestly evaluate change, celebrate successes, and acknowledge failure

    Feedback and recognition are critical to the process. Share and celebrate progress in a transparent manner as a standard part of regular communication activities. Confront reality when improvements don't go as planned, identify what can be learned from the experience, and re-engage your team to prioritize adjustments that need to be made.


    ​Change is not about personal gain, it's about gain for the entire practice. Keep everyone focused on this, celebrate steps of progress along the way and show appreciation for a job well done.

We need your help to keep our practice transformation strategies up-to-date amid today's unprecedented changes in health care. Please share your "best practices," innovations, implementation tools, and resources to help other AAP members keep pace as the health care environment rapidly evolves. Simply complete and submit the form below. Thank you for keeping pediatric practice strong. ​​​​​​


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