Blog | Tuesday, June 24, 2014

On orchestrating change

Change causes distress for most people. In medicine we have a hierarchy that disdains most change. Medical students, residents, attending physicians all seemingly reject change. Practicing physicians dislike change. Yet change occurs and is necessary. I learned a great deal about change from my mother. This anecdote may help put change into perspective.

Many years ago, over 50 years ago, we lived in a 3-bedroom house. In the evening we all sat in the family room watching our small TV. One evening, as my father sat in HIS chair, and my sister and I sat on the floor, my mother comes into the room and announces that a couch would look good against one of the walls. I remember my father rolling his eyes and mumbling something about another campaign. Nine months later he gladly bought a couch.

My mother understood patience. My father was not ready for change, so she started a campaign to change minds.

Many years later, I was a new internal medicine program director. I was full of ideas, but quickly learned that my ideas were often way ahead of the program. Once we had to rethink our clinic schedules. I had the idea of having interns come to clinic in the morning and residents in the afternoon. This plan would allow someone from the team to always be around during the day. This plan would take interns out of rounds 1 day each week, making a strong statement about the importance of outpatient training.

When I first presented this plan, it was roundly rejected. Over the next few months I gently made the case to reconsider this strategy. Eventually, the chair had this great idea of having interns in morning clinic. The idea triumphed after enough time for everyone to accept the logic.

Too often change in medicine occurs without involving those affected. Too often students or physicians reject well-meaning change because they were not involved in the process.

Change challenges us. We become used to the status quo. But we must change at times.

When we advocate change, we need to carefully understand the consequences and especially the unintended consequences. We cannot ignore those whom the change impacts. They must be part of the change process, or else the resistance will grow and grow.

Leaders forget these principles too often. We have seen many changes imposed on physicians without a clear understanding of how those changes will impact practice and their lives. They forget these principles and cause great angst.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.