There are many things that make the veterinary profession so richly rewarding to work in — the opportunity to work with like-minded people as part of a team, in a nurturing and supportive environment, and making a difference to both animal and human life. However, one of the best things about working in practice is the abundance of great ideas and positive energy that is always prevalent even in the most suppressed or depressed of working environments. Given the current poor economic climate, the frozen salaries and the increased cost of living, the owner in many practices may be faced with some tough decisions and difficult times; but give colleagues the slightest window of opportunity such as ‘what do you think?’ and this inevitably releases plenty of smart, bright, realistic and often achievable ideas.
‘It is not the strongest of the species who survive, not the most intelligent, but those who are the most adaptive to change.’
So given this wonderful rich environment, why is it that so many ideas do not realize or come to fruition and even if they get off the ground, do not quite reach satisfactory conclusion?
The answer, in the author's opinion, lies in the management of change and more specifically in the implementation of change.
Definitions
Change is defined by the Concise Oxford Dictionary as ‘making or becoming different’ — a definition which could be considered both vague and precise. Managing change is handling the journey from A to B and in most organizations, including veterinary practice, that means dealing with the complex interactions between equipment or technology, working processes, organizational structure and people. These four elements are so inextricably linked and related to each other that changing one or more directly impacts the others. This is what makes the implementation of change so difficult.
Implementation checklist
The Chartered Management Institute (2008a and b) have published action checklists for managing change and these provide a framework to use and adapt in veterinary practice.
1 Agree the implementation strategy
Although this sounds very much like ‘management speak’ it is important to decide in advance a plan for implementing the change. Is it going to be the ‘all together’ approach or is the change to be made in one section of the practice first? For example a mixed practice considering the introduction of a computerized diary or appointment system may decide to implement it first in the small animal department enabling the practice to learn from any issues before implementing it in the large animal department. Deciding the course of action in advance and communicating this to colleagues illustrates that considerable time has been taken to think about the practicalities and implications and will give credibility to the project and its manager.
2 Agree the time frame
Every programme of change should have a timetable and this time frame needs to be realistic and most importantly have a finish date. When planning the change the most common mistake is to underestimate the amount of time implementation of change will take and failing to take into consideration this is an ‘extra’ to the normal working day; even the best planners come across problems and issues that hold up progress and having an end date gives those involved motivation and focus while also providing a date from when evaluation can take place.
3 Set up a team of stakeholders
Stakeholders are those who have an interest or a concern in the project and although the team does not necessarily include partners or directors, it will benefit from their support. Using the example of a computerized diary above, the team might include a head receptionist, one of the veterinary surgeons who will be affected by the change, the clinic nurse, someone who is familiar with the practice management system and the person who is responsible for the rota or working patterns. It is important for the team to be able to communicate openly and easily with each other and that they recognize they are key to positive change. The team will be responsible for flagging up any problems, suggesting solutions and sharing information while the team leader is responsible for monitoring progress to keep the project on schedule.
4 Devise detailed implementation plan
Use the agreed strategy and time frame to draw up a detailed plan with the key people involved. The nature of veterinary practice today means that the ‘change plan’ will not be the only activity the team will be undertaking, and agreeing a detailed plan with the key people involved will help gain trust and respect, while also helping ‘the plan’ to achieve multi ownership. Good and proper delegation is an important skill in change implementation. As practice managers or head nurses we are trained to do a job but sometimes that can be seen as at best a ‘generalist’ or at worst a ‘catch all’. However, recognizing there are people in the practice better suited to carrying out certain work and utilizing strengths and recognizing weaknesses is a great way to ensure better success for change. When asking others in the team to help, provide them with the goals and time frame but give them the authority to decide how best to achieve their objective. It is often helpful if the team can perform some ‘quick wins’ at the start of the implementation process, i.e. something that is easy to achieve that makes a difference. For example, installing a cordless phone in the practice makes handling calls easier when staffing is limited or when required to move around the site in order to resolve an IT problem. This will help give confidence in their abilities to manage change and reassurance that a positive difference can be made. A newly formed team working well together may suddenly present the team leader with additional change options and goals which have come to the surface through healthy discussion and team work. It is tempting at this juncture to indulge and reward the team by incorporating any new goals into the change programme. However, the saying ‘to have more than one goal is to have no goal’ (Anand and Nicholson, 2004) is true and any new goals must be considered outside the current programme of change. If a new goal is worthwhile, explain to the team it deserves to be given the same treatment as the current plan and will be considered once the programme of change has been completed.
5 Personalize the case for change
Colleagues who can appreciate the effect any change will have on their own personal lives at work will feel more comfortable. Consider each individual and the impact the change may have on their day to day work practices, working hours or job descriptions. Speak to them and ensure they understand why the change is necessary and listen to any concerns they may have. Change can be very stressful especially if imposed, and creates a sense of uncertainty which in turn causes worry for people. Implementing changes gradually and providing information openly and honestly will help make changes appear less invasive (Freeston et al, 1994) as will keeping an ear out for rumours which inevitably arise and setting the record straight as quickly as possible.
6 Be prepared for conflict
Because change usually involves a number of people who, by the very nature of human beings, are all different, conflict invariably arises. Dealing with this conflict and establishing common ground from which to work is essential. In practice everyone has a common goal which is to serve clients and their animals better — this is usually a good starting point for any conflict resolution. From this point mediation and negotiation with individuals can get the change programme back on track.
7 Remember change is discontinuous
‘Change is the only constant’ according to the Greek philosopher Heraclitus. Constant however, does not mean continuous and change can be a stop/start process. Hitches which were not anticipated or which are taking longer to resolve than first planned can lead others to believe the change has failed or been abandoned. Keeping the team informed of non progress as well as progress is equally important so that colleagues understand that discontinuity is normal.
8 Monitor and evaluate
Monitoring and evaluation is often saved for the end of a project or change but it should be continual throughout the project. Assessing progress and measuring it against reality means you can quickly take any necessary corrective action. This underlines to your team that you also have a key role to play in the project and that you are involved at a level that enables you to help them deliver the change and succeed. It also emphasizes that you recognize the fluid nature of change and will not blame them for unplanned outcomes.
Common reasons for failure
Almost every change initiative starts with good intention, enthusiasm and momentum. However as the change progresses old ways and processes assert themselves, new problems emerge on the horizon and the day to day running of the organization diverts the manager from the project (Anand and Nicholson, 2004). Like a squeezed stress-ball suddenly released, the business returns to its former state and the change slumps quietly into failure. To manage change effectively requires a combination of both ‘hard’ and ‘soft’ skills. The hard side of managing change involves project management, planning, technology and analysis — all tasks with clear outcomes, easily measured progress and defined costs. The soft side however involves understanding culture and people, using negotiation and persuasion and is less tangible, measurable or budget friendly. As a result, managers may be tempted to concentrate on the hard side first forgetting that the two sides are inextricably linked and related to each other, only to realize all too late that the ‘soft’ side of change management is as important as the ‘hard’ side.
Richard Luecke (2003) cites, among others, two mistakes to avoid in Managing Change and Transition:
- ‘Don't try to impose a canned solution developed somewhere else’A solution that worked in another organization was a success at that point, at that time, with that product or service and with those people and it is therefore impossible to recreate that environment in a different organization
- ‘Don't bank on a technical fix alone’Luecke tells of a mining company that wanted to install new equipment which was technically superior to the existing equipment. However, in doing so the management team broke up employee groups that had learned to work together and support each other in a dangerous environment. The miners resisted the technical solution because it failed to account for the impact on their working lives. It is therefore important for change success that consideration is given to the effect on people carrying out the day to day service or product provision.
If change does fail, regardless of the reasons, the effect and consequences can be major. A business that fails to implement a change can lead to a feeling that change is not really necessary or worthwhile, the business is incapable of changing, any change is optional not necessary, management are not in control or in agreement, the business is susceptible to negativity. All or any one of these can then make any future change programme even harder to implement and very quickly the organization can find itself in a cultural vortex (Anand and Nicholson, 2004).
‘Making change a reality is only half the battle, making it permanent is the other half
On the subject of change in an organization, Anand and Nicholson (2004) state: ‘Having started without direction and continued without focus or monitoring, it ends in a whimper when those involved can go no further’. Sadly this is often true and it is a fact that the failure of change is often to do with the management and implementation of change rather than the purpose of the change itself. A quick glance at the long list of examples of change in veterinary practice in the last 20 years highlighted by Girotti (2011) (Table 1) in his article helps practitioners to understand that the veterinary profession has had a considerable volume of change to cope with and there is every reason to think that this will only increase in the future.
Table 1. Examples of change in the past 20 years
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Conclusion
In conclusion, planning is the key to implementing change couple with open communication, ownership and personalization of the case for change rather than a formulaic approach. These elements themselves though do not protect against failure but can help those implementing the change to be better prepared when things do not quite go to plan. Directors, partners and practice managers have the future of veterinary practice in their hands and the clue to the success of the business is in their job titles.
Key Points
- Implementation of change is difficult because modification in one area impacts on another.
- Deciding to implement change in a small area first can enable the organization to learn from issues before replicating them wider.
- Every programme of change needs a realistic time frame.
- Open and honest communication is essential for a positive change experience.
- Good and proper delegation by the project leader which utilizes strengths of others, encourages team ownership of the project.
- Establishing common ground is essential for conflict resolution.