Managing and Supporting Others Through Change


With all of the uncertainty facing health care in the coming years, the concept of change is inevitable.

Michael Connors, PT, DPT, OCS and Janey Evans, RN, BSN, CPCC-ACC

In the current health care environment, we continually adapt to the changing demands in our physical therapy practices. As clinicians and practice owners, we face challenges and changes from payers, regulatory agencies, and patients. The shift toward utilizing electronic medical records in outpatient therapy practices has placed an undue amount of stress and uncertainty on many owners and practitioners who have not yet made the transition from paper. In many situations, a practice may switch from one EMR to another in search of enhanced efficiency or management capability. With every change, regardless of the nature of the transition, an individual must prepare.

Change instills uneasiness for most individuals. All the uncertainty in health care results in the potential for an organization or an individual to experience change on a daily or weekly basis. According to Janey Evans, RN, BSN, CPCC-ACC, regardless of the source of the change, we need to keep in mind that all change is personal.

What does Evans mean by this statement? Every individual analyzes and adapts to a changing situation differently. We all face predictable stages when facing a changing situation. These stages are similar to those a person might face when grieving. Whatever the change, the process of the change is imperative to ensure a successful outcome. Prior to initiating any change, an assessment should be performed to understand the stages that must be made for a successful outcome.

Once a plan for change has been derived, the leaders of the organization should examine the mechanisms to support individuals undergoing the change. A proper level of support is imperative to assist people in moving through the various stages of change. But keep in mind, every individual will move through the stages of change at their own pace.

Evans notes there are three groups of individuals that possess varying degrees of acceptance when encountering a changing situation: early adopters, resistors, and silent skeptics. Early adopters are the agents of change in an organization. They face the impending change head on and welcome the transition. Those opposed to change take a negative viewpoint. The silent skeptics are the quiet majority in an organization. They usually avoid vocalizing their viewpoints until they have insight into the effect the change will have on their roles and responsibilities. Where should leaders allocate their time to prepare and implement change? Rather than convince the silent skeptics to accept the change, leaders spend time attempting to change the negative outlook of the resistors. The effort a leader exerts on this group is usually wasted and does not alter the viewpoint of these individuals. Due to the non-committal nature of the silent skeptics, this group represents a tremendous opportunity to positively impact the overall organizational acceptance of the change by convincing them of the positive impact the change will have on the individual, as well as the organization as a whole.

The stages of change are commonly met with an emotional reaction—shock and denial, defensive retreat, and acknowledgement—which is a natural response. To successfully overcome these emotions, a leader can create strategies to help their employees embrace and adapt to change.

Shock and denial produces uncertainty, fear, poor judgment, poor decision-making, and impaired information processing. Individuals in this stage may describe feeling disoriented or numb to the impending change. The shock and denial associated with this stage correspond to a person’s day-to-day activities altering, which leads to uncertainty toward the upcoming transition. The best way to support someone in this stage is to over communicate, maintain close contact, listen to their concerns, provide reassurance, offer assistance with decision making, and repeatedly reinforce information pertaining to the change on a consistent basis.

During defensive retreat, people come out of shock—typically in a bad mood. This stage can produce fear, resistance, negativity, anger, blame, mistrust, cynicism, victimization, decreased morale, rumors, passive-aggressive behavior, preoccupation, and camp building. Individuals in this stage typically experience a decrease in productivity and a decrease in healthy levels of communication. Feelings of paranoia about the potential loss of employment may also be present. Fear and pain are the main drivers of this stage and protect an individual from negative emotions. The most effective way to support someone in this stage is to offer compassionate listening, acknowledge their feelings, share accurate information, focus on what a person can control, and support people in their strengths. People often times remain stuck in this stage for long periods of time. Instilling a sense of respect and appreciation for the individual and their contributions to the organization are keys to moving to the next stage: acknowledgement.

When people begin to acknowledge the impending change and examine ways they can have input into the process, they are more willing to make the change a success. A sense of empowerment is encountered as people begin to feel safer and recognize they have choices. It is important to engage team members into problem-solving or planning for change. This stage will typically involve individuals recognizing that not all problems in the organization are directly attributed to change. Support in this stage should include helping everyone focus on the positive aspects of the change, stress management strategies, forgiveness for mistakes made by management and individuals, understand the core mission, and learn and grow from the change.

Once the change is adopted and implemented, the situation becomes old news. Adapting to change is no longer a concern, and individuals who successfully accepted the change, will look forward to future change. Although we cannot avoid change, the potential for growth of an organization is optional.

Michael Connors, PT, DPT, OCS, is an Impact editorial board member and principal of K&B Practice Solutions, in Fort Worth, Texas. He can be reached at

Janey Evans, RN, BSN, CPCC-ACC, is a certified professional co-active coach and owner of Capstone Coaching in Bend, Oregon. She can be reached at

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