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Q&A: What every physician executive should know about change management

By Prianca Pai

October 25, 2019

Virtually all physician executives share a common leadership challenge: successfully implementing strategically important change initiatives while simultaneously supporting the medical staff through the emotional toll of those changes.

This fall, we hosted physician executives from across the country at our 2019 Executive Leadership Development Forums to work through their top change management challenges. The Forums were facilitated by Matt Cornner, managing director of Talent Development, who oversees Advisory Board's executive development offerings. We sat down with Matt to debrief the Forums and get his take on what every physician executive should know about change management.

Q: In your experience, what do leaders most commonly overlook when managing a change initiative at their organization?

A: Most of us are asked to step into leadership because we have achieved some degree of expertise or technical mastery as individual contributors. When we take on a leadership role, a common first instinct is to apply that expertise or technical mastery to the new challenge of leading others. However, leadership requires a skillset beyond individually blocking, tackling, and executing against a well-defined problem.

Leadership involves making progress on often difficult and intractable issues. When we tackle complex leadership challenges, we not only need to engage with the uncertainty of those challenges—we need to engage the larger team in making progress against them as well. That means accounting for the complex human emotions associated with change and transformation, specifically loss and fear of loss. Too often, we fail to address these emotional aspects of change—or address them too late—causing change initiatives to stall or fail.

Q: Can you say more about the emotional aspects of change that physician executives should address?

A: Of course. In the work that we do with executives, we draw heavily upon the theory of adaptive leadership, which distinguishes between technical and adaptive challenges and solutions. Technical challenges deal with the known; they are well-defined problems for which there's already a known solution. For example, a change calendar is a well-known change management tool that solves for the technical challenge of rolling out too much change at once, and risking change overload.

In contrast to technical challenges, adaptive challenges require new learning. For example, they require new thoughts, beliefs, attitudes, assumptions, and ways of working on the part of organizations. As a result, they often involve loss (or at least the fear of loss) on the part of stakeholders. Part of adaptive leadership is knowing what losses, or perceived losses, to look out for—and acknowledging them outright.

In my work with physician teams and with executives through the Forums, the types of loss that come up most frequently include autonomy, time, identity, status, and compensation. Effectively leading change requires leaders to account for both the technical dimensions of a change and these adaptive dimensions that are likely affecting the team.

Q: What's the first step for leaders who want to practice adaptive leadership in their day-to-day?

A: I would say the first challenge is noticing the distinction between technical and adaptive leadership. Recognizing that if leadership was simply about tackling the technical problems with our known tools and expertise—the problem would be solved already.  

As a first step, I encourage all leaders to reflect on the change efforts they're leading for which progress is slow, stalled, or non-existent, and consider the question, "What's the real issue here?" Often, when we answer that question, we blow through peoples' emotional reactions to change. We tend to assume that people resist change, but what they actually resist is loss.

I'd challenge leaders to notice the specific ways different stakeholders react to change in the moment. Then, consider what loss or fear of loss might be associated with that change and how you can acknowledge and account for that loss as you move forward with an initiative.

More on physician leadership: Recordings and materials from our 15-Minute Physician Leadership Essentials webinar series

Q: Leading organizational change isn’t just professionally challenging, it can be emotionally taxing as well. How can physician executives sustain their own engagement when leading through change?

A: First, it's important to acknowledge the emotional and human components of personally leading change. Sometimes we, as leaders, have this sinking feeling that this is really hard work, but can't put a finger on why. I think it's helpful to recognize and name the emotional weight that we feel as leaders. We, too, may experience loss that we need to attend to. A change may require us to do something in a different way, take on a new role or move away from a role we enjoyed; maybe it involves working with a team we don't know as well, and moving away from a team we know deeply and enjoy working with. Even if you're leading a change, recognizing your personal losses is important in order to address and productively move past them. 

It's also important to have trusted peers and colleagues inside and outside of your organization who can help you do two important things. First, they can help reorient you towards the larger purpose behind a change—particularly when you're feeling overwrought, fatigued, and may be losing perspective. Second, we all need someone to help us vent a bit. It's critical to have trusted peers with whom you can share your own feelings about a change. Often, I recommend looking for peers outside of your organization because, frankly, in leadership positions it can be difficult to find internal peers to share openly with because you want to be mindful about how you share your feelings within the organization. It's important to have a friend or peer who can give you space to feel those feelings and bring you back to purpose—why the hard work matters and is worth doing.

Q: As an avid reader on leadership theory, what's the one book every physician leader should have on their nightstand?

A: None of these books should be on your nightstand…they're not exactly light bedtime reading! But, out of all the books a physician leader should pick up to navigate the issues we discussed, I recommend, "The Practice of Adaptive Leadership" by Ronald Heifetz, Marty Linsky, and Alexander Grashow. It goes into much greater depth on distinguishing technical and adaptive challenges, learning how to spot losses, knowing how to navigate them, and engaging stakeholders around difficult changes.

Learn more: How to turn uncertainty to your advantage

Uncertainty (in your role, on your team, in the industry) can feel uncomfortable. But, paradoxically, certainty can be worse than uncertainty. Leaders who think they’ve figured out the future become blind to emerging possibilities and ignore evidence that doesn’t fit their predefined narrative.

Learn how to embrace uncertainty on three levels: as a leader, with your team, and across your organization.

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