Feature Article:

A Proactive Stance for Managing Change

By Shelley Simon, RN, DC, MPH, EdD
Founder, Beyond Practice Management

Healthcare providers are facing change that is unprecedented in its pace and intensity, and they’re not alone. In today’s complex society, everyone is significantly and routinely impacted by shifts in economic conditions, politics, technology, social norms, and expanding globalization. Some of us embrace and welcome change. We’re the cultural creatives, the early adopters, we fancy ourselves as being on the cutting edge, and we thrive when our lives are in a whirl. Others among us retreat and hunker down in the face of change. Worn down by uncertainty, we long for the “good old days” and do whatever we can to maintain the status quo. We prize continuity and stability. Where do you see yourself on the “embrace” versus “resist change” spectrum?

Love it or hate it, constant change is the new cultural norm. The stability and familiarity of the past is becoming a distant memory. Management professor, consultant, and author Peter B. Vaill, PhD calls times like this “permanent whitewater.” Despite the challenges, confusion, and stress of our times, practitioners still strive to deliver high quality care and make a difference in their patients’ lives. They also remain motivated to have satisfying and profitable practices. In this article we will explore how practitioners can recognize when they are letting the stress of change get the best of them, discuss why self-awareness matters, and offer ideas for developing a proactive stance toward change.

There are many types of change — expected or unexpected, wanted or unwanted, initiated or imposed, internal or external, superficial or transformative, incremental or cataclysmic. No matter how you label it, all change brings with it a degree of stress. To complicate matters, not only is change stressful in and of itself, but for most people, being under stress makes it even more difficult to cope with change. Could this be the very definition of “vicious cycle” or “double-edged sword?” Change = stress. Stress = change. It’s enough to make you want to lie down for a nap. But there is a solution: escaping the spiral of stress and mastering change.

Change and the downward spiral of stress

Many healthcare professionals lament that practicing is increasingly like being on a roller coaster. They long for the steady, linear rises (or even the plateaus) of the past. Yet how much of the roller coaster experience is due to external change and how much is due to poorly managing one’s reaction to change? A pattern of reactivity, resistance, or generally coping poorly with change only adds to the already complex problem of managing — internally and externally — during times of confusion. Since chronic or acute stress makes coping with change highly challenging, our ineffective attempts at soothing the immediate discomfort of dealing with change can quickly result in a downward spiral of stress. Here is a short list to help you recognize when you are entering or persisting in stressful patterns of behavior. When faced with change, do you . . .

• Rely on caffeine, alcohol, food, shopping, or sex for comfort?
• Engage in dangerous behaviors or “act out?”
• Sleep too much or not enough?
• Blame, dominate, judge, have angry outbursts, or become defensive?
• Deny or avoid facts?
• Become bored or resigned?
• Procrastinate or dig your heels in and refuse to act?
• Live in the past or wish things could be the way they “used to be?”

Some of these behaviors or attitudes may make you feel better for a while, but the relief is temporary at best. These “coping” mechanisms are ultimately not effective and do nothing to support you in developing skills to manage change nor help you take the action steps that would make a difference. In addition, the behaviors can become problems in their own right, causing even more stress and a further decreased ability to cope. A better approach is to acknowledge that change is inevitable and let that awareness guide you toward a proactive stance that is healthy and effective. The first step in developing that stance is increasing self-awareness.

Self-awareness and becoming “change hardy”

Author and management consultant Meg Wheatley has said that the foundation for success in the twenty-first century is having a high level of self-awareness and an ability to manage change. The capacity to thrive in the face of constantly changing conditions requires controlling one’s response to change . . . a process that necessitates self-awareness. The catch-22 is that we can control our response (stress level, emotions, thoughts, and behaviors) only to the degree that we can see ourselves clearly enough to understand our motivations and actions.

Before we move into suggestions for mastering change, consider these seven questions to get a sense of how you currently cope during times of confusion or change:

1. When you are offered the possibility of a new experience, what is your usual immediate reaction?
2. What is your typical reaction to an abrupt change in conditions (e.g., surprise, anger, excitement, dismay, despair, engagement, dread)?
3. What are the consequences (negative and/or positive) of this reaction?
4. Do you tend to manage your practice with an eye toward protecting what you have or with an eye toward achieving something more in the future (even if there is risk involved)?
5. When faced with an unwanted change, where do you tend to focus your energy first?
6. What impact does your focus have on others?
7. How do you “make meaning” of change? What do you tell yourself about change?

Taking the time to reflect on these questions will help you build self-awareness about your patterns and tendencies and provide the foundation for becoming a true change master.

Mastering change

Here are eight suggestions to help you build resilience, make sense of change, learn to see it as an opportunity rather than as a threat, and co-create in a healthy and enjoyable way with whatever is emerging in the moment. By incorporating these ideas into your stance toward change, you’ll become more proactive in your approach and be less likely to slip into the downward spiral of stress.

1) Expect the unexpected. Watch for signs and clues that change is in the air. Indications that change is imminent may be obvious and concrete, or quite subtle. If you find yourself having unexplained physical symptoms, mental unrest, or a creeping sense of discontent, know that these may be signs of impending change. When you expect the unexpected you won’t be thrown off balance by every curve ball tossed in your direction. Pay attention.

2) Acknowledge that change is stressful. Even change that is planned, wanted, and positive can be stressful. If you’ve ever been on a first date, bought a new home, or welcomed a baby into your life you know this to be true. When change is unplanned, unwanted, and negative, the associated stress may be overwhelming. All change requires adaptation and adjustment because you are venturing into new territory. In times of change, self-care should be a priority. Look for stabilizing factors in your life and tend to the basics like eating well, exercising, getting enough sleep, and not over scheduling yourself.

3) Maintain perspective. In the midst of a major change (or even in the face of a series of small changes) it may feel like everything is spinning out of control and there is nothing to anchor yourself to. The tendency is to focus intently on the problem at hand and become blind to all of the things that remain constant and positive. This is the time to slow down, breathe deeply, examine your assumptions, dismantle the stories you are telling yourself, and monitor your reactions and behaviors. What seems overwhelming today may turn out to be the beginning of a new, positive chapter in your life. To gain perspective, ask yourself how important the current change or problem will be a week, month or year from now.

4) Don’t fight it; learn from it. When we resist change, all of our energy goes toward staying bound to the familiar, to what we already know, or to how we want things to stay. In this rigid, restrictive state we miss out on opportunities to observe ourselves, increase self-awareness, challenge long-held assumptions, and learn from the experience. When we struggle against the flow and try to control the uncontrollable, we create more stress for ourselves and miss clues and signals that are uniquely designed to show us a new way of looking at a situation. Try not to fight the unexpected. Instead, embrace and learn from it.

5) Stay present. Life expands or contracts based on our ability to adapt and be present with whatever is happening now. Pay attention to both what is happening internally (emotions, sensations, and thoughts) as well as externally (the facts, your behavior, and the actions of others). In the midst of change, stress and fear, it’s tempting to flee to either the future or the past. And yet, the present moment offers our best opportunity to learn, participate fully in the immediate experience, and influence the direction of our lives. Staying present when it’s tempting to rewind or fast-forward builds self-awareness and resilience.

6) Practice flexibility. When conditions feel unstable, the easiest reaction is to hold on tightly to past experiences. In this comfort zone, we grit our teeth and suffer unnecessarily. How do you respond when you’re stuck in traffic? When patients no-show? When claims are rejected? When an employee quits without notice? To remain flexible, calm, and centered when conditions are uncertain is a skill that can be practiced and mastered. When we do this, we become more capable of coping with the tests and challenges associated with change. Try to identify what you can and cannot change or control. Make an effort to see things from different points of view. Remain curious and cultivate tolerance for ambiguity. Yes, this process may cause discomfort. But once you realize that you can be uncomfortable and survive, staying flexible and “going with the flow” can become a habitual stance.

7) Focus proactively. In the intensity of a rapidly or dramatically changing situation, it is difficult to stay focused on what it most important long-term. The tendency is to slip into panic mode, dwell on worst possible scenarios, and spend too much energy putting out fires. A more effective approach during stressful times is to stay focused. Remind yourself of your long-term, big-picture goals and remember, “This too shall pass.” Shift your attention away from the problem and look for opportunities that the current change or challenge may ultimately bring about. Stay present with what is happening, but simultaneously maintain broad awareness about the future so that you can see options, openings, and the next steps to take on your path to success. Focus on your most closely held values, act rather than react, and keep moving in the direction you want to go with a sense of curiosity and creativity.

8) Seek support. Even if you’re a true “change master,” it never hurts to have support when life feels confusing or your practice is in a temporary state of upheaval. Gather information, talk to friends and colleagues, or confide in your significant other. If you want more structured support and accountability, hire a coach who can guide you through the whitewater with objectivity and compassion while offering resources you might not have access to.

What matters most now

Taking your practice beyond the current conditions and personal patterns that limit your success requires a commitment to mastering change. On the upside, change can be seen as progress, an opportunity for growth, renewal, and innovation, and experienced with excitement, confidence, and curiosity. But it can also be perceived as a time of instability, threatening, disorienting and experienced with anxiety, fear, and stress.

“I want to be different, I just don’t want to change.” That may sound like an irrational statement, but it is an all-too-common attitude. Having read this article, you understand that a key factor in mastering change is the ability to self-assess and make adjustments as needed. Success in today’s world is no longer about the survival of the fittest. Self-awareness and the ability to adapt to change is what matters most now.

Read Online:

Dr. Simon’s Column in Dynamic Chiropractic

Dr. Shelley Simon’s regular column, Beyond the Basics, debuted last month in Dynamic Chiropractic. Read her second article, Teaching vs. Preaching: A Critical Look at Patient Education online here.

An Offer:

Request a Consultation, Beat the Fee Increase

Last year was busy at Beyond Practice Management. I feel fortunate to have coached a wide variety of highly motivated clients and to have witnessed the amazing changes they made in their business and personal lives. These clients have been loyal and forthcoming with a great many referrals. Because of this, my practice was at or near capacity for most of 2007. I am grateful to everyone I worked with last year and enjoyed learning from each and every client.

Effective April 1, 2008 my coaching fees for new clients will be increasing across the board by about 25%. Due to the level of customization I provide to coaching clients, I can work with only a limited number of people at any given time. So, if you’ve been thinking that this is the year to make sustainable change in your practice and you’ve been on the fence about signing up for coaching, now is the time to take action. Clients who begin prior to April 1 can lock in current coaching rates for the remainder of this calendar year.

The first step in deciding whether coaching would be effective for you in 2008 is to request a complimentary, introductory consultation. When you schedule this session online you’ll be asked to answer several thought provoking questions as a way for you to: (a) become clear on what your most pressing issues are; (b) think about what you would like to get out of our conversation; and, (c) convey to me how I can best help you. To request your consultation, please click here.