Feature Article:

Making Sense of Change

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

Running a profitable and satisfying practice today is complex, unpredictable, and increasingly stressful. Solutions to problems last only as long as the next coding change, shift in regulations, decline in statistics, or turnover in staff. Despite these challenges, healthcare practitioners still strive to deliver high-quality care and make a difference in their patient’s lives. In the February, 2008 issue of Practice Your Way I wrote about how to proactively manage change. In this issue, we take a step back and look at how to understand and make sense of change.

While your practice moves in a relatively linear fashion through the expected stages — start-up/survival, growth, accumulation, leisure/prosperity, and eventually into retirement — you concurrently cycle through a series of predictable transitions within each stage. Highly successful practitioners develop skills and strategies for adapting to these transitions and constant change, no matter which stage of practice they are in.

To thrive in practice today, consider broadening your perspective to include a cyclical model of change and growth. One such model, the Cycle of Renewal (see diagram) created by Frederic Hudson, PhD, of The Hudson Institute of Santa Barbara and described in his book The Adult Years, illustrates that change is not a linear process.

In his four-quadrant/phase model, Hudson makes the distinction between a “life chapter” (the top two quadrants on the model) and a “life transition” (the lower two quadrants). A life chapter is a period of relative stability marked by structure, familiar routines, goals, and external accomplishments. This familiar and successful chapter inevitably comes to a close, followed by a transitional period of instability, disenchantment, and uncertainty. These transition times necessarily pull us away from the past so that we can take stock of our present situation. From this vantage point, we take the time to re-purpose, re-envision, and re-invent.

© Hudson Institute of Santa Barbara

To stay renewed and flourish in practice and in life, one needs to be able to manage both experiences of change — the stable and the unstable. To fully appreciate Hudson’s model it is helpful to understand each of the four quadrants/phases. As you read through these descriptions, refer to the diagram.

In the go for it phase, your energy level is high, you are excited and confident. You manage your practice in a way that is in alignment with your goals, purpose, and values. You’re focused, engaged, communicative, creative, and you are able to recruit others into your vision. A healthcare practitioner in the go for it phase will likely be coming up new ideas for marketing and improving his or her practice, collaborating with staff to get them involved, making plans for the future, and feel highly motivated toward achieving goals. It is common for high-achievers or drivers to identify themselves only in the go for it phase. However, it is normal to cycle through all of the four phases; no one sustains the go for it phase indefinitely.

It’s not uncommon for practitioners to think that if they could only figure out how to stay in the go for it phase permanently then everything would be perfect. Interestingly, many people struggle once they’ve been in the go for it phase for a while. On the surface, this phase appears to have no downside. But too much of a good thing can turn negative and when it does, the results are not pleasant. What starts out as energy and enthusiasm turns into workaholism and burnout. Confidence morphs into arrogance. Too much taking care of others results in the doctor not taking care of him or herself. With so much attention on practice growth you neglect developing the infrastructure required to sustain that growth. Staff works longer and harder to keep up with the demands of the thriving practice, and their professional development is put on the back burner. Healthy competitiveness becomes toxic and colleagues who were once friends begin to look like rivals. At this point, the healer is wounded and needs to be healed.

In the doldrums, your current reality is not what you want. You feel disconnected, restless, bored, and trapped. Your motivation has taken a vacation and left you behind to stew in your own frustration and angst. You’re unable to adapt to change and you avoid responding to challenges. You may experience full-blown burnout. If you allow yourself to stay in this phase, you may find that both patients and staff begin to disappear.

The worst possible place to be is in the doldrums with no exit strategy. This is the one phase in this model where the answer is always to get out as quickly as possible. You can stay in the other three phases for indefinite periods, but there is nothing to be gained by staying in the doldrums. If you are in the doldrums, an exit strategy of either a mini-transition or a career transition is in order — pronto. More on this in a moment.

The cocooning phase is where you turn attention to reflection and self-nurturing. This is a time to recharge your batteries and renew your spirit, to reflect on values, purpose and your desired future. In cocooning, instead of ignoring challenges you take a good look at them. You come to terms with what’s not satisfying about your work and you begin to create a new vision. Many healthcare practitioners wonder if cocooning involves a sabbatical from practice. It does not, but it does require that you carve out time for reflection and to take care of yourself as you design your next chapter. It is in this introspective quadrant or during the doldrums phase that practitioners often contact me to begin a coaching relationship. Having a guide during this time of self-evaluation and personal/professional reflection is extremely valuable.

When the inner work of the cocooning phase is complete, you move naturally and gradually into the getting ready phase. With clarity, energy, and a desire to move forward, you tap into your creativity, explore new possibilities, and ask yourself questions that will help you chart a new course. You may learn new skills, approach the business side of your practice in a new way, or modify your definition of go for it to avoid landing back in the doldrums. The getting ready phase is about integrating what you know about yourself with providing patient care in a way that is congruent with your most deeply held values and your particular stage in practice.

Understanding and using this four-phase model of change allows you do to several things: (1) identify which phase you are in; (2) understand the internal and external factors that naturally prompt movement from one phase to another; (3) know when it’s time to be proactive about moving from one phase to another; and, (4) view change differently — with a deep understanding that it is predictable and in accord with natural life principles.

When you find yourself in the second phase — the doldrums (an indicator that your current chapter isn’t working well) — one option is to initiate a mini-transition where you take a short-cut across the Cycle of Renewal and re-enter the go for it phase. This option involves restructuring or improving the current chapter, which may include things like changing your schedule, adding a new service or technique, attending a practice building seminar, or redecorating your office.

Mini-transitions work, but if you find yourself bouncing back and forth between go for it to the doldrums with increasing frequency that’s a signal for you exit the current chapter and begin a career transition where you’ll commit to self-care, clarify your values, and begin to understand why you keep getting the same outcomes over and over again.

In a career transition, you let go of your current chapter and design a new one. This process, while perhaps difficult, requires slowing down and take a deeper look at your situation and yourself. A career transition that includes cocooning and getting ready is what ultimately builds resilience, satisfaction, and a stronger practice.

Is it possible to maintain excitement for practicing regardless of your practice stage — in the early days when hours are long and money is tight and later when you’ve mastered your profession and need to keep working for another ten or twenty years? Is it possible to sustain your energy and passion for your work, regardless of where you are in the Cycle of Renewal? It is, if you learn to recognize the phase you are in and either leverage the positive aspects of that phase, develop an exit strategy, move on to another phase, or design a new chapter.

Can you learn to thrive on change, rather than hang on by a thread in survival mode while relying on outdated models and strategies? Yes, if you let go of the expectation that you should always be in the go for it phase. When you can find meaning and purpose in all the phases and conditions in your life, you build the resilience to thrive in your career for decades.

To effectively guide your practice in changing times, it is important to understand and apply both cyclical and linear growth models. If you use only a linear model to view your practice, you’ll have no way to effectively manage the inevitable ups and downs and transitions. If you rely on only a cyclical model, you’ll be at a disadvantage for long-term planning. Using both allows you to honor the predictable changes within the cycle of renewal while mapping your practice plans using the linear model. The ability to master change — to work with it instead of struggling against it — will support you in re-inventing a practice that works for you over the long term, through all stages of growth and development.

Note: A version of this article was published in Today’s Chiropractic Lifestyle, October/November 2006. Cycle of Renewal© diagram and model concept used with permission of the Hudson Institute of Santa Barbara

Book Recommendations:

On Managing Personal and Career Transitions

• The Adult Years: Mastering the Art of Self-Renewal, by Frederic M. Hudson
• LifeLaunch: A Passionate Guide to the Rest of Your Life, by Frederick M. Hudson and Pamela D. McLean
• Transitions: Making Sense of Life’s Changes, by William Bridges

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Read Dr. Simon’s Latest Columns in Dynamic Chiropractic

If you’d like to have a practice filled with patients who are genuinely loyal to you be sure to read Dr. Simon’s article Beyond Charisma: 10 Tips for Building Patient Loyalty from the July 29, 2008 issue of Dynamic Chiropractic.

An Opportunity:

Ready for Coaching?

Are you in the doldrums? Wondering if a mini-transition would catapult you back into the go for it phase or if you need to put a toe into the rich waters of cocooning to effectively plan your next chapter? Coaching is valuable in either case. The first step in deciding whether coaching would be effective for you is to request a complimentary, introductory consultation. When you schedule this session online you’ll be asked to answer several through 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.