by Leslie Ann Fox, MA, RHIA, FAHIMA, and Patty Thierry Sheridan, MBA, RHIA
Change is part of life. You lie comfortably in your mother’s womb and suddenly the cozy environment changes. A flood of hormonesthen pushing, pulling, and pop! Your senses are instantly assaulted by touch, sound, and light, and you reflexively cry out. That cry is your first emotional response, and it enables you to survive. Your lungs fill with air, and you take your first breath.
You have just had your first life-altering change. You are now in the midst of a transition, the first of many you will experience throughout your life. Each is accompanied by a period of adjustment and an emotional memory of change as a shock to the system, one that creates at least a moment, if not longer, of disequilibrium. How we manage our anxiety through transitions affects not only ourselves but our family and the other social systems in which we function, such as our workplace.
Healthcare in Transition
Transition is an emotional process, rooted in our evolutionary past. Our ancestors evolved in social groups that were alert, creative, and highly cooperative, the traits needed to be resilient enough to meet the environmental challenges of their day. If they had lacked them, we wouldn’t be here now.
Today’s healthcare organizations need the same kind of resilience. The slow but steady adoption of electronic health records and the emerging public interest in personal health records put HIM professionals at the center of important and far-reaching changes in the healthcare system.
The reflective practitioner is likely concerned about what it means to lead oneself, one’s staff, and one’s organization through such a disruptive transition. To translate this into action, leaders must maintain a greater presence and patiently guide and challenge people as they go through the ups and downs of a transition.
Transition Is More Than Change
Transition is not the same as change, although the words are often used interchangeably.
William Bridges, a leading expert in transition management, says “transition is psychological; it is a three phase process that people go through as they internalize and come to terms with the details of the new situation that change brings about.”1 Change is situational, Bridges says; for example, a change in reporting structure, implementation of technology, or a shift in strategy.
Transition is the true coming to terms with the change and letting go. To take Bridges’ insight a step further, transition is an emotional process, instinctual behavior that is regulated through the interactions of a social group, in this case the healthcare organization.
Thus, individuals experience transition based on their own history and the emotional functioning of the organization.
For example, an organization that is already highly anxious will likely have more difficulty with the uncertainties of transition. Even in very calm organizations, clinicians anticipating the launch of an EHR may be filled with concerns. The organization’s performance during a transition reflects the emotional state of the organization, how well it has managed past transitions, and how well the concerns of clinicians and other staff have been addressed in planning for the change. Managing transition effectively requires an awareness of emotional process in the relationship system affected by the change and a transition plan that addresses the emotional side of transition.
Bridges describes three phases of transition: the ending, a neutral zone, and the new beginning. Each phase provokes anxiety.
Endings represent loss and a need for a period of mourning as individuals prepare to leave their comfort zones for the neutral zone. The neutral zone is a time of confusion, when individuals still have one foot in the old world. At this juncture, people need consistency and reassurance from their leaders. The new beginning is a time of excitement and fear, a time when leaders should provide positive energy and ample encouragement.
Finally the day arrives when the record is no longer paper-based. The old friend is gone for good. Change has happened. The reflexive cry may be silent, but it is still felt until a new equilibrium is achieved.
Everyone Experiences a Transition Differently
Bridges focuses on the transition at the individual level, but he notes that there is variation across the group. Not everyone completes a transition in the same amount of time. That is the crux of the challenge for those leading change and transition.
The anxious response experienced by individuals at varying levels of intensity is contagious. If just one member is uncertain, fearful, or angry, his or her anxiety can spread like wildfire through the organization. However, a leader who is calm can modify anxiety throughout the system, because being calm is contagious, too.
Organizations that are creating and experiencing significant change need leaders who understand the difference between change and transition. They require leaders whose presence and words throughout the transition convey conviction about the importance of the change and the imperative for a successful transition. Leaders must challenge others to realize the full potential of the change.
Getting Started with a Transition
Leaders can begin managing transitions by first communicating what is changing in as much detail as possible. Some staff might overreact to the news. This is normal because of the losses that accompany change. People react to the losses.
It’s important for leaders to learn what people are losing, acknowledge those losses, and deal with them directly and respectfully. People cannot move forward until they accept the endings.
Leaders should then involve as many people as possible in planningnot just in creating a project implementation plan, but a plan for managing the emotional side of change during the period of transition before, during, and after implementation.
Finally, leaders must stay focused on their own responses during the transition. Managing their own reactivity during a stressful time affects everyone involved, calming the system and raising functioning throughout. That is how equilibrium is re-established and the transition completed.
1. Bridges, William. Managing Transitions: Making the Most of Change. Cambridge, MA: De Capo Press, 2003.
Leslie Ann Fox (firstname.lastname@example.org) is CEO and Patty Thierry Sheridan is president of Care Communications in Chicago, IL.
Fox, Leslie Ann; Sheridan, Patty Thierry.
"Change Packs an Emotional Wallop: Calming the System through Leadership"
Journal of AHIMA