In clinical practice we manage change constantly

In clinical practice we manage change constantly. We manage disease symptoms, response to treatment and complications of treatment. But, paradoxically, we see ourselves as victims of change in health care delivery, reimbursement and regulation. We feel oppressed by government, health insurers and even patients. We physicians are good at dealing with change in physiology and pathology, but not so good at coping with it in our business lives and our leadership strategies.

Our way of thinking is taking us down the wrong paths of health care, health care leadership and medical management. Our resistance saps our energy, creating burnout and dissatisfaction, risking our health. These unspoken costs of health care pile up: discontent, denial and departure from the profession.


This is the sludge of health care change—the build-up of habits, behaviors and preferences that diminish our energy and limit our creativity. Sludge causes the “hardening of the arteries” of health care.

• Indirect communications;

• Drama and conflict;

• Blame and criticism;

• Low accountability;

• Control and command styles of leadership.

To free ourselves and our organizations from a sludge-filled environment, we must create opportunities for change.


Instead of reflexively fighting tough situations with anger or denial, stop and ask yourself: I wonder why I find myself in this circumstance again and again, and I wonder what I can learn from it? How am I contributing to the problem, and how can I contribute to the solution? Since you have no control over anyone but yourself, commit to your own accountability and face the facts honestly.

To create change in yourself—and by example in those around you:

• Face the unequivocal evidence that change is needed;

• Accept your role in the problem;

• Commit to openness rather than defensiveness;

• Take action in a clear way;

• Sustain yourself and your changes, and face the facts honestly.

These are the FACTS of a prescription for fighting sludge. You can use the following three strategies to shift away from resistance to change and into openness to change:

• Give appreciation;

• Adopt an attitude of curiosity;

• Claim your role in the issues.

Notice enhanced energy and return of joy and satisfaction in your work as evidence of your commitment to change. These learnable skills can profoundly influence your health, the health of our profession and our organizations. Work with appreciation as a strategy for creative change. Creativity is positive; it’s the antithesis of sludge. Get the sludge out of yourself, your staff, and your organization. Instigate change, and see how positive energy can transform you as a leader, your physicians and other caregivers, and the service your organization delivers.

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