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Tears and drama not included: How to restructure clinic staff


When there is an important position needing to be filled, but every staff member is gunning for the job, how do you pick the best without hurting people’s feelings? Here are the 5 thoughts to remember before making that decision.

Take-home message:

When there is an important position needing to be filled, but every staff member is gunning for the job, how do you pick the best without hurting people’s feelings? Here are the 5 thoughts to remember before making that decision.


Putting It In View By Dianna E. Graves, COMT, BS Ed


Perception: A way of regarding, understanding, or interpreting something; a mental impression.”

My definition of perception is as follows: Reality as it pertains to you and where you are in your life right now. Not bounded by reality, truth or acceptance of facts present.

More from Dianna Graves

Our clinic is in the middle of a forced restructure of the staff ladder to the perceived top. My right-hand man is moving out of state soon to be closer to her family.

When these announcements occur to you, you will naturally go through a grieving process with the obligatory steps of Loss: anger, questioning (why me?), despair, melancholy, depression, and finally acceptance, which eventually will allow you to move forward again. Then, add the in between steps of panic, terror and initial shock, and the circle will be complete. These steps often occur at a rapid-fire rate and can take less than a week to cycle through you and your clinic.

This is the manager’s reaction to a change of this magnitude. Then multiply it by the number of staff you have!

NEXT: Letting the dust settle


After letting the dust of the announcement you received settle, you need to initiate a game plan for the future. This involves a broad, eyes wide open look at your clinic, at the staff you have, and your doctors to eventually determine who is going to be the next heir apparent for this open position. How tumultuous will it be bringing a new person into that role? And, the big issue: You want a specific person in that role, but they are running for the hills and want nothing to do with moving forward!

After you find your next potential clinic site lead, the next step is ‘buy in.’ Buy in from the doctors, the rest of the staff, management, and the other lead technicians.

Even more from Dianna Graves

There very often will be a trickle down affect. “If I move Jane to this position, who can/will take her place in the clinic she is currently at?”

At this point, I am in the process of changing leads and lead site locations in six of our eight clinic sites!

Questions arise regarding every option: Do I move Sarah, who is running clinic A fantastically to clinic D, and now move Amy into clinic A, praying Amy will do an equally a great job? Do you court disaster by making this broad of a change?

Sadly . . . the answer is often yes.

Sarah, who is currently running a one-doctor office and does a great job, but is very underutilized there, will now move to a busy two doctor office. It’s a step up, and will test her strength. She can do it, and will, once she comes out from hiding!

With initial game plan in hand, next I need to present it to the doctors for their reaction and buy in. It’s a sales pitch effort, full of pronouncements of faith and support. After having achieved their buy in, the hardest part of the process comes-telling the staff.

You may be thinking: “Why is this so hard?” Tell them the way it will be, answer minimal questions, then shut the book -case closed. It has been so decreed, now move on.

Oh for it to be so simple, because that’s not how a major change occurs in their world. Each staff person (including the doctor) will view the change as it occurs to his or her world.

NEXT: Settling the dust further


Let’s return to Sarah, past Lead of Clinic A and now the new Lead of clinic D. Staff loved going to Clinic A because Sarah was a fun lead. Calm, relaxed, mellow-of course she was! She only had one doctor to keep moving. She had minimal stress on most days. Staff had plenty of free reigns, with minimal heartburn. Now she has fast paced Clinic D and she has turned into Attila the Hun!

Everyone is towing the line, having to follow the book to the letter and it is a tense clinic because she’s in a new role and is trying to prove that she can do it.

And the new lead of Clinic A? She wanted to stay in her old clinic, but said she would change and is now sullen and grumpy all day.

In this chaotic switch, we are also adding a new lead, and one of the current leads is going into the float pool as she is cutting her hours. While most of the staff professes their support for the new lead, the dinner bells for the piranha in waiting have begun ringing!

Wait a minute -simply because she is a new lead, now the rest of the staff will treat her differently and they are not thrilled with her anymore even though they loved her before the upgrade? Absolutely!

NEXT: Perception is key


Because of perception.

The hardest part of this whole process is that you probably will have angry staff, hurt staff, someone may even get depressed or belligerent because you didn’t choose them as the next Lead.

Explaining your rationale will not be easy because in their mind, you made the wrong choice and didn’t even give them a chance to a position they have the right to hold. Beware-you may even lose a staff person during this process.

Thoughts to back up your decisions:

1. No one has the right to any position simply because of years of service, age, degree or salary.

While I applaud tenure and education, being a lead is not book learned or the ability to survive in a group for years.

I can’t make a lead that has the traits of empathy, sympathy, loyalty and teamwork. You either have these traits or you do not. In order to be a lead you need these qualities to ensure fairness and evenness when you make decisions. Your decisions need to be group based, not elevating your personal position in the group.

2. Drama Queens, Doctor’s Pet, Divas and Schmoozers need not apply.

I remind the staff over and over-it is not about you! It is about your group at your site.

Someone once asked me when I became the manager over fifty people how it felt to be ‘Number One,’ ‘The Lead Dog of the pack.’ My response was: “What number 1? I am number 51-everyone is above me.” If I can get them to all move together in one flow towards the eventual end of each day, including the doctors and patients, with minimal uproar, I have done my job.” I repeat again-it is not about you.

NEXT: Further thoughts


3. Tattling, begrudged staff who feel they were bypassed will bring the faults of current leads to you at this time in an effort to prove they would do a better job than the current slacker.

Listen to the criticism, and if the criticism is valid, correct it immediately. Otherwise, these are usually hit and run comments that they do not want you to pass along. They are hurt and lashing out.

4. Beware of elevating the doctor’s favorite technician.

The doctor may really want this to happen, but it very often will cause a great deal of resentment by the staff toward you (not the doctor) because they will feel you caved in and didn’t protect them from this change. The doctor may be irritated if you do not place their person as a lead, but explain to them you need to do what is right for the site and all the doctors.

5. Make the decision based on reality, the facts at hand, and what is best for the clinic, then stand by your decision. Be aware: reality means the staff will need to face the facts from all sides, not the perception of which they like the best and what will benefit them most.

Lastly, after the dust has settled, the leads and staff are finally adapting and there is some semblance of normalcy again returning to you at work, always remember the following: this is what you wanted, to be # 1….the lead dog.

Then, remember these famous words of wisdom from Suzanne Sugarbaker (from the TV show “Designing Women”):

“Life is like a dogsled team-if you are not the Lead Dog, the view never changes!”

There is a reward for doing the job you do every day!


Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Dianna Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.


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