Mr John Borrelli, Chief Administrator of the Department of Anaesthesiology at Duke University Medical Centre, recounts his experiences managing organisational change and advises how to overcome obstacles in the face of adversity.   
  • The greatest facility to inertia is uncertainty in the face of change
  • Change can be complex, and culture can be unyielding
  • Chief administrators are agents of change, must be visible and approachable

“In order to be successful administrators, you have to understand change,” said John Borrelli, Chief Administrator of the Department of Anaesthesiology at Duke University Medical Centre, as he addressed a group of administrators from the SingHealth Duke-NUS Academic Clinical Programmes.

In a medical institute, the resistance associated with change does not just come from reworking technical processes. Having to persuade individuals to move out of their comfort zones is more often the harder struggle.

Speaking at the Academic Medicine Administrator Forum, Borrelli shared his past experiences from managing the post-merger of Eastman Dental Centre (EDC) and the University of Rochester Medical Center (URMC). He took up the position as its Director of Finance and Administration in 1999.

Merger of URMC and EDC

After the merger in 1997, URMC-EDC faced a slew of problems: their clinical services were struggling financially, there was a decline in development  dollars and it faced difficulty retaining and recruiting faculty.

Their reality was the result of an improperly communicated merger. Staff were unsettled because they were not told of the management’s plan after the merger.

It took three years to introduce new management teams and for the staff to be restructured. There was strong resistance to change, and many were opposed to practices differing from their traditions.

‘But we’ve always done it this way’ was often asserted.

Why do people fear change? 

Perhaps the greatest facility to people’s inertia is uncertainty. Most fear not being able to adapt to new practices and consider it a threat to their daily routine and job security.

Another compelling reason is the complexities that come with change. More innovation inevitably come with more problems.

“Change requires a lot of effort from not only the person initiating it but the receiver as well,” Borrelli explained.

He quotes Rosabeth Moss Kanter's law of management, where teams driving new initiatives will find themselves facing adversities, with struggles intensifying in the middle of the change.

“Everything looks like a failure in the middle. Everyone loves inspiring beginnings and happy endings; it is just the middles that involve hard work.” – Rosabeth Moss Kanter

Other than these reasons, a major factor in predicting receptiveness to change in an organisation is its culture. An organisation with a predominantly pessimistic culture will be less susceptible to corrective actions and changes.

 “Culture can stop progress and it is important for administrators to understand their organisational culture before they implement changes,” he added.

Why change?

Being resistant to change puts an organisation at risk of losing their innovativeness, as well as missing opportunities that could improve their productivity or threaten their relevance and survival. 

To Borrelli, chief administrators are the agents of change, and he believes in the imperativeness of being visible and approachable. “It is important to develop good relationships with your staff. That way, you can push your team to achieve the goals together,” he said.

All in all, leaders should try to foster a working culture that embraces change and have continuous conversations on why certain changes are essential.

“You know you have provided enough communication about the change when people can reiterate what you have been communicating.”

Mr John Borrelli was the keynote speaker at this year’s Academic Medicine Administrator Forum, where he presented on the importance of employing dashboards for managing change, as well as the faculty reporting system for reviewing academic and clinical productivity.