- Or how I learned to stop worrying and love the challenge.

Anyone who has ever had an extension built on to their house will understand three of the basic laws of change management. The first is that a change, like building work, always takes longer to complete satisfactorily than anticipated. The second is that it always costs more than you or your builder estimated. The third is that the process of change is stressful, (certainly to you, probably to your builder and definitely to your stocks of tea and coffee).

Many would argue with the concept of change being finite (like a house extension), and it is indeed true that change is probably the only constant factor in all of our lives in the late 20th century. However, if we are keen to manage change, rather than let it manage us, it is important that we embrace the idea of dealing with portions of phases of larger changes that are going on around us. It is unlikely , for example, that individually we can influence some of the changes that are taking place in Health Services. We cannot necessarily stop or alter dramatically the changes imposed by current or future governments. We can however, consider our response to those external factors and choose to adopt an approach to the cahnge which best suits our aspirations, ethics and purposes.

This is, of course the fourth law of change management: we cannot manage change itself, but we can manage our response to it. Often in the midts of dealing with change we confuse coping (reacting) with managing (responding). If we wish to do the latter, we need to consider the following approach.

1. Know why you are making the change that you are.

If you are not convinced that the change you are making is the right one for your practice then you have very little chance of success. As the change manager in your practice, you need to be sure that the cahnge is necessary and right and be able to convince others too. This holds true for all types of change, from a move from old health service practice to practice following Government reforms to computerisation of a practice.

2. Involve people.

One of the biggest traps in change management is underestimating the resistance factor in people whom the change affects. Involving people in the planning process reduces the risk of resistance, and offers them a sense of control over the change.

3. Communicate and provide help in understanding new values and ways of working.

Staff and patients need information and guidance on why the changes have taken place and the effect taht they will have on them. The staff team , in partcular, also need a forum for expressing their concerns . Regular meetings can he;lp in planning the way forward and help people overcome the sense oif loss that they naturally feel when 'the old way of doing things', the familiar and the comfortable, are taken away from them. Acknowledge the loss and present the new way as attractive.

4. Mark the change.

How do people know a change has taken place? Provide some tangible evidence, generat a new image, design a new logo, celebrate the change with a special event (preferably planned and executed by the team with your guidance). Let your patients know that the change will benefit them.

5. Acknowledge and thank people

It is easy to take success and effort for granted, even more so when change is happening successfully. Who helped you to effect the change? Take the time to show your appreciation - to staff and patients.

Finally, this sequence underlines the importance of the fifth law of change managemnet: any organisation wishing to manage change must help its people move through it. For a practice , this means not just staff, but patients as well, and this can only be achieved through effective communication. Talk to anyone who has had an extension built , and they will probably tell you how much less painful the process would have been if everyone concerned had udnerstood everyone else's priorities, concerns, availability and working methods at the outset.

Fiona Stuart -Wilson is the principal consultant with UMD, a management consultancy which specialises in the health sector. She is also Associate Editor of the British Dental Journal, and acts as co-ordinator of the Management Research Initiative set up by the BDJ and Denplan to promote research into the management of general dental practice.