Getting Staff Buy-in For EHR Implementation

One of the national speakers at this year’s MGMA convention was renowned leadership expert and best-selling author Marcus Buckingham. Catching up with him minutes after delivering his general session presentation we had the opportunity to talk with him about his approach and techniques for motivating and managing staff. An EHR implementation is a huge undertaking, impacting every staff member of a practice. Our key question to him was how physicians and practice administrators can get buy-in from their staff throughout the implementation process.

If Buckingham’s face looks familiar it may be because you recognize him from his appearances on The Today Show, Larry King Live, Oprah and other leading talk and news shows. I’m familiar with his work going back to his first book, First, Break All The Rules: What the World’s Greatest Managers Do Differently.The book is based on the results of Buckingham’s work for Gallup conducting thousands of interviews on employee engagement. Named as one of the top 100 best business books of all time, the book changed my approach to management overnight. Buckingham has gone on to publish a number of other best sellers.

Buckingham is soft spoken, engaging, incredibly knowledgeable and funny. Add in his British accent and you can understand why he’s a sought-after speaker. Addressing the question above here’s the recorded transcript of what he had to say:

“The two solutions for buy-in, at the risk of over generalizing, are vividness and individualization. If you want to get anyone excited about change then what you’re first dealing with is anxiety. Everyone is anxious about the future because the present is so much more specific and you know what it is. Leaders needing to get people excited about the future have got to be able to be vivid in describing what that future looks like. If you want to take me into the land of milk and honey I have to be able to taste the milk, I’ve got to taste the honey. I think what leaders forget so often is that what you’re trying to do is turn anxiety into confidence and the solution to doing that is vividness. Tell me what this new world is going to look like with stories and vignettes, not bullet points.  So for example you can say desegregation is a good thing or you can say, as Martin Luther King said, I see a world with a black girl and a white boy walking hand in hand, sitting in the same classroom and drinking out of the same water fountain. Can you see that? Because that’s the world we’re moving to. The moment I paint that picture the vividness is there. The moment we fall back onto bullet points and concepts but we don’t tell stories it’s lost. If you want buy-in, tell stories. Practice your stories, rehearse them. Stories have drama, detail, dialog, and a beginning and an end. And we’re hooked with the narrative. So if any leader wants to grab people and make sure that their anxiousness and anxiety about the future is changed into spiritedness stories are the best way to do this because the person is right there with you. Leaders have to understand that this is their job. Vividness through story telling is a skill of the best leaders and at the most basic level, a leadership responsibility. If you get that right you get buy-in. If you don’t get that right you don’t get buy-in.”

(Note: MGMA conference attendees were provided with a question-and-answer self assessment to describe their individual strengths in a number of broad categories. Buckingham’s two-part answer on getting buy-in references some of these strength categories. )

“The second thing for buy-in is individualization. So if you want to get buy-in you have to realize the truth in the cliche  ‘what’s in it for me’. The challenge here is that everyone is wired a little differently. And I don’t mean doctors versus staff. As a leader you need to know what the various strengths are of your team and of yourself. If you’re a pioneer you’re excited about change, you’re excited about ambiguity. You think the world is a friendly place. If one of your people is a pioneer then the way to get buy-in is to say we’ve never done this before. This is exciting. Let’s try this. Another strength role is advisor. If you’re an advisor your practical and in the face of challenge and conflict you’re the person everyone turns to when they need to know what is the best thing to do. You’re invigorated by problems. If you’re wired that way and you’re my direct report and I want to secure you’re buy-in I would say this is just more effective. All of these health IT systems are just more effective and solve more problems. The moment I say that to you, ‘solve more problems’, I’ve got you hooked. If you’re a pioneer the moment I say ‘this is new ground here, this is exciting’, I’ve got you hooked. Another strength is equalizer. Equalizers like order, structure. Their question is what is the right thing to do. So if I wanted to get an equalizer excited about these new systems I would simply say ‘this is the way to get it right. Do you want to get it right? Because this is the way.’ The best leaders are able to figure out what your individual  strengths and trigger words are because if they use another’s trigger words on you they don’t work. There is no way around it that all of us are wired to get tripped by different triggers and you as a leader need to know them. Otherwise you’re screaming at people in Icelandic and they’re not from Iceland.”

“So in the end buy-in requires a leader create vivid stories as well as understand the strengths and various trigger words and phrases that match how their people are wired.  There is no short cut. And buy-in will require both.”

You can learn more about Marcus Buckingham and his ground-breaking work at  Read more here about his best-selling books.  You can also follow him on Twitter @mwbuckingham and on Facebook at