Working with clinicians: earning the right to change anything
A consultant once ended a twenty-minute presentation of mine with a single sentence: “Your last three systems wasted my time, so why should I believe this one?” He was right on the facts. Three previous projects, none of them mine, had each added a step to his morning and removed nothing.
That is the position you start from. Not neutrality — a debt. Someone in your organisation, wearing a role like yours, has already spent this clinician’s patience. Every digital change you propose is being evaluated against that history, not against your business case.
The mistake I made early was treating this as a communication problem. Better slides, clearer benefits, a champion in the medical advisory committee. It is not a communication problem. Clinicians are assessing whether you understand the cost of their time and the weight of their name, and they can tell in the first five minutes whether you do.
Why doctors resist, and why most of it is rational
Strip out ego and you are left with four objections that recur in every hospital group I have worked in.
- Time. A busy consultant in a Tier 1 unit may see a large number of patients in a morning OPD. Anything that adds fifteen seconds per patient is an unfunded tax on their day, and nobody has ever compensated them for it.
- Their name. A doctor’s reputation is portable and personal. Your web page, your campaign, your aggregator listing, your chatbot answering a clinical question — all of that appears under their name. If it is wrong, it damages an asset they own and you borrow.
- Loss of control over the patient relationship. Online booking, digital triage and teleconsultation all insert the institution between the doctor and the patient. Some of that is the point. They know that.
- Evidence of past failure. Every hospital has a graveyard of half-implemented systems. They remember all of them.
None of those are solved by explaining the benefits again. Three are solved by changing the design. One is solved only by time.
The difference between an objection and a veto
This distinction took me two years to learn properly, and it is the single most useful thing in this article.
An objection sounds like a problem with your plan. A veto sounds the same, but it is a statement about clinical safety, professional ethics or personal reputation. If you treat a veto as an objection and try to negotiate it, you do not lose the argument — you lose the relationship.
In practice, the tells are consistent.
- Objections are about workflow, effort and convenience. “Who is going to type all this?” “This will not work on the OPD computer.” “My secretary handles that.” These are requests for you to fix the design, phrased as refusal.
- Vetoes are about harm, accuracy and attribution. “A patient could read this and delay coming in.” “I will not have my name on advice I did not give.” “You cannot promise that outcome.” These are final, and you should say so out loud in the room.
When you hear a veto, stop, write it down verbatim, repeat it back, and confirm that the feature is off the table in its current form. The clinician will watch to see whether you actually do it. That moment is worth more to you than any pilot result. It establishes that you can be trusted with a no, which is the precondition for ever getting a yes on something harder.
What actually persuades a clinician
Not ROI. Not market share. Not the group’s digital maturity score.
Four things move clinicians, in roughly this order.
Their own patients. Show them what five of their patients said, in the patients’ own words, about finding them, reaching them, waiting for them. Not aggregate satisfaction scores — individual feedback, verbatim, including the awkward ones. A consultant who has read a patient saying they called four numbers before reaching the right department will argue your case for you in the next HOD meeting.
Removing work, not adding it. The most successful clinician-facing change I have been involved in did not add a feature. It cut the number of times a consultant was interrupted during OPD by the front office asking about a slot. When a clinician experiences your function as a reduction in friction, everything after that is easier.
Their practice, not the institution. A consultant cares about case mix, about the complexity of what reaches them, about referrals from physicians they respect. If you can show that a specific content or referral initiative brought them two complex cases in the right specialty, that lands harder than any volume number.
Peer behaviour. Doctors discount what administrators tell them and weigh heavily what colleagues do. This is not cynicism, it is how professional communities work. Your job is therefore not to persuade fifty clinicians. It is to persuade two, properly, and make their experience visible.
Running the pilot with a willing consultant
Find the one who is already interested. In every unit there is a consultant — often younger, often in a specialty with an educated, self-referring patient base such as dermatology, fertility or orthopaedics — who already runs their own social presence and is mildly frustrated that the institution is slower than they are.
Work with that person, and run the pilot properly.
- Narrow it. One consultant, one specialty, one workflow, one unit. Not a pilot across three units, which is a rollout wearing a disguise.
- Agree the success measure with them before you start, in their language. Not clicks. Something like: how many of the patients who reached them were appropriate for their practice, and how many minutes of their morning this cost.
- Fix their problems within the week. Pilot participants forgive flaws and do not forgive slowness. Your credibility here is measured in turnaround time.
- Give them a visible win. Let them present the result to their peers, not you. Prepare them well and then get out of the way.
- Set an end date. A pilot without a defined end becomes a permanent special arrangement for one doctor and a grievance for everyone else.
One caution. A willing consultant is not a representative consultant. What works for the person with the most appetite for change will not survive contact with a senior interventional cardiologist who has been at that unit for fifteen years. Pilot with the enthusiast; design for the sceptic.
The consultant who will never agree
Some will not come around, and you need a settled position on this rather than a permanent campaign.
Work out whether their refusal blocks the group or only themselves. A senior clinician who declines to appear in a content programme costs you one profile. A senior clinician who refuses to accept digitally booked appointments breaks the promise you are making to patients at that unit, which is a different matter and belongs with the unit head and medical administration, framed as a patient-experience inconsistency rather than as non-compliance with your project.
Where it only affects them, leave it alone visibly. Carry on delivering for everyone else. In my experience, roughly a third of the hard sceptics eventually ask to be included once they see colleagues getting something they value — and they ask privately, which is why you must never have made it a public fight.
The mistakes that cost you years
I have made or watched all of these. Each one costs more than it looks like it will.
Going over a clinician’s head early. You can get a management instruction issued. You will get compliance in form and resistance in substance, and you will have taught every other consultant in the group that you are someone who escalates. I did this once, in my first year in healthcare, on something that genuinely mattered. I won the decision and spent eighteen months recovering the relationships.
Publishing something with a doctor’s name on it that they have not seen. This is the unforgivable one. Not a wrong qualification, not a misspelling — those are embarrassing. A clinical claim attributed to someone who never made it is a professional problem for them. One instance is enough to close the door for a year.
Presenting digital metrics to a clinical audience. Impressions, cost per lead and engagement rate in an HOD forum signal that you are measuring your own activity rather than their outcome. Bring patient-level and practice-level facts instead.
Promising a timeline set by a vendor. Your vendor’s estimate is not a commitment you can make to a consultant. Pad it, and then beat it.
Treating the HOD as the decision-maker for every consultant. HODs vary enormously in the authority they actually hold over senior colleagues. Find out, privately, before you rely on it.
What you owe them in return
The right to change things is bought, not granted. Three payments work.
First, accuracy as a standing service. Their profile, their qualifications, their timings, their special interests — correct everywhere, permanently, including on external platforms and aggregators you do not control. Assign a named person in your team to own this. It is unglamorous and it is the most valuable thing your team can do for clinician trust.
Second, protection from the public internet. Clinicians get reviews that are unfair, and occasionally reviews that are about parking or billing and not about them at all. A function that responds quickly, professionally and on their behalf without requiring them to get involved earns enormous goodwill.
Third, honest reporting of your own failures. Tell them when a campaign sent the wrong patients. Tell them when a booking flow broke. The instinct is to keep digital’s problems inside digital. Do the opposite. Clinicians are trained in morbidity and mortality review; they have more respect for a function that audits itself than for one that only reports wins.
Who should carry the message
Often, not you.
The most effective internal channel I have used was not a presentation or an email from my function. It was the medical superintendent at one unit explaining a change in a clinical governance meeting, with my team present to answer questions and otherwise silent. The message was identical. The reception was not.
Identify, at each unit, the clinician whose opinion functions as permission for others. It is rarely the most senior person and almost never the loudest. Ask the front-office staff and the nursing leads; they know exactly who it is.
If you’re starting this next quarter
- Spend the first month in OPDs, not meetings. Sit in, watch the interruptions, count the steps. Take no slides.
- Fix one thing that annoys clinicians and costs you nothing politically. Wrong timings on listings is the usual candidate. Tell nobody in advance; report it afterwards.
- Find your two willing consultants across different specialties and units. Ask what their patients struggle with, and listen without proposing anything.
- Run one narrow pilot with a defined end date and a success measure in their words.
- Write down every veto you receive, and honour all of them for at least two quarters. Revisit only with new evidence and their knowledge.
- Stand up the accuracy service — profiles, credentials, timings, everywhere — before you ask for anything else.
- Let the pilot consultant present the result to their peers. Stay in the room and say little.
You do not get the right to change a clinician’s workflow by proving you are right. You get it by being the person who has never once made their morning worse.
Questions people ask
Strip out ego and four objections recur. Time: anything that adds fifteen seconds per patient is an unfunded tax on a busy OPD. Their name: your page, campaign, listing or chatbot appears under it, and if it is wrong it damages an asset they own and you borrow. Loss of control over the patient relationship. And evidence of past failure — every hospital has a graveyard of half-implemented systems. Three are solved by design. One is solved only by time.
An objection is about workflow, effort and convenience: who will type this, it will not work on the OPD computer, my secretary handles that. It is a request to fix the design, phrased as refusal. A veto is about harm, accuracy or attribution: a patient could read this and delay coming in, I will not have my name on advice I did not give. Vetoes are final. Treat a veto as an objection and you lose the relationship, not the argument.
Stop, write it down verbatim, repeat it back, and confirm in the room that the feature is off the table in its current form. Then honour it for at least two quarters and revisit only with new evidence and their knowledge. The clinician will watch to see whether you actually do it. That moment establishes that you can be trusted with a no, which is the precondition for ever getting a yes on something harder.
Not ROI, market share or a digital maturity score. Four things, roughly in order: their own patients’ words, verbatim, including the awkward ones; removing work rather than adding it — the most successful change I have been part of cut OPD interruptions; their practice, meaning case mix and referrals from physicians they respect; and peer behaviour. Doctors discount what administrators say and weigh what colleagues do. Your job is to persuade two clinicians properly and make their experience visible.
Find the consultant who is already interested — often younger, in a self-referring specialty like dermatology, fertility or orthopaedics, running their own social presence. Narrow it to one consultant, one workflow, one unit. Agree the success measure in their language before starting. Fix their problems within the week; pilot participants forgive flaws and not slowness. Set an end date. Let them present the result to peers. And remember a willing consultant is not representative — pilot with the enthusiast, design for the sceptic.
Work out whether the refusal blocks the group or only themselves. Declining to appear in a content programme costs one profile. Refusing digitally booked appointments breaks a promise made to patients at that unit, which belongs with the unit head and medical administration as a patient-experience inconsistency. Where it affects only them, leave it alone visibly and carry on delivering for everyone else. A fair share of hard sceptics eventually ask to be included — privately, which is why it must never be a public fight.
Almost never, and never early. You can get a management instruction issued, and you will get compliance in form and resistance in substance. You will also have taught every consultant in the group that you are someone who escalates. I did this once, in my first year in healthcare, on something that genuinely mattered. I won the decision and spent eighteen months recovering the relationships. The cost is always larger than it looks in the meeting.
Publishing something with a doctor’s name on it that they have not seen. A wrong qualification or a misspelling is embarrassing. A clinical claim attributed to someone who never made it is a professional problem for them, and one instance is enough to close the door for a year. Every profile, campaign, listing and chatbot answer that carries a clinician’s name needs their sign-off, and the process should make it impossible to skip rather than merely discouraged.
Patient-level and practice-level facts, not digital activity. Impressions, cost per lead and engagement rate in an HOD forum signal that you are measuring your own output rather than their outcome. Show instead what five of their patients said about finding and reaching them, how many appropriate patients a specific initiative brought to their practice, and how many minutes of their morning a change cost or saved. A consultant who sees a patient called four numbers before reaching the right department will argue your case for you.
Often, not you. The most effective channel I have used was the medical superintendent at one unit explaining a change in a clinical governance meeting, with my team present to answer questions and otherwise silent. Identical message, different reception. At each unit, find the clinician whose opinion functions as permission for others — rarely the most senior, almost never the loudest. Ask front-office staff and nursing leads; they know exactly who it is.
Three payments. Accuracy as a standing service: profile, qualifications, timings and special interests correct everywhere, permanently, including aggregators you do not control, with a named owner. Protection from the public internet: responding quickly and professionally to unfair reviews, or ones about parking and billing, without involving them. And honest reporting of your own failures — the campaign that sent the wrong patients, the booking flow that broke. Clinicians respect a function that audits itself more than one that only reports wins.
Longer than any project plan allows, because you start from a debt, not neutrality. Someone in a role like yours has already spent this clinician’s patience. Expect a quarter of listening before proposing anything, two quarters of honouring every veto, and a year before sceptics start asking to be included. The mistakes cost more: one unauthorised claim under a doctor’s name closes the door for a year, and an early escalation can take eighteen months to recover.
Spend the first month in OPDs, not meetings — watch the interruptions, count the steps, take no slides. Fix one thing that annoys clinicians and costs nothing politically, usually wrong timings on listings, and report it afterwards rather than announcing it. Find two willing consultants in different specialties and ask what their patients struggle with. Stand up the accuracy service before asking for anything. Run one narrow pilot with an end date and a success measure in their words.
Very little, which is why it is under-prioritised. The accuracy service needs one named person and tooling for listings. A pilot needs a week-long fix turnaround, which is a management commitment rather than a spend. Review responses need a process. What it does cost is the digital head’s time in OPDs and governance meetings, and the discipline to pad vendor timelines rather than promise them to consultants. The expensive part is getting it wrong.
