Moving to a new practice management system (PMS) is a significant undertaking (whether it is a Xestro migration or other software). Most practice managers know this before they start. What they dont always know is that a successful migration is not one job. It is three and most practices only do one of them well, the technical setup.
The process of getting the data across, configuring the system and making sure it runs. That is the part that gets the attention, the timeline and the resources. And it should. But the other two jobs, workflow redesign and change management, are the ones that determine whether the migration delivers the return you were hoping for. And they are the ones most practices underestimate, defer or skip entirely.
A migration is not complete when the system goes live. It is complete when the practice is running the way it was designed to run.
In this article I want to walk through all three jobs: what they are, why each one matters and what happens when a practice attempts the migration without doing all three.
Job 1: Disciplined Setup
The first job is the technical foundation and it is more complex than most practices expect.
Xestro is not a simple data migration. It is a purpose-built system with a specific architecture. Before it can do what it is designed to do, the structure underneath it needs to be built correctly.
This means:
- Locations configured as admin centres is only required for sites where billing will be generated..
- Appointment types created with the correct settings, not just copied across from Genie.
- Financial configuration completed correctly: billing, fee schedules and claiming need to be set up accurately before go-live to avoid errors that cost the practice income from day one.
- Integrations connected: EFTPOS, HPI-O, HPI-I, prescriber registration, health fund links.
- Staff access and roles assigned correctly so each person can do their job without workarounds.
- Item numbers, products and templates set up before go-live so the system is functional from day one.
This is the work most practices focus on. It’s visible, measurable and it has a clear finish line: go-live day. The problem is that go-live day is not the finish line. It is the starting point for jobs two and three.
Setup gets you live. It does not get you the outcome you were after.
Job 2: Workflow Redesign
The second job is where most of the value sits, and where most practices fall short. Xestro is built around workflow and automation. Its value comes not from what it stores but from what it does automatically when the right structure is in place. Appointment types that trigger SMS’s, documents, letters and tasks. Locations that enable seamless billing. Patient journeys that move through the system from first contact to completion without manual intervention at every step. But that automation only switches on when the workflows underneath it have been redesigned to support it.
And here is what typically happens instead.
The practice migrates. The data comes across. The team goes through software training. And then everyone goes back to work in largely the same way they worked before, because nobody stopped to ask which parts of how they currently operate should be done differently in the new system
The software is only as good as the structure you build around it.
Three months later the practice is not running on the old workflow. But it is not running on the workflow Xestro was designed to support either. It is running on something in between: a collection of survival patches and workarounds built under pressure during go-live that have quietly become the new norm. That in-between costs the practice time, energy and capacity every single day.
Where to Start
Workflow redesign does not mean redesigning everything before go-live. That would be unrealistic while a practice is still functioning and managing patients. It means starting with a wish list. Before the migration, or at any point if you are already on Xestro, ask yourself two questions:
- What was not working well in the old system that led you to make the change?
- What do you want to work differently in the new software?
The answers to those questions are your priority workflows. Start there. Pick the patient journeys that run every day: new patient bookings, post-operative follow-ups, billing and reconciliation. Map how they actually work right now. Then ask: which parts of this could Xestro be handling automatically if the structure underneath was set up properly?
That question is the beginning of getting the value you were hoping for when you decided to change software.
Job 3: Change Management
The third job is the one practices are least prepared for. And it is arguably the most important. A new system changes how people work and change is hard, not because people are resistant or incapable, but because habits built over years do not disappear because a new system went live.
When something does not work the way it used to, people find workarounds. They revert to what they know. They get through the day and the workaround becomes the new way of doing things, not because it is better, but because it is familiar. This is not a team problem, it’s a leadership and structure problem and it requires active management, not just a hope that people will adapt.
Training vs Learning
Most practices treat training as a single event. A walkthrough. A session with the software provider. A tick in the box that says the team has been shown how to use the system. But training is not the same as learning. Learning is when the behaviour actually changes: when the team member no longer needs to ask how, when the new way of doing something has replaced the old way in how they work every day. The gap between those two things is where implementation falls apart.
People learn at different speeds and in different ways. A training session designed for the fastest learner in the room leaves everyone else behind and the people left behind do not always ask for help, they find a workaround and three months later the practice is running on habits, not on the system it invested in.
Medical practices run with lean teams. There is rarely spare capacity to absorb inefficiency. When workarounds become the new norm, they consume time the practice does not have and time in a medical practice is not just a resource, it’s revenue. Every hour a staff member spends navigating a workaround instead of using a system that works is an hour the practice is paying for twice.
Before any training begins, ask:
- How does each member of my team learn best?
- After the session: based on what you have seen and what you currently do, is there anything you are concerned was not covered that you will be responsible for after go-live?
- Have I created a safe way for staff to flag what is not working?
That last question matters more than most practice managers realise. In most practices, staff stay silent about problems because raising them feels like criticism of a decision the leader already made. Making it clear that identifying a problem is a contribution, not a complaint, is one of the most important things a leader can do during any implementation.
Ownership and the Systems Champion
Change management also requires someone to own the outcome. Not the tasks. The outcome.
When everyone is involved in an implementation and nobody is specifically accountable for whether it actually works, the gaps go unnoticed. The referral process nobody followed up. The billing workflow nobody checked. The staff member who quietly reverted to the old way because change is hard and the familiar is always easier to go back to.
Successful implementation requires one person who checks whether the process is actually running the way it was designed to run. Someone who notices when it is not. Someone who is responsible for doing something about it: at 30 days, 60 days and 90 days after go-live.
David Jenyns, who has spent years systemising hundreds of businesses, identified this person through his research. When he studied what separated the businesses that sustained their systems from the ones that quietly drifted back to old habits, the difference was not the software. It was not the training. It was one dedicated person whose job was to own and protect the systems, weeks, months and years after go-live. He called this person the Systems Champion.
In a medical practice implementing Xestro, the Systems Champion is the person who keeps the change alive long after the go-live pressure lifts.
Everyone being involved is not the same as someone being responsible. Plan for that difference before you go live.
Why Most Practices Only Do One
The answer is simple. The first job has a deadline. Go-live day creates a visible, unavoidable finish line that focuses all available time and energy on getting the system running. Jobs two and three do not have the same urgency. Workflow redesign can always be done later. Change management can happen after go-live. The training can be sorted once things settle down. But later has a cost. Every week the practice runs on survival patches instead of designed workflows, is costing time and money. Every week the team uses workarounds instead of the system it invested in, the gap between what was expected and what was delivered gets wider.
The practices that get the most from a Xestro migration are not the ones that rushed to go-live. They are the ones that treat all three jobs as equally important and planned for them before the migration began.
Your Next Step
Look honestly at where your practice is right now. If you are planning a migration: map out all three jobs before you start. Assign ownership of each one. Define what success looks like at 90 days.
If you are already on Xestro and it is not running the way you hoped: identify which of the three jobs was not completed. That is where the work is.
The good news is it is never too late to do the jobs properly. The structure can be built. The workflows can be redesigned. The team can be supported.
But it starts with understanding that a migration is three jobs, not one.
Working With Denise Pacey
If reading this has made you realise that your practice is missing one or more of the three jobs, or if you are planning a migration and want to get all three right from the start, this is exactly what Pace MediSystems consulting services are designed to support.
Whether you need help with disciplined setup, workflow redesign, change management or all three, Denise works with medical practices across Australia to make Xestro implementation work the way it was designed to. Get in touch to discuss what your practice needs.
About Denise Pacey
Denise Pacey is the founder of Pace MediSystems and a Certified SYSTEMologist with over two decades of experience in specialist medical practice management. She works with medical practices across Australia in three areas: practice systemisation, Xestro implementation and coaching/mentoring.
Pace MediSystems. Systemise for Success.