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Navigating change — there are good reasons to follow a guide

Health care organizations sometimes choose change, and sometimes have change thrust upon them; either way, the response frequently seems to be a burst of redesigning, restructuring and rebranding that leaves staff stressed and often convinced they and their patients are worse off than they were.

It doesn’t have to be that way. Change — brought about by economic, political and social shifts — is a constant in our world. But uncontrolled upheaval is not inevitable: there’s strong evidence that successful transformation can be brought about by following the principles of change management.

Theories about change management emerged from the study of group psychology and organizational behaviour in the 1940s, and thus change management is not about the practical side of change: buildings, technology, even regulations do not need to be persuaded to adapt. The changes that need to be managed are all about people.

One of the best known approaches today was developed by John Kotter, formerly a professor at Harvard Business School, who developed a list of eight steps for successful change:  

  • Establish a sense of urgency
  • Form a powerful guiding coalition
  • Create a vision
  • Communicate the vision
  • Empower others to act on the vision
  • Plan for and create short-term wins
  • Consolidate improvements and produce more change
  • Institutionalize new approaches.

After some 20 years of advising companies on his approach, Kotter followed up with a paper on why transformations fail. While a sense of urgency drives action, he observed, leaders can “underestimate how hard it can be to drive people out of their comfort zones.” On the flip side, some pull their punches, because they don’t want to lower morale.

Leaders also fail to communicate anything close to as much as they should, Kotter said. Change requires frank, on-going discussions of why it’s necessary and intense efforts to explain the vision — people won’t support change if its ultimate goal isn’t clear.

Another paper from Harvard Business Review suggests staff resist changes they think clash with their values, so “…health care leaders need to focus on aligning innovation with existing cultural values and devote more time to explaining how [it] will allow employees to better enact their values and deliver high quality care.”

In an article for the National Center for Biotechnology Information, authors Jennifer Barrow and Tammy Toney-Butler say health care leaders should use change management approaches to improve their odds of success. They endorse change theories that recommend focusing on getting the support of “early adopters” whose enthusiasm will win over many of their colleagues, and not wasting time on “resistors” who are not likely to come round.

There are many more models of change management than these few, but all emphasize the importance of thorough planning for a difficult journey, best done by following sound change management advice from a good guide.


This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about physician-led innovation? Please connect with us at