Change Management in Healthcare

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The Health Care Manager
Volume 27, Number 1, pp. 23–39
Copyright # 2008 Wolters Kluwer Health |
Lippincott Williams & Wilkins

Change Management
in Health Care
Robert James Campbell, EdD
This article introduces health care managers to the theories and philosophies of John Kotter and William Bridges, 2 leaders in the evolving field of change management. For Kotter, change has both an emotional and situational component, and methods for managing each are expressed in his 8-step model (developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don’t let up, and making it stick). Bridges deals with change at a more granular, individual level, suggesting that change within a health care organization means that individuals must transition from one identity to a new identity when they are involved in a process of change. According to Bridges, transitions occur in 3 steps: endings, the neutral zone, and beginnings. The major steps and important concepts within the models of each are addressed, and examples are provided to demonstrate how health care managers can actualize the models within their health care organizations. Key words: change management, information technology, transitions

If your time to you
Is worth savin’
Then you better start swimmin’
Or you’ll sink like a stone
For the times they are a-changin’
(Bob Dylan)
ODAY’S HEALTH CARE manager occupies an extremely challenging position: how to maintain a competitive edge in the
health care market while leading an organization through constant change. Rapid change is occurring as health care organizations (HCOs)
strive to adopt new technology such as the
electronic health record (EHR), implement
quality improvement initiatives, and institute
pay-for-performance plans. To deal with this
change and help employees transition to new
ways of doing things, managers need an edge.
Providing this edge are the philosophies of
John Kotter and William Bridges, two of the

T

Author Affiliations: Department of Health Services
and Information Technology, East Carolina
University, Greenville, North Carolina.
Corresponding author: Robert James Campbell, EdD,
Department of Health Services and Information
Technology, East Carolina University, Greenville,
NC 27834 (campbellr@ecu.edu).

most widely regarded thinkers in change management. The following discussion focuses on how the ideas of these 2 experts can be
used to successfully implement a change management project.
KOTTER’S CHANGE
MANAGEMENT MODEL
Kotter believes that organizational change
can be managed using a dynamic, nonlinear
8-step approach. The steps in his model
include the following:
 Increase urgency
 Build guiding teams
 Get the vision right
 Communicate for buy-in
 Enable action
 Create short-term wins
 Don’t let up
 Make it stick
Kotter organizes each of these steps into 3
distinct phases. The first phase is called
‘‘creating a climate for change’’ and includes
steps 1, 2, and 3. The second phase, ‘‘engaging and enabling the whole organization,’’ consists of steps 4, 5, and 6. The final phase,
‘‘implementing and sustaining the change,’’
encompasses steps 7 and 8.
23

Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

24

THE HEALTH CARE MANAGER/JANUARY–MARCH 2008

SEE ME, FEEL ME, TOUCH ME
To fully appreciate Kotter’s work, the
manager must understand 2 prominent ideas
about the suppression and engenderment of
employee emotions. During any period of
change, a manager must deal with feelings
of complacency, anger, false pride, pessimism,
arrogance, cynicism, panic, exhaustion, insecurity, complacency, and anxiety among employees.1(p180) These are all emotions that
can undermine attempts at promoting change.
As will be discussed below, Kotter’s model
provides tools for turning these negative
feelings into positive...
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