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 Points:
- Kotter’s model helps manages change staff negative feelings about change, like anger, anxiety, and pessimism, into positive proactive feelings for change such as hope, trust and excitement.
- “See-feel-change” approach – manage creates a “compelling, dramatic situation” geared towards helping employees envision a problem and to identify solutions which creates an “emotionally changed change behavior or reinforced change behavior.” – when behavior is fueled by emotion it is likely to last longer.
- Step 1: Creating urgency – managers should use example to show employees firsthand what or why a change must occur.”
- Step 2: Building a guiding team – team members should have relevant knowledge about the changes that occur in the industry, have the ability to establish credibility with peers, development of relevant knowledge of the department, division, or group, have formal authority and the ability to develop and communicate a vision and motivate individuals to achieve the vision.
- When creating a vision statement Kotter recommends starting with 6-7 broad visions of the future and identify key dimensions that would help describe the options available for each vision.
- “Adoption of a service-oriented vision statement will raise urgency among staff and motivate them to work as hard as they can to make the changes a reality.”
- “A successful vision statement explains the employee behaviors needed and h ones that should be eliminated. It calls on people’s emotions and motivates them to take action.”
- Layered approach to process – figure 1 – page 29
- Q&A session – team establishes questions they feel employees would ask regarding the change and then develop a short, clear answer
- Completed tasks provide examples of short-term wins that help build urgency and momentum as well as lessening the impact of negative comments made by critics of the project.
- William Bridges “it’s not the changes that determine the success of a project, it’s the transitions.”
- Stages: Endings, neutral zone, beginnings
- “It isn’t the changes themselves that the people in these cases resist. It’s the losses and endings that they will experience and the transitions hat they are resisting.”
- 7 points on a compass: 1) protect people from being overwhelmed with change, 2) Think of how policies and procedures can be updated to help people move through the neutral zone, 3) set short-range goals that lead to projected results, 4) Do not bite off more than you can chew, 5) provide training for supervisors/staff to navigate the change, 6) develop a sense of connectedness, 7) create a transition monitoring team
- Process: Purpose (explain the problem and solutions) –> Picture (what will life look in the new beginning) –> Plan (how lives are going to change) –> Part to Play (what part do people play in the transition process)
- Change is both situational and psychological and when either is ignored change is doomed.