Leading Systems Change in Health Care – Why Efforts Fail

Leading change is not easy and 50-70% of change efforts fail.  Leaders, directors, project managers, program, coordinators and others are looking for strategies to move programs and projects forward, to manage change, in challenging times and circumstances.     They seek to develop a deeper understanding of how to overcome their individual and organizational challenges and barriers.  Yet many leaders, CEO’s, directors do not consider all of the aspects/components/phases of change, they simply initiate it – a new program, process, system without examining how to make it work, the impact it will have on the people involved.  Or, all too often if the return on investment is not immediate, they abandon it altogether – change takes time.

Every organization has its own culture, an agreed upon mindset from which they work. People fear and resist change, because they are comfortable as it is or do not know how a change – your change – will impact their work and lives.  It is essential to “walk in their shoes” to understand from the stakeholder perspective the impact of your project or program for each person whether they are actually involved in the project or impacted by it.  In leading change you will likely be impacting and changing the culture of the organization and as such, a more holistic approach is needed.

The John A. Hartford Foundation Change AGEnt’s meeting in Philadelphia in December of 2015 afforded participants a learning opportunity, a way to advance their individual initiatives.  Rob Schreiber MD, Medical Director Hebrew Senior Life and Clinical Instructor Harvard Medical School and I were honored to co-facilitate a workshop on Kotter’s 8 step change framework.    This framework developed by John Kotter of Harvard University afforded participants an opportunity to examine their individual projects/programs in light of this evidence based change process.   Kotter’s change process was developed over four decades of observation and testing and is addressed in many of his books and publications including one used in this workshop, “Our Iceberg is Melting.”  It is a wonderful framework and guide from which to plan and work on creating change in an existing system or organization.

Kotter’s eight steps include:

1.            Establish a Sense of Urgency

2.            Pull Together a Guiding Team

3.            Create a Change Vision and Strategy

4.            Communicate for Understanding and Buy In

5.            Empower Others to Act

6.            Produce Short Term Wins

7.            Never Let Up

8.            Make it Stick


After an overview of Kotter’s change process participants discussed their programs and receive feedback from colleagues.  Change agents found this to be very valuable engaging a colleague, one or more, in examining “change” projects is an effective way to solicit diverse viewpoints and feedback.

Some of the lessons learned during the Change AGEnts process included:

  • Change involves loss which has to be acknowledged and time is needed for people to mourn and heal in order to move forward.
  • It is important to take a look below the surface, for the beliefs, values and thoughts of those we involve and engage.
  • While the eight steps are a roadmap for change it is not linear process– reviewing and repeating steps may be necessary and often several steps need to be engaged at the same time.
  • Sometimes we may need to change our own beliefs and perspectives first.
  • Stories are a very powerful method of engaging others support and their “hearts”.  Thinking differently can help change behavior and lead to better results.  However, stories and experiences that change how people “feel” about a situation can lead to a significant change in behavior.
  • Conflict is inevitable, plan for it.  Examine ways in which conflict will surface and strategies to address it.
  • Sustainability is critical – keep talking about the change and create a plan for it to be continued even after you have moved on as a leader.
  • Change is relationship driven and requires a village approach
  • Change takes patience and time and is most often worth it.


These were just some of the many lessons that were learned and it is clear that leading change is an evolving skill set and demands ongoing, continuous learning and a willingness to be open to the thoughts, beliefs and perspectives of others.


*The Hartford Change AGEnts Initiative accelerates sustained practice change that improves the health of older Americans, their families, and communities. It does this by harnessing the collective strengths, resources, and expertise of the John A. Hartford Foundation’s interprofessional community of more than 3,000 scholars, clinicians, and health system leaders.

For more information, see:

The John A. Hartford Foundation

Hartford Change AGEnts Initiative

The Gerontological Society of America

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