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Change Models

The Model for Improvement efficiently guides healthcare organizations in making and testing specific process changes. However, to increase the odds of success for a large initiative, consider incorporating elements of the two models outlined here—which address the needs and motives of those tasked with carrying out the change.

Kotter’s Heart of Change Model

In his books, including the very readable The Heart of Change: Real-Life Stories of How People Change Their Organizations, John Kotter explains that to be successful, improvement initiatives should capture the "hearts and minds" of the people involved. The approach is summarized in eight steps:

1. Increase urgency

  • Shake up the current situation
  • Create a sense that change must happen
  • Share compelling stories and things that people can see, feel, and touch
  • Show evidence that change needs to happen

2. Build the guiding team

  • Create a team of influential and effective leaders
  • Ensure the team is diverse
  • Verify the team is fully committed and able to drive the change

3. Get the vision right

  • Clear vision is critical to success
  • Team must focus on the change and implementation
  • Leadership must set the direction
  • Allow for opportunities for brainstorming about the change

4. Communicate for buy-in

  • The team and leadership must communicate
  • Establish a gut-level buy-in by being clear and credible
  • Be simple and sincere
  • Get to the “heart” of the message
  • Communicate constantly

5. Empower action

  • Remove barriers to allow action and build confidence in the change

6. Create short-term wins

  • Show immediate success and inspire people
  • Seeing a win shows change can be implemented successfully

7. Don’t let up

  • Change is not complete until it is a reality
  • Maintain full support
  • Build momentum from short-term wins
  • Maintain the excitement and urgency

8. Make change stick

  • Ingrain the change in the organization
  • This takes time
  • Don’t stop at Step 6!


Galpin’s Human Side of Change Model

In The Human Side of Change: A Practical Guide to Organization Redesign, Timothy Galpin proposes that change has the greatest opportunity for success when it is carefully planned around the "softer" elements—in other words, the people involved. He outlines a nine-step process:

  1. Establish the need to change
  2. Develop and disseminate a vision of the change
  3. Diagnose/analyze the current situation
  4. Generate recommendations
  5. Detail recommendations
  6. Pilot test recommendations
  7. Prepare recommendations for rollout
  8. Roll out changes
  9. Measure, reinforce, and refine changes


Note: Content on this page is based on The Learning and Action Network Guidebook for Quality Improvement.