Variation in clinical care among providers in all specialties accounts for a significant amount of wasted healthcare dollars. Reducing this variation within their institutions is a daunting, yet essential task of health care administrators. They are already consumed with managing overburdened providers who are not only struggling to maintain technical expertise in their respective fields but how to handle the increased burden of non-clinical work created by poorly designed electronic health records and insurance authorization requirements. So, how can they encourage these providers to engage in a process of change that will help them work smarter, not harder and at the same time improve the quality of their care and reduce overall costs?   

I believe John Kotter’s ideas about managing change in institutions– direct, align and motivate–applies to groups of physicians as well. I have adapted a few of his concepts and offer some thoughts on how his methods might specifically apply.


Create a vision.

Leading any group requires defining an overarching vision that can unify members around a common goal. In healthcare, the vision is usually focused on “always acting in the best interest of the patient.” In my experience, physicians can always be rallied around this idea, so it is important to tie all change initiatives back to this vision.


Develop a credible sense of urgency around the need for change in a specific area.

Based on an analysis of strengths, weaknesses, opportunities and threats, define a project in a clinical area that has a potential for short and long-term gains. Create a sense of urgency around the need to effect this change. A classic example is the painful experience of a high rate of staff turnover in a clinic that has physicians who exhibit huge variation in clinical practice.  


Identify and align key stakeholders.

Identify key stakeholders in the process and create a strong guidance team composed of opinion leaders as well as members who have power and accountability.


Communicate the vision and sense of urgency clearly, consistently and often.

Tell stories that resonate. Avoid use of complicated data sets to make your point. Despite their training, physicians tend to request more data or refute its quality when it does not support their preconceived notions. But remember, communication is a two-way street. Listen to concerns with the intent to understand, not the intent to respond.


Motivate the group to implement change.

Lead by example, walk the talk. Commit to eliminating barriers in order to achieve success. Encourage risk taking and non-traditional ideas, activities and actions. Allow the team to fail forward quickly. Rapidly eliminate ineffective process changes and foster continued change towards improvement by creating short-term wins and celebrating success.