Leading Change: What Is Being Asked of Physician Leaders?

By Jerry Garfield
September 28, 2018

Walk through the change process and discover what you need to know as a physician leader and change agent.  Input from those dealing with organizational change offers insight. 

Most of us would agree that change is a constant, demanding presence in health care.

Jerry Garfield

Jerry Garfield

But how many of us would agree to what exactly is being asked of physician leaders as they take on the mantle of change agent?

Agreement is crucial because how well you manage change will determine how effectively you are able to achieve improvements in the delivery of health care services, in patient care experiences and in controlling costs.

To take on the role of change agent is to face questions such as:

  • What is it about the nature of organizational change and your ability to manage it that makes unique demands on you and your organization?
  • What leadership skills are most relevant for staying the course toward successful change?

A study from April 2014, conducted with physicians, nurse managers, administrators and others working with organizational change in health care institutions across the United States, provide insights into these questions.

Physician leaders face the irony and paradox that transformative change is a valuable contribution to an organization’s vitality and a significant disruption to organizational life.

Only when you have deliberately disrupted familiar work routines by insisting people change the way of working that has brought them success in the past — and then dealt with their being upset with you about what you are doing — will you be considered an effective change agent.

Leading change is a tall order; to be successful, everyone in your organization needs to better understand how change looks and feels and how it will impact work life.

Experienced from the inside, change feels like a roller coaster of personal feelings and emotions — from excitement, relief and hope to confusion, fear and uncertainty.

Viewed from the outside, change is a series of calculated events driven by a long list of goals and objectives aimed at attaining a determined target or result. It begins with an official kickoff and ends with a celebration, even if the change has not been fully implemented.

Experienced from the inside, change feels like a roller coaster of personal feelings and emotions — from excitement, relief and hope to confusion, fear and uncertainty. It is experienced less as a series of calculated events and more as a journey through uncharted lands that are fraught with disappointment and elation, challenges and opportunities, and resisted throughout by many of the people expected to benefit most from the goals of the change.

Organizations undergoing transformative change are in transit from a present that has been judged unproductive or too costly to a desired future. It is this aspect of moving through change — transition — that is crucial for change agents to understand and manage effectively.

Insights into the workings of transition, with its three distinct stages, are found in the seminal work of William Bridges.1 Here is a summary about what happens in each stage and how you as a change agent can respond:

Change is coming: With change in the air, the first stage of transition focuses on what is ending. Because you’ve made a solid business case for change based on an analysis of internal factors, external market forces or both, it is now clear that what once contributed to productivity and success is no longer viable. “Business as usual” is the malady; change — strategic disruption and discontinuity toward a desired future — is the remedy.

RELATED: Some Ground Rules for Overcoming Resistance to Change

As change agent, your focus during this first stage of transition is to formally recognize and commemorate what is ending. Commemoration honors the loss that comes with endings, as well as related feelings of uncertainty and unhappiness many stakeholders will experience.

Your efforts should support the necessary process of letting go; this takes time. Rushing it or ignoring reactions by saying everything will be fine, that people shouldn’t worry because leadership has researched “best practices” and knows what’s needed, glosses over genuine stakeholder reactions replete with important thoughts and feelings. This “father knows best” approach infantilizes stakeholders, fueling distrust and resistance.

Uncertainty rules: The second stage of transition is an unknown, uncharted wilderness, a liminal place where uncertainty dominates. What was familiar and routine has faded, and what is forming to take its place is too embryonic to provide stakeholders qualified assurance and reliability.

Some stakeholders will view this time of incipient change as a failure of their leaders, the health care system, the government or some combination of all three. Feelings of fear, frustration and anger will surface.

RELATED: Leaders Who Get Change Right Know How to Listen

But for others, change heralds an opening, an exciting opportunity for new, unexplored possibilities for more creative and productive ways of working. Anticipation, optimism and hope are in the air. Absent the old ways of doing things, new solutions to vexing problems are invented and tried out.

Welcomed or resisted, change disrupts work and causes stress. This is normal, and in expecting it, you and your leadership team must prepare to respond to an array of emotions nested in questions and concerns that will be voiced throughout the long journey of change. What is this change really about? Why do we need it? Why can’t we just do things the way we always have? Where are we going? How will we get there? What’s going to happen next? What am I expected to do?

Seasoned change agents have learned to welcome questions as opportunities to reaffirm the purpose for change, to provide understanding and support for those struggling to adjust to what is unfolding, and then to get out of the way of people’s creativity and originality as they invent new ways of getting work done.

New routine: The third stage of transition arrives as a personal sense of familiarity and routine when what’s new is established. The successful implementation of change — new beginnings — occurs when a renewed purpose, and creative adaptation of one’s efforts in support of that purpose, slowly becomes routine and leads to a new vitality about how work gets done.

RELATED: Use Project Teams to Direct Change

Your focus at this final stage of transition is to reinforce consistent adoption of all that’s new — priorities, policies, procedures, and individual and team behaviors. Identifying and celebrating early successes frequently will solidify desired outcomes and signal, in actual and symbolic ways, that indeed new beginnings are being achieved.

In summary, the best way to get people through these three stages of transition is to affirm their experience and help them deal with it. Learning together about the terrain of each stage is an important first step in the change journey.

Then, as a physician leader advises in the findings report, “… leaders must have the ability to reach out continually with compassion, resolve and resiliency to reassure others, all the while confronting resistance and disbelief from co-workers.”

RELATED: Three Areas of Concern for Leaders During Times of Change

To succeed with change, physician leaders must be successful transition leaders, proactive and strategic, not unwitting and reactive.

Editor’s note: The author conducted the research from which this article is taken. The research report contains tools and strategies for physician leaders as they design and implement change while managing the impact of change and transition on their organization. Click here to read the report.

Jerry Garfield is an executive coach, leadership consultant, certified trainer of organizational change and transition management, and a former corporate manager in the health care industry. This article was originally published by the Physician Leadership Journal in 2015.


  1. Managing Transitions: Making the Most of Change, Third Edition. Boston: Da Capo Lifelong Books, 2009.

Topics: Leadership Journal

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