Leadership Essentials for the Chest Physician: Change.

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Change is a fact of life; the absence of change creates stagnation. This is perhaps especially true in healthcare, where progress in treating disease depends on innovation and progress. At the same time, change is often uncomfortable. Thus, it is helpful to model the change process in order to optimize the chances of successfully effecting change. Furthermore, how to lead change is a critical leadership competency. Three models for leading change are reviewed - the first by Kotter, which was not designed for healthcare, the second by Heath and Heath called "switch", and the third by Silversin and Kornacki, which was uniquely designed for healthcare. The models share many common features, with the explicit reminder in the third model that physicians should be involved in the change effort early. While sparse, evidence does suggest the applicability of these models to healthcare. Beyond having a roadmap for leading change, it is helpful to assess the worthiness of undertaking a change effort and of predicting the phasic response to change efforts, given that humans are often change-averse. In this regard, both the "payoff matrix" and the change curve, derived from Kubler-Ross' work on grieving, are offered as tools. Finally, physicians' avidity for change is framed by two opposing vectors. On the one hand, physicians share in a general human aversion to change. On the other hand, physicians are data-reverent and also wish to do their best for the patients, which encourages their embracing ever-increasing evidence and change.


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