Kotter 8 Step Change Process

See below resources around a change model by Dr. John Kotter to consider implementing when designing a project plan.


Bush, H. (2017). How to Embrace Change. Ausmed.

Campbell, R. J. (2008). Change management in health careThe Health Care Manager27(1), 23-39.

Kotter J & Cohen D 2002, The Heart of Change, Harvard Business School Press NHS Improvement Foundation, Boston, MA [summary]

Kotter International. (2019). 8 Steps Process. Kotter International, Boston, MA.

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotter’s change model for implementing bedside handoff: a quality improvement projectJournal of Nursing Care Quality31(4), 304-309.

Tools for Knowledge and Learning: A Guide for Development and Humanitarian Organisations

Journal Club Article: Ramalingam, B. (2006). Tools for knowledge and learning: A guide for development and humanitarian organizations. London: Overseas Development Institute.


“No one should be dying or suffering because knowledge that already exists in one part of the world has not reached other parts. It is up to each of us to take the responsibility to ensure the knowledge flows easily to where it is needed” (Geoff Parcell, Learning to Fly, 2006).

The application of learning and knowledge based strategies derived from learning from lessons of the past and from elsewhere, to then overcome the challenges and boundaries of time and space.

Strategies of the Learning Organisation

A Holistic View of Knowledge and Learning Tools

  • Organisational contexts: Strategic alignment, management behaviours, institutional pressures, funding cycles, historical evolution.
  • Relationships and collaborations: within and across organisation – via networks, ICTs, communications plans; core functions; support functions.
  • Organisational knowledge: Forms and locations; creation, sharing, storage, use; key activities and tools; relevance, how the message is packaged and communicated.

Five Competencies Framework (Collison & Parcell, 2001)

Aim: “To work out how well they are performing against organisationally established criteria for knowledge and learning, and to identify goals and priorities for improvement. The competency framework works on the principle that effective knowledge and learning is based on improving performance in:

  1. Strategy Development
  2. Management Techniques
  3. Collaboration Mechanisms
  4. Knowledge Sharing and Learning Processes
  5. Knowledge Capture and Storage.”

Knowledge Audits: Taking a systematic and strategic approach to knowledge and learning can help to integrate the diverse activities of an organisation, and facilitate more productive processes of knowledge sharing and dialogue between internal and external stakeholders.

Social Network Analysis: a research technique that focuses on identifying and comparing the relationships within and between individuals, groups and systems in order to model the real-world interactions at the heart of organisational knowledge and learning processes.

Most Significant Change (MSC): the process involves the collection of significant change (SC) stories emanating from the field level, and the systematic selection of the most important of these by panels of designated
stakeholders or staff.

Outcome Mapping: As development is essentially about people relating to each other and their environments, the focus is on people.


A facilitator supports use of imagination to think of the ideal workspace, organisation and what the 5 year plan looks like,

Management Techniques

The SECI Approach

“There are four key processes through which tacit and explicit knowledge interact, namely, socialisation, externalisation, combination and internalisation. Together, these processes make up the SECI principles.

  • Socialisation allows to share tacit knowledge
  • Externalisation converts tacit into explicit knowledge
  • Combination combines different types of explicit knowledge
  • Internalisation converts explicit into tacit knowledge.”

SECI model of Knowledge creation.

Lewin’s Force Field Analysis

“Force Field Analysis was developed by Kurt Lewin (1951) and is widely used to inform decision making, particularly in planning and implementing change management programmes in organisations.”

 Activity Based Knowledge Mapping

“Is a tool which enables knowledge inputs and outputs to be
linked in a systematic fashion to ongoing organisational activities and processes – from office mail to strategic reviews.”

Other resources are also discussed.

Team Collaboration

“Team development has been described in terms of five stages, beginning with a simple ‘membership’ group, and working through ‘confrontation’ to a ‘shared-responsibility’ group (Bradford and Cohen, 1998). Bradford and Cohen suggest that the different stages of groups differ in terms of the following characteristics:

• Atmosphere and relationships
• Understanding and acceptance of goals
• Listening and information sharing
• Decision making
• Reaction to leadership
• Attention to the way the group is working.”

Communities of Practice

Action Learning Sets

Six Thinking Hats

Mind Maps or Concept Mapping

Social technologies for collaboration

Knowledge Sharing & Learning

  • Storytelling
  • Peer programs
  • Challenge sessions
  • How to guides
  • Blogs
  • Reviews and retrospects
  • Intranet resources

Additional Resources

Collison, C., & Parcell, G. (2001). Learning to fly: Practical lessons from one of the world’s leading knowledge companies. Capstone Ltd. [GoodReads]

Davies, R., & Dart, J. (2005). The ‘most significant change’(MSC) technique. A guide to its use.

Earl, S., Carden, F., & Smutylo, T. (2001). Outcome mapping: Building learning and reflection into development programs. IDRC, Ottawa, ON, CA.

Ramalingam, B. (2005). Implementing Knowledge Strategies: From Policy to Practice in Development Agencies. ODI Working Paper 244, London: ODI.

Diffusion of Innovations by Everett Rogers (Book Club)

Book Club: Rogers, E. M. (1995) Diffusion of innovations. (5th ed.) Simon and Schuster, New York, USA. [summary article]

What is Diffusion?

“Diffusion is the process in which an innovation is communicated through certain channels over time among the members of an social system” (pg. 5).

What are Innovations

“An idea, practice, or object that is perceived as new to an individual or another unit of adoption” (pg. 137).


Innovation-Development Process

  1. Recognising a problem or need.
  2. Basic and applied research.
  3. Development- from idea into actual use.
  4. Commercialisation.
  5. Diffusion & adoption.
  6. Consequences of the innovation and adoption.

Diffusion of Innovations

4 main elements:

  1. The innovation.
  2. Communication through interpersonal networks and wider channels of communication.
  3. It takes time.
  4. Disseminates among the members of a social system.

The Adopters

Adopters within the social system do not take up the innovation at the same time. They adopt in an “over-time sequence”. Individuals can be classified into adopter categories of innovators, early adopters, early majority, late majority and laggards.

The S-shaped Diffusion Curve 

Diffusion of ideas

Early Adopters


Importance of Time

New ideas are difficult to adopt, from the time they become available to the time they become adopted. It is also difficult to measure adoption as this occurs over time, and trying to identify the why factors or causalities is part of this difficulty.

Drivers of Change

The importance of interpersonal networks in the adoption or rejection of an innovation. Opinion leaders can lead and influence others through their behaviour and actions to engage with the innovation.  Diffusion networks and the interpersonal communication aspects are vital drivers on the diffusion process. The role of champions, are the drivers who throw everything behind the innovation and support unflinchingly to increase uptake of a new idea.

The Role of the Change Agent

  1. To develop a need for change.
  2. To establish an information an information relationship.
  3. To diagnose problems.
  4. To create an intent to change in the client/organisations.
  5. To translate an intent into action.
  6. To stablise adoption and prevent discontinuance.
  7. To achieve a terminal relationship.

Relevance in Healthcare

The innovation to be successful must be client orientated (this is vital in healthcare for consumers to provide a experiential view). The book provides some great stories of successful and failed innovations. One theme that comes across in the failed stories is one of not understanding or considering local customs or practices, failing innovations due to a discordance with social behaviours, means adoption does not take place.

Not every innovation should be diffused and adopted, so a rigorous process (research) should be in place to prevent bad or low value innovations. Questions to ask of an innovation:

  1. What is the innovation?
  2. How does it work?
  3. Why does it work?


The diffusion of innovations provides a framework to engage in change, but the healthcare team still need to mindful to avoid bad innovations, especially wasting valuable time and resources (#culture). The innovation and change management perspective and the view of the early adopters and change agents can assist in developing ideas. Client orientated innovations must be considered, which links with human centred design philosophy. I was informed that this book would change my perspective on so many things and by page 10 I was hooked on the change process, the use of stories are used effectively to convey the important messages.

Thanks to the very knowledgeable Dr Kay Rolls (@Kay_Rolls) for the excellent book recommendation.


Rogers, E. M. (1995) Diffusion of innovations. (5th ed.) Simon and Schuster, New York, USA. [summary article]

Ross, P. (2017) Deimplementation of Practice. Nursing Education Network.

Ross, P. (2016) Human Centred Design. Nursing Education Network.


Change Theory: 6 Thinking Hats Theory


Edward De Bono’s Six Thinking Hats tool is a powerful change process technique and is used
to look at different points of view or lens to aid change management. This provides a team orientated and more rounded view of a situation and more effective group thinking.  The processes involve a detailed and cohesive way to drive thinking processes to work together more effectively (De Bono, 1985).

6 Thinking Hats

Each hat is a different colour and represents a different style of thinking:

  • White Hat – facts, figures, and objective information.
  • Red Hat – emotions, feelings, hunches, intuition.
  • Black Hat – logical negative thoughts, “devil’s advocate,” why something will not work.
  • Yellow Hat – logical constructive thoughts, positive aspects of why something will work.
  • Green Hat – creativity, generating new ideas, provocative thoughts, lateral thinking.
  • Blue Hat – control of the other hats, thinking about the thinking process, directs attention to
    other hats to facilitate “mapmaking” thinking” (Carl, 1996).

This provides “parallel thinking” where all the team members are focusing on the problem and a collaborative approach ensues.

Practical Tips 

  1. “The meeting may start with everyone assuming the Blue hat to discuss how the meeting will be conducted and to develop the goals and objectives.
  2. The discussion may then move to Red hat thinking in order to collect opinions and reactions to the problem. This phase may also be used to develop constraints for the actual solution such as who will be affected by the problem and/or solutions.
  3. Next the discussion may move to the (Yellow then) Green hat in order to generate ideas and possible solutions.
  4. Next the discussion may move between White hat thinking as part of developing information and Black hat thinking to develop criticisms of the solution set.

Because everyone is focused on a particular approach at any one time, the group tends to be more collaborative than if one person is reacting emotionally (Red hat) while another person is trying to be objective (White hat) and still another person is being critical of the points which emerge from the discussion (Black hat). The hats aid individuals in addressing problems from a variety of angles, and focus individuals on deficiencies in the way that they approach problem solving” (Wikipedia, 2017).

Some useful handout resources:


De Bono, E. (2017) www.edwdebono.com.

De Bono, E. (1999). Six thinking hats (Vol. 192). New York: Back Bay Books. [presentation]

De Bono, E. (1985). Six Thinking Hats: An essential approach to business management. Little, Brown, & Company, New York, USA.

Carl III, W. J. (1996). Six Thinking Hats: Argumentativeness and Response to Thinking Model.

Wikipedia (2017) Six Thinking Hats.


Seven Behaviors to Advance Teamwork

Journal Club: Weberg, D., & Weberg, K. (2014). Seven behaviors to advance teamwork: findings from a study of innovation leadership in a simulation center. Nursing administration quarterly, 38(3), 230-237. [abstract]

This article discusses leadership as a team dynamic and presents 7 characteristics of innovation leadership that support the work of teams. The belief that traditional notions of individual-based leadership behaviors are now no longer adequate to achieve innovation in health care organizations. The idea is for everyone in an organization to lead, at the same time in meaningful teamwork, and in dynamic ways.

To better understand how group interactions can facilitate innovation, build the future of health care, and describe how “everyone can be a leader,” there is a need to shift from individual centric leadership notions and embrace leadership as a team dynamic.

The 7 innovation characteristics are:

  1. Boundary spanning,
  2. Risk taking,
  3. Visioning,
  4. Leveraging opportunity,
  5. Adaptation,
  6. Coordination of information flow,
  7. And facilitation.

Leadership As A Team Dynamic

“As information, globalization, and technology continue to grow and impact organizations, the traditional conceptualization of the leader as an individual is no longer adequate. Command-and-control methodologies, prevalent in traditional leadership theories, restrict information and create a culture of reliance on the leader for all answers. The literature describes how innovation leadership provides evidence that organizations that support team leadership behaviors have significantly better success in improving innovation and organizational outcomes than those supporting only the traditional hierarchal power structures. Team-based programs that focus on communication, coordination, and cooperation have been shown to improve patient fall rates, team work in times of crisis, and enhance a culture of safety in health care organizations.”

Moving Away from Command and Control Leadership

To innovate, evolve and achieve innovative outcomes, organisations should:

  • move away from command and control centric models of leadership,
  • support the development of diverse teams and promote collaboration among these teams.

The leadership model involves one of shared accountability and networked decision making. Innovation is influenced by more team-centric leadership behaviors, such as engaging the organizational network and proactively seeking out innovations. Weberg & Weberg state that examples of the traditional models of leadership can be seen in physician-centric models of care, poor performing unit-based teams, and requirements for executive approvals for small tests of change.

Developing Diverse and Collaborative Teams

“Creating diverse teams with members who have differing influence and viewpoints allows for disruptive convergence of information that may lead to innovation. Research has demonstrated support for
team diversity as a nonlinear characteristics of high-performing teams. Teams with too much diversity in opinion and direction and lacking leadership behaviors tended to become stuck in argument. In contrast, high performing teams were able to oscillate between diverse discussions with ease, demonstrating the right amount of heterogeneity. Sustaining diverse teams requires organizational support and structure that promote relationship-based communication and collaboration among the teams.The creation of a relationship-oriented culture in which information and ideas are exchanged through interconnectedness and open communication leads to higher-performing teams and can directly impact the care of patients.”

Seven Characteristics Of Innovation Leadership

Weberg & Weberg state “it is important to consider the team-based approach to leadership, in which a mixture of leadership characteristics is displayed by different people, regardless of their role, at various times. The implementation of an innovation is not a single planned event but rather the synthesis of multiple interactions and changes that occur as the innovation is introduced into the system.

1. Boundary Spanning

Boundary spanning is the process of team members in a system making connections to
otherwise unconnected groups. In traditional leadership, boundary spanning is reserved for
top levels of the organizational hierarchy. In innovative organizations, boundary spanning is encouraged and facilitated at all levels of the organization. Boundary spanning can also disrupt linear thinking by creating networks and experiences that challenge inadequate assumptions.

2. Risk Taking

Risk-taking behaviors are reflective of a team’s ability to process new information and determine a lack of fit between the information and the organizational structure and culture. Many risk-taking behaviors focus on trial-and-error efforts to test different technologies and implementation strategies in order to determine the best fit with the organization.

3. Visioning

Creating a vision of the future requires collaboration between networks of agents. Instead of an executive leader spending significant amounts of time creating a compelling vision of the future in a silo, teams including frontline managers, directors, and subject matter experts can be connected and interviewed to create the shared vision of the future

4. Leveraging opportunity

Leveraging opportunity occurs when conflict and divergence are identified, and an organization utilizes this awareness to problem-solve and identify opportunities for improvement and innovation. When a vision is shared among a team rather than kept within a formal leader, the opportunities for identifying divergence multiplies and the effort to leverage these opportunities become more diverse, inclusive and focused.

5. Adaption

To quickly and effectively respond to the changing environment in health care, a leader must be able to effectively adapt his or her roles, messages, and strategies. As information is shared, and interpretation and behavior adaptation occur in response, so does the relationship between teams and team members. Therefore, teams that display adaptation to these pressures have improved ability to innovate, adapt, and move on.

6. Coordination of Information Flow

Leaders who can effectively gather and share resources are better positioned to overcome stagnate organizational structures. The transfer of information within an organization requires the collaboration and participation of various agents, therefore, supporting the need for teams built on connections and relationships within a system. An innovation leader is able to open information flow into the system and help the team begin to process and make sense of it.

7. Facilitation

Team-based leadership relies on the notion that all people demonstrate various leadership characteristics at different times, regardless of their formal role. Facilitation is accomplished through building relationships, gaining understanding, and connecting the day-to-day work of the organization with the larger organizational mission/vision.”


Health care leaders may stand to benefit significantly from understanding and facilitating the 7 characteristics of innovation leadership. The term “leader” according to Weberg & Weberg refers to all individuals in the organization who administrate, enable, and adapt novel solutions to complex situations.


Weberg, D., & Weberg, K. (2014). Seven behaviors to advance teamwork: findings from a study of innovation leadership in a simulation center. Nursing administration quarterly, 38(3), 230-237. [abstract]