Implementing a change is a great effort, whether it is a personal matter, or within a group or institution.

As in a personal way, the force of habit dominates us, so does it happen to human groups. The improvements that must be made inside a hospital, with no doubt, are changes. Sometimes they are small changes of learning techniques and other times are great changes of culture.

Many of the changes fail in the moment of making them, because the difficulty that really exists to change is yet unknown.

The strategy for changing leads us to study it, as a real battle (figuratively).

  • There will be winners and losers.
  • There will be friends and enemies (or simply people who oppose).
  • It is better to prepare the troops, that is, to bring together all those who can help us and instruct and motivate them to support change.
  • There will be an evolution, that is, a process. Everything will not happen in an instant, but in a sequence, that must be studied and conducted.
  • Change will bring a new reality and new problems to be anticipated.
  • If the desired change cannot be achieved, the situation must be anticipated and there will be a new stable situation.
  • Is it possible and convenient to divide the change into several stages?

Moving forward a change requires a level of leadership. The person should stand out by his position, his history, virtues or knowledge. From inside out, the leader must have great personal discipline and emotional mastery of his person.

We normally classify the changes in: large, medium and small.

  • The big ones will be resisted and probably prevented, as they will seriously affect someone.
  • The little ones will be undone to the back when the wave of change happens. And there will be no change.
  • The realization of several medium changes is a great change and is the most probable way to evolve by overcoming the resistances.

Darwin quotation

We need to emphasize the need to prepare people for change. Fears, and especially the fear of the unknown, create a great force of opposition to change. It is easier to change when the consequences are fully known and help is requested to move forward.

The hospital environment, being a human set of many people and different levels with a gradient of authority and a strong tendency to exercise positions of power, is especially sensitive to all changes.

The change first occurs in the head of people and then in reality. That is why transmitting a vision of post-change reality and selling that idea, properly, is the way to a successful change.

It is often necessary to argue that change will occur anyway, either now or later and that resistance will be overcome by another, with a better or worse outcome than the current one. People should also envision non-change. That is, how a situation can be degraded by lack of conduction towards a positive change, leading to a situation of deterioration. Although we often oppose a change to maintain the status quo or current situation, in fact there is always a change and in that case, for lack of a driving force, it will be for the worst.

There are the top-down changes in the hierarchical scale and the bottom-up changes. The two may fail for lack

of support. It is necessary to recognize which position you have and complement with what you miss, that is, the two supports are necessary and must be developed.

After the change, it is necessary not to trust that everything is already achieved. The changes come back as much as they advance. It is necessary to do a follow up and to correct or improve, tying all loose ends;

In short, we can summarize this way:

  • Study and prepare yourself for change.
  • Take effective leadership, with the necessary supports.
  • Transmit a vision.
  • Choose several medium changes to make.
  • Track and improve post-change.

In change, death and taxes are the only certain things in life.