Our project is stuck.
If I stop pushing, things stop moving.
I need people to do things differently, but they don't report to me.
People are overloaded. I can't get them to pay attention.
These common refrains highlight the real-world challenges leaders face when trying to implement change. And, given everything from cost pressures to technological disruptions like AI, the pressure to transform healthcare organizations has never been more intense. Yet despite the urgency, many change initiatives fail to achieve their desired impact.
McKinsey research suggests that 70% of the reason change doesn't happen is because of mindsets and beliefs, not structural or technical barriers. Leaders often cite key obstacles to be a lack of time, skepticism about whether doing things differently will help, and insufficient support to translate ideas into action.
Navigating these complex waters may require approaches that go beyond simple directives from organizational leaders. Three exceptional healthcare executives I spoke with earlier this year—Ruth Bash, FACHE, senior vice president/chief experience officer, Inspira Health, Mullica Hill, N.J.; Sabrina Granville, chief human resources officer, Tufts Medicine, Burlington, Mass.; and Marty Sargeant, CEO, Keck Medical Center of USC, Los Angeles—shared three key principles for implementing change efforts, and I share their guidance below.
1. Effective change needs to be both top-down and bottom-up.
Leaders must strike a balance of setting clear direction while simultaneously tapping into the creativity, resilience and commitment of the entire organization. You need both a strategy that is planned and later executed, and innovation that emerges and is later recognized.
Granville shared how leaders at Tufts Medicine demonstrated this principle when integrating their HR practices across a growing system. While the strategic direction came from senior leadership, the successful implementation relied on engaging managers and front-line staff in shaping how the strategy would be realized in their specific contexts.
2. The future is here! But it's unevenly distributed.
Most innovations aren't new. Instead, they recombine existing ideas or extend them with a new twist. Studies suggest that 85% of innovative ideas are already present somewhere in the organization. The challenge is identifying them and helping them spread.
Bash shared an example of this principle in action at Inspira Health. "I found out about an initiative where photos of team members from different units were displayed in areas they frequently interfaced with," she explained. “This simple innovation, which originated within our organization, increased empathy and understanding between departments that needed to work together." Rather than taking an entirely new approach, they focused on identifying internal practices that were achieving results and creating mechanisms for those practices to spread more widely.
3. "Pull" is stronger than "push."
Creating "pull" means helping people see opportunities they want to commit to as opposed to change they feel obligated to commit to. When people are pulled toward change because they see value in it, they aim higher and bring more creativity to the process than when complying with directives.
According to Sargeant, Keck Medical Center of USC exemplified this approach by focusing on clear performance metrics that demonstrated the influence and impact of their leaders. By connecting change initiatives to metrics that mattered to people across the organization, they created natural pull for participation.
One of the most counterintuitive insights these executives shared was the importance of viewing resistance as a natural part of the change process—not something to be overcome or eliminated but rather engaged with constructively.
Resistance is part of the work. When leaders treat resistance as valuable feedback rather than an obstacle, they gain crucial insights that can strengthen their change initiatives and identify potential blind spots.
Healthcare transformation requires more than technical solutions—it demands leadership that can navigate the complex human dynamics of change. By applying these three principles, leaders can increase the probability of successful change and create more resilient, adaptive organizations capable of meeting healthcare's evolving challenges.
Jennifer L. Tomasik, FACHE, is vice president, CFAR Inc., Providence, R.I.