From the Kotter Playbook: Patient Experience As a Model for Creating a Sense of Urgency and a Working Coalition for Change

1Cleveland Clinic, Cleveland, OH

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 216


Patient satisfaction is measured across hospitals through a uniformly administered patient survey called the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). This was developed by the Centers for Medicare & Medicaid Services (CMS). Upcoming pay‐for‐performance and current public reporting will place many health care institutions at risk of financial, reputational and credibility crises. This frames a considerable impetus for health care provider entities to rapidly adapt culture change geared toward improving patient experience.


To demonstrate an effective and sustainable model for changing the practice behavior of a large tertiary‐center hospital medicine department using Kotter's 8‐step change model.


The 8 steps of the model are: create urgency, form a powerful coalition, create a vision for change, communicate the vision, remove obstacles, create short‐term wins, build on the change, and anchor the changes in corporate culture. Urgency was established through a high‐profile information campaign that truthfully framed our low HCAHPS scores as a severe credibility crisis. Updates on current scores and individual hospitalist scores were revealed through small‐group and one‐on‐one discussions. The meetings were conducted by a coalition consisting of the department chairman and midlevel leadership coupled with clear outside support from higher institutional leaders. The following vision was communicated: “Each individual in this department is to be renowned not just for clinical, administrative, and research skills but for patient‐centered compassionate care.” The campaign resulted in open participation in doctor‐communication‐based project pilots: bedside nurse–doctor rounds, a predischarge “flyby,” patient‐centered “who is my doctor” business cards, “doctor communication bundle” cue cards, a postdischarge call‐back program and a tip of the week email. As broad‐based support from the majority was solidified, resistance elements were significantly rare. Gains were noted in the HCAHPS doctor communication metric across our 3 medicine units. From April 2008 to August 2010, the mean score was 68.4%. September 2010, the initiation phase of the strategy, posted 77%, representing an all‐time high. October attained 72%. Partial data for November reflected 86%, consistent with 90th‐percentile performance. We intend to sustain the change through constant evaluation, ownership expansion, recurrently telling our story and emphasizing the same for all new hires.


Hospitalists have the greatest knowledge of hospital systems and need to assume ownership of quality and patient experience initiatives. Kotter's principles are an effective and sustainable leadership strategy for when culture change of an organization is required.


V. Velez ‐ none; B. Harte ‐ none; C. Whinney ‐ none; T. Crone ‐ none; J. Trem ‐none; R. Rivera ‐ none; B. Folds ‐ none

To cite this abstract:

Velez V, Harte B, Whinney C, Crone T, Rivera R, Folds B, Trem J. From the Kotter Playbook: Patient Experience As a Model for Creating a Sense of Urgency and a Working Coalition for Change. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 216. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed September 20, 2019.

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