← Back to Insights
June 24, 2015
Download PDF 
David W. Johnson
Innovation System Dynamics

Welcome Back, Kotter! Leading Health System Change

A version of this commentary first appeared in “Academy 360” on June 11th

In the popular 1970s television how, Welcome Back, Kotter, Gabe Kotter returns to his Brooklyn alma mater, Buchanan High, to teach self-proclaimed “Sweathogs” — failing students heading for oblivion.

Here’s the twist. As a remedial student himself at Buchanan, Kotter had founded the Sweathogs ten years earlier. Through persistence, humor and constant support, Kotter pushes his student Sweathogs (even John Travolta’s Vinnie Barbarino) to recognize their potential and graduate.

In 1996, Harvard Business School professor John Kotter published Leading Change. Originally conceived as “the next installment in a series of research projects,” Leading Change became a seminal work on organizational transformation.

Welcome Back, John Kotter

Like his television namesake, John Kotter returned home. In 2012, Kotter reissued Leading Change with a new preface. Why? The speed and complexity of today’s marketplace demand agile and change-friendly organizations.

Kotter’s key insight is that “management is not leadership.” Management makes systems work. Leadership builds new systems and transforms old ones.

Too often, complacency stymies organizational change. Only effective leadership can overcome it.

8-Step Program

Leading Change offers an eight-stage, sequential process for guiding organizational transformation. It’s clear, logical and incisive. Missing steps can and usually does cause failure. Here are the eight steps:

  1. Create Urgency
  2. Build Guiding Coalitions
  3. Vision and Strategy
  4. Communicate Change
  5. Empower Employees
  6. Short-term Wins
  7. Consolidate Gains
  8. Anchor Change in Culture

Walk Before Seeing: Leading Change

Placement of “Vision and Strategy” third is illuminating. Far too many CEOs crystalize their vision before establishing organizational urgency and building strong coalitions to sustain change strategies. Kodak comes to mind.

By contrast, the most compelling visions and successful transformation strategies emerge within organizations that create urgency, overcome complacency and build formidable change coalitions.

If Vinnie Barbarino can Graduate…

Rhetoric exhorting transformation overwhelms healthcare; yet, there are few transformative health systems.

Structural impediments slow progress. Fee-for-service reimbursement still accounts for almost ninety percent of provider revenues.

If we’re being honest, however, structural explanations are insufficient. There’s too much management in healthcare and not enough leadership.

Vinnie Barbarino discovered that good looks and a “strong brand” aren’t enough to survive beyond high school. Gabe Kotter provided the leadership needed that inspired Vinnie to graduate and become a productive member of society.

Health system executives know their organizations need to deliver transparent, outcomes-driven, customer-friendly care. In Leading Change, John Kotter gives these executives a roadmap for the journey.


About the Author

David W. Johnson

David Johnson is the CEO of 4sight Health, an advisory company working at the intersection of healthcare strategy, economics, innovation. Johnson is a healthcare thought leader, keynote speaker, and strategic advisor to organizations busting the status-quo to reform our healthcare system. He is the author of Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare, and his second book, The Customer Revolution in Healthcare: Delivering Kinder, Smarter, Affordable Care for All (McGraw-Hill 2019). As a speaker, Dave plays the role of rebel, challenger, industry historian, investor and company evaluator to push audiences forward. (Watch bio video.) Johnson applies his 25+ years of investment banking in healthcare to identify ways the healthcare industry must change to deliver better care. He received a Masters in Public Policy from Harvard Kennedy School, an English degree from Colgate University, and served in the African Peace Corp service. Join over 10k+ healthcare executives who read our weekly insights and commentary on www.4sighthealth.com. His third book, Less Healthcare, More Health: The Prescription for a Happier, More Equitable and Productive America, will publish in 2024.

Recent Posts

The First Step to Recovery for Healthcare Is Standardization
They say you can’t improve it unless you measure it. I say you can’t measure it unless you… Read More
By May 22, 2024
Podcast: How Healthcare Revolutionaries Think with Matt Marek
Do Caregivers Know What’s Coming? Matt Marek Talks About Changes in Home Healthcare The revolutionary work Matt Marek… Read More
By May 21, 2024
How Healthcare Revolutionaries Think: 10 Questions with Matt Marek
Welcome to the latest installment of 4sight Health’s series, How Healthcare Revolutionaries Think. Our interview series profiles healthcare… Read More
By May 21, 2024