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Welcome Back, Kotter! Leading Health System Change

#Leading Change-Market Corner Commentary: June 24, 2015-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 Arnold Horshack) 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 Horshack 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.

Arnold Horshack discovered that good looks (or a strong brand) weren’t enough to survive beyond high school. Gabe Kotter provided leadership that inspired Horshack’s transformation.

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 4sight Health Author
David W. Johnson
David Johnson CEO 4sightHealth

David Johnson is the CEO of 4sight Health, a boutique healthcare advisory and investment firm. Dave wakes up every morning trying to fix America’s broken healthcare system. He is a frequent writer and speaker on market-driven healthcare reform. His expertise encompasses health policy, academic medicine, economics, statistics, behavioral finance, disruptive innovation, organizational change and complexity theory. Dave’s book, Market vs. Medicine: America’s Epic Fight for Better, Affordable Healthcare, is available on