The Seven Phases of Change

Career transitions are all about change. For physician leaders considering a different path, Frank Cohen and Owen Dahl reflect on the Seven Phases of Change in their book, Lean Six Sigma for Medical Practice.

Change is such an important and common event that many organizations have people whose sole responsibility is change management. And change management is often a discipline defined more by psychology than by business acumen.

Change is, in fact, like most everything else, a process. And like every other process, it involves a series of steps that are necessary to reach a successful conclusion.

It’s quite interesting, actually, that the steps (or phases) associated with the change process are not dissimilar to the five phases of death. In fact, many workers are more fearful of change than of death.

They cite a 2001 article “Managing Change — Definition and Phases in Change Processes,” in which Oliver Recklies identifies seven distinct phases by which people perceive change.

• Phase 1—Shock and Surprise: People can confront unexpected change “by accident” (e.g., losses in particular business units) or through planned events (e.g., workshops for personal development and team performance improvement). These situations make people realize that their own patterns of doing things are not suitable for the new conditions. Thus, their own perceived competence decreases.

• Phase 2—Denial and Refusal: People activate values to support their conviction that change is not necessary. Hence, they believe there is no need for change; their perceived competency increases again.

• Phase 3—Rational Understanding: People realize the need for change. Their perceived competence decreases again. They focus on finding short-term solutions and thus cure only the symptoms. They are not willing to change their own patterns of behavior.

• Phase 4—Emotional Acceptance: This phase, which is also called “crisis,” is the most important one. Only if people are willing to change values, beliefs, and behaviors, will organizations be able to develop people’s real potential. In the worst case, however, change processes are stopped or slowed down here.

• Phase 5—Exercising and Learning: The new acceptance of change creates a new willingness for learning. People start to try new behaviors and processes. They experience success and failure. It is the change that managers use to create some early wins (e.g., by starting with easier projects). This leads to an increase in peoples’ own perceived competence.

• Phase 6—Realization: People gather more information by learning and exercising. This knowledge has a feedback effect; people understand which behavior is effective in which situation. This, in turn, opens their minds for new experiences. These extended patterns of behavior increase organizational flexibility. Perceived competency reaches a higher level than before the change.

• Phase 7—Integration: People totally integrate their newly acquired patterns of thinking and acting. The new behaviors become routine.

Management’s willingness to embrace both the change itself as well as the emotional manifestation that change creates is what is necessary to ensure transitional events with the least amount of resistance. The pain is not in the change; it’s in the resistance.

Excerpted from Lean Six Sigma for the Medical Practice: Improving Profitability by Improving Processes by Frank Cohen, MPA, and Owen Dahl, MBA, LFACHE, CHBC, LSSMBB.