This 2 – Minute Topic defines change and provides insight on how to manage it.

There are three distinct types of change: 1) straightforward change, 2) moderate change, and 3) uncontrolled change.

Straightforward Change

Straightforward change is the simplest of all change. It is not necessarily related to habit. This type of change is the easiest to describe in terms of examples.

Example 1: you wake up in the morning to find that it snowed several inches, and it doesn’t look like the plows have made it through your neighborhood. You decide to leave 10 minutes early. Not a major change.

Example 2: you decide to go to your favorite fast-food restaurant for lunch and the menu selection you normally choose is not available. You pick something else. Not a major change but it may be a tad upsetting.

Moderate Change

Moderate change is more difficult than straightforward change. Moderate change is not as difficult as uncontrolled change, but it is certainly not easy. With moderate change, the individual is still in charge.

The best example of this type of change is on full display at the start of the new year. Many Americans choose weight loss as their number one goal. It is moderate change as it requires quite a bit of effort and staying power. Nevertheless, the individual still has the choice to continue with the goal and the changes needed to achieve that goal or go back to old habits.

Uncontrolled Change

Uncontrolled change is the most difficult change as it is not within our locus of control. Examples of uncontrolled change would be a lay-off, or termination. Another example of uncontrolled change directly related to the field of healthcare would be an unexpected diagnosis or the tragic loss of a loved one.

Managing Change

This section is broken into two parts: 1) understanding how to manage change, and 2) how we personally handle change.

Part 1: Understanding how to manage change. The following 13 steps to managing change is adapted from the North Central Regional Educational Laboratory (Dennis Sparks).

  1. Educate your leaders of change.
  2. Use a systems approach to ensure all aspects of the organization are covered.
  3. Use a team approach that involves as many stakeholders as possible.
  4. Share power with employees and others to implement the change efforts.
  5. Make plans but hold your plans loosely. No need to create boundaries when they are not needed.
  6. Realize that there is a tension between readiness and implementation.
  7. Provide appropriate levels of training and staff development for those involved.
  8. Choose innovative practices for change efforts.
  9. Recognize that change only happens through people.
  10. Be prepared for the implementation dip. It gets worse before it gets better.
  11. Be sure everyone fully understands the reasons for the change.
  12. Seek out change cheerleaders.
  13. Take the long view and understand that change does not happen overnight.

Part 2: How we personally handle change. Knowing how we handle change is imperative if we are to be change leaders in our organization. Change is loss. Although the severity of loss is dependent on the situation, change takes its toll on a psychological level. Understanding the psychology is the goal of Part 2.

In 1969, Elizabeth Kubler-Ross published her ground-breaking book, On Death and Dying. In the book, she postulates how we cope with loss by identifying five stages of grief. They are: denial, anger, bargaining, depression, and acceptance. It is important to note that not everyone experiences all five stages, nor do they make it to the final stage acceptance.


Denial is a very powerful tool that helps us manage our emotions in real-time. Some events are so catastrophic that our brain knows it is easier for us to deny that it happened. Denial allows our subconscious the time it needs to process the information and prepare our conscious for the ultimate realities that will set upon us.


Anger is a secondary emotion. It is a reaction to a primary stimulus. We may be angry at the person (or people) who put the change upon us such as our deceased loved one, physician, ourselves, our boss, or even God. Not everyone experiences anger and unfortunately, some people may get stuck here. Unresolved anger is ultimately detrimental to our health. Anger utilizes far more energy than we consume, and it easily causes fatigue or secondary issues such as stress, high blood pressure, etc. It can even lower our immune system making us more prone to illness.


In the bargaining stage, people turn to those who they perceive to have the ability to correct the loss. They may bargain with a physician, a boss, a spouse, or God. Most bargaining does indeed turn to God. This is one of the primary reasons why there are chapels in health facilities.


When the above stages do not work, the next stage is often depression. There is a huge difference between sadness and depression. Everyone experiences sadness to some degree. However, sadness that starts to affect a person’s daily activities, is not alleviated after deliberate measures, or lasts for more than two weeks, may actually be depression. Depression affects an estimated 17 million individuals in the US. If you, or if someone you know, is suffering from depression, please see the resources at the end of this course for help.


The final stage in Kubler-Ross’s stages of grief is acceptance. Not everyone makes it to this final stage. It may take years or longer to work through the above stages especially if there is an associated feeling of guilt that may complicate matters. Acceptance does not necessarily mean that the person has moved past the loss, rather, acceptance means that the person has come to understand that they cannot change the outcome and that it is okay to go forward.


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