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36 Practical Leadership Skills forFamily Medicine Residency Program Directors
429
their committees. Be available for guidance but trust them to
do the work and give them real authority. It will be an important part of developing your team of faculty members.
Communication Management
In today’s world, communication is instantaneous and pervasive. People tend to expect quick responses to e-mail and
texts. The resources today for communication are legion. As
program director, you will be inundated with e-mails, texts,
and other forms of communication from people upstream
and downstream from where you sit in the organization.
Taming the e-mail beast is an important skill to learn. This is
not a comprehensive discourse on how to best manage
e-mail, but an encouragement to nd a method that works for
you and leverage the method to your advantage. Your organization may require you to use a particular e-mail client.
Explore its abilities and learn how to create folders, rules for
e-mails, and most importantly, manage the junk/spam folders! Set up rules to send e-mails you don’t need to read
immediately (or ever!) to your junk/spam folders, for
example.
What is more important is to learn how and when to
respond to e-mails or other forms of communication. It is
easy to quickly respond to an e-mail especially when it is
something that particularly strikes a passionate streak within
you. However, always take a deep breath, and spend time
gathering some background before you respond. As one of
my mentors would say “never write an e-mail that you
wouldn’t be afraid to be seen on the front page of the local
paper.” By all means, respond in some fashion but take your
time when the topic is nuanced and has room for misinterpretation. Maybe it is better to pick up the phone and talk to
the individual in person rather than putting a response in
writing. For the quick factual question, respond quickly and
move on to the next item. Remember the concept of “whose
monkey is on your back” and get the issue off of your plate
of things to do.
There will be times that thoughtful and meaningful explanations of vision, personnel changes, program planning, and
other important events will need to be put in words for distribution to the faculty and residents. Use these opportunities
sparingly as you don’t want it to be viewed as the daily
“meaningless message from management” by residency program members. At the same time, these messages can serve
as important milestones inthe life of the residency program.
Use them to your advantage to convey important concepts
and plans for everyone.
A communication opportunity unique to family medicine
residency directors is through the Association of Family
Medicine Residency Directors (AFMRD) list-serve. This is
an online e-mail list-serve to which you can post questions or
comments about residency education and receive feedback
or comments from other program directors across the nation.
It is an invaluable source of information, comments, and
ideas for your role as program director. While it can be voluminous, you can easily use your e-mail client to put the messages in a folder for you to review at your leisure. Many
pearls of wisdom can be found in the collective that is the
program director community!
Lessons Learned fromtheTrenches
After 27years of being a Family Medicine Program Director,
I can say that it has been a wonderful career, full of many
challenges and rewards but also of lessons that have been
hard earned and learned. This chapter is full of lessons in
leadership learned over the years but is not all encompassing,
by any means. I have compiled what I thought were ve of
the most important lessons for a program director to know
[8, 9]. I offer this in the hope that it will bolster you in the
work of training the next generation of family physicians.
First: Never believe your own press.
There are days that residents won’t believe or trust you and
other days that you are the greatest person that has graced
the halls of the hospital. There are times that your faculty
colleagues will not want to follow your lead and other
days they thank you for your hard work. Through it all
remember that your self-worth is not determined by the
opinions of others, whether negative or positive. Be humble and do the job for the meaning it brings to all of us, not
to win the praise of others.
Second: Time is your ally.
Sometimes it is better to just listen and not act. A lot can be
accomplished by waiting for tempers to cool, people to
come back with new ideas, and for the sun to set. Be
patient.
Third: Use anger judiciously.
There are very, very, few times to be angry about issues.
Injustice and falsehoods are examples of such situations.
The people you work with will remember the one time in
10years that you were angry and know that it was a seri-
ous moment. Be wise as to when you need to show anger.
Fourth: Have fun!
I have a regular habit of placing on each weekly faculty
agenda a short comic strip, funny quote, or something else
that has brought a smile to my face. Not everyone appre-
ciates the humor, but over the years I hope that each per-
son on the team remembers to smile once in a while and
know that this work is both meant to be meaningful and
enjoyable.
430
D. Araujo
Fifth: Create a family.
The name of our specialty is Family Medicine. Not only do
we take care of patients in that context, we take care of
each other as a team. Work hard at creating a family with
your faculty and residents, it will give your work a sense
of mission.
References
1. Logan D, King J, Fischer-Wright H. Tribal leadership: leveraging natural groups to build a thriving organization. New York:
HarperCollins e-Books; 2007.
2. Liberating Structures. Including and unleashing everyone. https://
www.liberatingstructures.com
3. Accreditation Council for Graduate Medical Education. ACGME
program requirements for graduate medical education in family
medicine. Published online, in effect 07 Jan 2023. https://www.
acgme.org
4. Oncken W, Wass D.Management time: who’s got the monkey?
Harvard Business Review, December 1974.
5. Accreditation Council for Graduate Medical Education. ACGME
online learning portal for faculty development. https://dl.acgme.org
6. Society of Teachers of Family Medicine. https://www.stfm.org
7. Lencioni P.The ve dysfunctions of a team, a leadership fable. San
Francisco: Jossey-Bass; 2002.
8. Goleman D. What makes a leader? Harvard Business Review,
January 2004.
9. Araujo D.Lessons from the trenches. AFMRD Nikitas J.Zervanos
Program Director of the year award presentation. AFMRD annual
meeting, March 2023, Kansas City, MO.
Managing Change in Family Medicine Residency Programs
JoanneSuh, JustinBui, MatthewSayre, WilliamFang,
andJehniRobinson
37
Key Points
• Change is inevitable, Kotter model is useful for managing change, create urgency, build coalition, develop and
communicate a vision, identify stakeholders and get
buy in, empower others, generate quick wins, consolidate gains, anchor change in the culture and put people
rst.
Introduction
Change is inevitable. As physicians caring for people across
the lifespan, as educators preparing learners for a complex
world, and as local leaders in our health organizations, managing change is expected in the work of family physicians.
Family Medicine is uniquely poised to be the leading specialty to effect positive change in our healthcare systems
because of our breadth, depth, whole-person and communityrooted approach. Modeling and teaching change management in residency programs is vital to prepare future family
physician leaders for rapidly shifting healthcare and educational landscapes. From global pandemics to new ACGME
requirements to adaptation to new models of care and the
impact of healthcare consolidation, change is the only
constant.
J. Suh · J. Bui · M. Sayre · W. Fang · J. Robinson (*)
Family Medicine, Keck School of Medicine of USC, University of
Southern California, Los Angeles, California, USA
e-mail: joanne.suh@med.usc.edu; Justin.bui@med.usc.edu;
Mathew.sayre@med.usc.edu; William.fang2@med.usc.edu;
Jehni.Robinson@med.usc.edu
What Is Change Management?
Change can feel daunting, but it doesn’t have to be.
Borrowing from organizational science, change management is a structured framework and set of tools to optimize
effectiveness, efciency, and success. Utilizing established
change management frameworks like the Kotter Model
can help navigate change and transitions smoothly. The
Kotter Model, also known as Kotter’s 8-Step Process for
Leading Change, is widely used in many industries including business, education, and healthcare, and is considered
a foundational change management methodology. The
three core tenets of successful change distilled from Kotter
are communication, collaboration, and commitment.
Though the Kotter Model is a sequential approach, change
is often cyclical and not linear. Figure 37.1 depicts the 8
steps of the Kotter Model in a circular fashion to represent
the iterative nature of change management:
1. Create Urgency
Why is this change happening? Why is this change important? Communicate and highlight the potential opportunities, and the potential risks of not implementing the
change. Establish a sense of urgency to motivate individuals to move beyond their comfort zones to embrace the
change, and for leaders to sponsor the change.
2. Build a Coalition
Who can drive this change forward, and who will this
change affect? Form a coalition of inuential leaders and
stakeholders who are committed and have the credibility
and inuence needed to drive the change forward.
3. Develop Vision
What is the change? Develop a clear and compelling
vision for the future. This vision should articulate what
the organization will look like after the change, and ideally be co-created with the coalition of stakeholders and
leaders assembled in the previous step.
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
R. Kellerman, G. Irwin (eds.), Graduate Medical Education in Family Medicine, Excellence in Medical Education 2,
https://doi.org/10.1007/978-3-031-70741-4_37
431
432
Fig. 37.1 8 steps of the
Kotter Model in a circular
fashion to represent the
iterative nature of change
management
J. Suh et al.
4. Communicate Buy-in
Why should people care about this change? What is in it
for them? Understanding what motivates people, their
“why” or their “WIFM” (what’s in it for me) will enable
mobilization of a broad network of champions to advocate for the change and drive momentum.
5. Empower Others
Who are the change agents and how can you activate
them? Who are the change resistors and how can you strategically engage them? This step involves identifying and
addressing structural, procedural, or cultural barriers that
may hinder the implementation of the change.
6. Generate Quick Wins
What does success look like? Plan and execute shortterm, achievable goals that concretely demonstrate the
benets of the change. Communicate and celebrate these
quick wins to build condence, momentum, and support.
7. Consolidate Gains
Repeat. Repeat. Repeat. Sustain acceleration and avoid
complacency by continually reinforcing the importance
of the change. Build on the momentum from the quick
wins, continuously communicating progress, reinforcing
the importance of the change, addressing any remaining
resistance, and activating new change champions.
8. Anchor Change in Culture
Embed the change into the organization’s culture and
processes. This step involves ensuring that the new behaviors and practices become the norm, there are new leaders
and champions for this change, as well as increasing
capacity and adaptability of the entire team for change.
The “People Side” ofChange Management
Whether the change is big (starting a new residency program) or small (new clinic scheduling process), change management is about putting people rst. The “people side” of
change management recognizes that organizational change
is not just about processes, structures, and systems, but also
about the individuals who make up the organizations. If the
people most affected are not engaged and empowered every
step of the way, change will not be effective or sustainable.
Organizational change can only occur if individual beliefs
and behaviors change. Managing the people side of change
involves understanding and addressing the emotional and
psychological aspects of change for stakeholders. This is
essential to minimize resistance, cultivate a positive culture
of continuous improvement, and ensure that the change is
collectively embraced and sustained over time.
Change Management Case Study
In this chapter, the authors describe how they applied the
Kotter Model to systematically and comprehensively address
the strategic and human aspects of a major change, starting a
new residency program in a new sponsoring institution. The
unique perspectives from the Department Chair, Founding
Program Director, and Inaugural Chief Residents are highlighted to provide a multi-dimensional narrative of a change
process that puts people rst.
37 Managing Change in Family Medicine Residency Programs
433
Kotter Model
Step 1: Create Urgency
As a new chair, I was asked by our new dean and my
former chair, to unwind our relationship with a community hospital where our residency was based. This
could mean laying off six faculty members within a
year’s time. After a brief period of denial passed, where
I thought that I could salvage the program and our
involvement, I realized I had to move forward with this
change. As a new leader, it was challenging to think
about how to best support our people through a change
they didn’t want, to acknowledge the loss and fear
while thinking strategically about how to move forward towards an outcome that I couldn’t completely
control. (Jehni Robinson, Department Chair)
Leaders are often faced with implementing change.
Sometimes leaders are engaged in choosing and designing
the change but often they nd themselves faced with implementing changes others have directed, from a local executive
or, as a result of national policy decisions that must be implemented locally (such as new requirements for residency
training like Competency-Based Medical education). The
rst step in the Kotter change model is establishing a sense
of urgency. When tasked with implementing a change they
did not choose, a leader must step outside of their comfort
zone and change their mindset and the resulting actions and
behaviors [1]. Developing a sense of urgency requires a
leader to authentically support the change effort because perceptive followers will quickly assess whether the leader is
really behind this change or not and, as a result, whether or
not to engage with the change effort. Pausing to conduct a
self-assessment to determine how the leader feels about this
change can help to get behind it. The following questions
may be useful to consider:
• What is my gut reaction to this? How do I feel about it?
• What, if anything, am I worried about? What do I fear?
• What, if anything, am I excited about?
• What could the results be from this? Consider the positive
and negative outcomes equally.
• What is most important to me in this process?
• Who are the key stakeholders and what might be impor-
tant to them?
• Why does this change need to happen now?
Answering these questions via writing or talking it
through with a trusted colleague is designed to give the
leader a clear sense of both how they feel and what they think
about the impact of the anticipated change. It is important for
leaders to use both thinking and feeling as part of a comprehensive self-assessment, and it will be more important to use
both of these constructs with others later in the process. As
Kotter describes, leaders have to recognize and address the
range of negative emotions from anger to panic to exhaustion
and understand how to tap into positive feelings of faith,
trust, and passion. Leaders must also engage cognition and
rational thought to be able to convince followers that a
change makes sense [2]. Having completed this initial assessment of thoughts and feelings behind the change, the leader
has to honestly answer, “Can I make a compelling argument
to get behind and lead this change and what will that argument be?” The goal is to develop a compelling, sincere, and
urgent case for change that the leader can sell to others. In
the process, it is important to reect on the argument against
the change, both to acknowledge the inner conict that may
exist as well as to begin to anticipate what others may have
concerns about. Inherent is to answer the question of why
now? Adding urgency moves this change action to the top of
the priority list and gives it the necessary attention and
energy to create momentum. Sometimes, the compelling reason may not be inspiring. In our vignette, the chair has inherited a decision she cannot change. In this instance, the
compelling argument may be the decision cannot be reversed
and the leader must commit to the fact the change will happen. It may be useful to consider what parts of the change the
leader and their team can impact and how they want that to
be. Having control over some of how the change will occur
and infusing principles to make the change more palatable to
those impacted can help engage the leader even if she may
not agree with the change that is happening.
Step 2: Build aCoalition
I had a sense that I needed to better understand the
concerns of our faculty and that I had a duty to them to
help them through this process. There were also the
residents to consider. This change could be disruptive
to their education and training. I also knew we had a
long history of partnership with this community hospital. What would happen to the patients if the residency
ended altogether? The community hospital indicated
they wanted the residency to continue and to directly
employ the faculty but was that what was best for the
faculty? I wondered how they felt about this. I decided
no matter what the outcome, I would try to put people
rst as we made decisions and do whatever I could to
support the faculty and residents through the process
and consider the impact on the patients as well. (Jehni
Robinson, Department Chair)
434
Skilled leaders recognize they will not be successful
working alone and develop teams to help drive a change to
completion. The second step in Kotter’s change model is
forming a powerful guiding coalition. A guiding coalition is
important for two reasons. First, leaders need to identify and
understand how key stakeholders feel and what their priorities are. Second, leaders may not have all the skills and
knowledge needed to lead a signicant change. Selecting
team members with the right content expertise, knowledge
of the inner workings of an organization, the appropriate
formal or informal authority and who have credibility with
peers is important [2]. Interviewing key stakeholders can
help leaders better understand stakeholders’ thoughts and
feelings about the change, help leaders learn more about the
topics, timing and strategies to consider as well as the skills,
attributes and resources the stakeholders can contribute to
the change effort. Therefore, an appreciative inquiry frame
is essential in conducting key stakeholder interviews and
active listening is critical. In other words, leaders shouldn’t
come prepared with a speech, ready to sell, and tell about
the change. They should come ready with a list of questions
designed to better understand the concerns of those
impacted, garner intelligence on what additional factors the
leader may not be aware of and be ready to demonstrate that
they heard what was said by summarizing key points and
then, checking did I hear you correctly? Anything else I
missed? What else should I know? The purpose is to assure
constituents that the leader has heard them as well as gathering as much information as possible to help make the change
effort successful.
Here are some questions leaders should consider when
conducting stakeholder interviews:
• What is your understanding of the change taking place
and why it is happening?
• What are your thoughts about this change? What do you
think will happen?
• Who do you think will be most impacted? What concerns
might they have?
• What do you think is most important to do or consider?
Have we forgotten anything important?
• What’s your gut feeling about this change?
• What, if anything, are you worried about? What, if any-
thing, are others worried about?
• Are there positive outcomes you are anticipating? What,
if anything, excites you about this change?
• Who do you think can help with this change? From whom
should we ask for help?
J. Suh et al.
The key stakeholders included the faculty, our department administrator, the program director, the DIO, the
Dean, the residents, the patients, clinic staff, and the
hospital leadership team. Of these, the residency faculty was most impacted. I met with each of the faculty
members to hear what their concerns were and gain
more information. I reached out to the dean’s ofce to
get input and understand the options for faculty.
I learned that most of the faculty valued their role in
residency education and wanted to remain in residency
education. I did my best to listen, hear their questions,
and be honest about answering what I could and directing them back to the community hospital to get other
questions answered. We met regularly with the CEO
and her team from the community hospital, developed
a comprehensive task list to complete, and shared this
with stakeholders to make sure we weren’t missing any
items. We identied a shared goal—to make the faculty transition to employees of the hospital as seamless
as possible and to ensure the residency program continued operating. We provided them with a complete
list of vendors we used with the residency program for
things like laundering scrubs in hope they might take
over the contracts. We decided to donate all the furniture and computers in the clinic space to the hospital
which agreed to take over the lease so that a move was
not required. We planned together notication of the
ACGME to make sure the program was in compliance.
(Jehni Robinson, Department Chair)
We were left without a residency program. I met with
the Dean who voiced support for starting a new program and suggested I meet with different groups and
explore different possibilities. I met with the DIO at
our local county hospital where all of the other residency programs at our institution were based and
learned the institution was on probation and couldn’t
start any new programs. I reached out to the former
program director and others I knew in our local community, from new FM residency programs to contacts
at community hospitals. I reconnected with a faculty
member I knew from when I was a resident who had
started other residency programs. I asked her for advice
and she offered to come work with us and help start a
new program. Having someone on our team who had
done this before was reassuring. She joined our exploration visits and began to explore what might be pos-
(continued)
37 Managing Change in Family Medicine Residency Programs
sible given the current landscape. She discovered that
our health system could become a new sponsoring
institution and draw new cap to support the cost of
hosting a program. I went to the CEO of the health
system with this information and inquired if he’d be
willing to have us help get the health system a new
sponsoring institution designation and have family
medicine as its rst residency? There was no hesitation
in his response. “Absolutely. We would be happy to
sponsor your new residency program.” (Jehni
Robinson, Department Chair)
Regular communication with the guiding coalition
should happen through a variety of mechanisms—regular
group meetings, one on one communication with key stakeholders, brief email updates, pulse surveys to seek input/
hear concerns and walking rounds to take the pulse and hear
how people are doing. These mechanisms should serve to
seek input and share updates, take the temperature and
check in with key stakeholders as well as to continue to use
the group’s expertise to help guide the change. These
updates should contain as much specicity where possible
and answer the question from the audience perspective,
What matters most for me? Leaders often fail to focus
enough time explaining why we need a change and why
now, what is the full extent of the change needed, what will
improve as a result of the change and how will we measure
it, and how does this change relate to our overall strategic
plan [8].
Leaders should check for understanding and assess concerns. Incomplete information framed in what is and what is
not known is important to help alleviate anxiety about
change. Absent information, constituents will create their
own narrative, lling in gaps with what they think or fear
might happen and sharing these concerns with colleagues.
Regular two-way communication is essential to correct misinformation and allay fears. These discussions should repeatedly seek input from constituents and engage them where
possible to provide input into changes they can control. For
instance, designing a new curriculum based on new ACGME
regulations might include inviting residents and faculty to a
committee to discuss how this should be integrated into the
current curriculum, seeking their input and design ideas.
Empowering people by giving them voice and input into
decisions they can impact can lessen feelings of powerlessness. Additionally, working collaboratively with other constituents involved in the change can build relationships,
enhance empathy and understanding, and foster a sense of
we are in this together and prevent groups from vilifying
each other or blaming one another for disruption caused by
change.
435
Step 3: Develop theVision
The groundwork was being laid. We had established
the urgency for a new Family Medicine residency program. We had built a coalition by securing Sponsoring
Institution accreditation, garnering broad leadership
support at the health system and medical school, and
launching a Residency Steering Committee. The
Steering Committee consisted of department leaders,
clinic and operational staff, residency faculty from
within and outside our institution, medical students/
learners, and community members. The rst task for
the Committee was to create the program’s Vision and
Mission Statement. What was our purpose, our North
Star, our “why” in starting this new Family Medicine
residency program? Why did it matter? Why now?
Why here? Using human-centered design tools, we
generated and consolidated key themes of Clinic-rst,
primary care for all, academic-community partnership,
health equity, and trailblazing. We co-created our
Vision and Mission Statement that became our compass guiding us throughout the change process. (Joanne
Suh, Program Director)
Change can feel daunting and uncertain. Crafting a clear
vision of what the change will look like and feel like helps
ground and orient the team and when done well, answers the
important questions of who, what, how, when, where, and
why. It also serves to keep the team on track and inspires
them to keep moving toward the future state. A vision should
start simple and concise and then be expanded to consider
the additional dimensions that will be needed to guide the
team toward execution. In the example of the vignette, a simple, starting vision was that a new Family Medicine
Residency Program sponsored by the health system would
welcome its rst class by July of 2021. However, as additional expertise was added to the team and engagement with
stakeholders occurred, the vision expanded and additional
depth and clarity was added.
In developing the vision, leaders should use networks to
nd others who have been successful making a similar
change and ask about the experience, to learn as much about
the new change as possible and learn about what potential
competitors are doing. What will make this vision different
or compelling to stakeholders? Surveying the literature and
consulting with local and national organizations who have
done similar work is also helpful. However, leaders also need
to build diverse teams who have the experience with the task
at hand and not rely exclusively on their own ideas to create
a compelling vision. This may mean hiring or contracting
with additional external resources or it may mean consider-
436
J. Suh et al.
ing if there are resources within the department or across the
institution that may have a requisite skill set or perspective.
There also may be community resources that may be available that should be considered as well. However, absent networking and asking a lot of questions, leaders may miss out
on key resources that could help develop and guide a vision
for a successful change effort as well as having a team with
the breadth of knowledge and experience to be successful.
As a leader is developing a team to help further articulate
the vision, they will need to consider several additional
dimensions of the change and get input from the team to help
further clarify the vision. These dimensions might include:
• What models of care do we want the residents to have
exposure to? What type of practice do they need to be
prepared to practice in?
• What kind of physicians do we want to train? What attri-
butes will they have?
• Which communities do we expect the residents to impact
and what will that impact look like?
• How do we infuse the Department guiding principles of
excellence, integrity, inclusion, joy at work, collabora-
tion, and innovation into the curriculum?
• How might we cultivate a commitment to lifelong learn-
ing, interest in research, and dedication to community
service?
and how much power they have to disrupt the change and
whose support is needed to counter the resistance from others. Key stakeholders to consider in matters related to a
Family Medicine Residency program include:
• Designated Institutional Ofcer (DIO) of the Sponsoring
Institution
• Program Directors and DIOs of Participating Sites
• CEO, CMO, and COO of health system or hospital
• Dean of afliated Medical School
• Associate or Assistant Deans who have oversight over
education
• Chairs of other departments
• Clinic leadership of resident clinic
• Clinic staff of resident clinic
• Residents
• Other clinicians who practice in the clinical setting where
residents will be (clinical faculty, advanced practice providers, and behavioral health clinicians)
• Patients and Family Members
• Other learners who may work alongside residents (medical students, residents from other specialties)
• Other local leaders who are impacted by a residency program and its requirements
• Funders
• ACGME
As the vision evolves, developing images to share the idea
and to use to solicit impact can help to make the vision tangible and accessible to stakeholders. An example is shown in
Fig.37.2.
In rening the vision, it is useful to have a team together
brainstorm the list of key stakeholders considering who will
be impacted, how strongly they will feel about the impact
Fig. 37.2 Dimensions of
resident development
For each stakeholder identied, the leader should consider the relationship they have with that stakeholder, what
they already know about how the stakeholder might feel
about the proposed change and what information is needed
to better understand the stakeholder’s potential concerns or
support for the change. Finally, the leader should consider
how much power the stakeholder has to inuence the change,
37 Managing Change in Family Medicine Residency Programs
either positively or negatively. From this analysis, the leader
will prioritize which stakeholders need to be engaged rst
and consider how to best to share the vision for the change
with them. For stakeholders that the leader is concerned may
not be supportive, it will be important to better understand
why and how to manage this. The leader should consider
their relationship with the stakeholder. If a good relationship
exists, it may be worthwhile further exploring why there is
concern or opposition and seeing if, together, a solution or
strategy to address the concern can be found. If there is not a
strong relationship, it may be worthwhile to consider if the
leader can task someone else who has the relationship in
place to have this discussion. The leader may also consider if
a discussion is warranted, which may depend on how much
power the stakeholder has and whether their approval is
needed for the change. In some instances, other key stakeholders who are supportive can buffer the negative reaction
of an unsupportive stakeholder and be ready to help overcome it if they have the motivation and authority to do so.
As this analysis is completed, leaders should be cautious
and remember that both formal and informal power structures exist. It is better to speak with stakeholders, using the
questions outlined above and test out assumptions to make
sure a leader is not missing key stakeholders or their concerns. Asking questions such as, “Who else should I speak
with?” or “Who else might be concerned about or impacted
by this change?” can help to uncover these concerns. Keeping
a list of the reasons that stakeholders support the change as
well as their concerns can help with developing key messages for constituents as the change progresses. Once the
change is in process, leaders must remember to keep key
stakeholders posted on progress and frequently provide
updates and continue to address concerns that may arise.
Developing an advisory or steering committee that meets
regularly to review progress on a signicant change can be
one way to engage key stakeholders.
Step 4: Communicate Buy-In
VIGNETTE: Communicate Buy-In
One of the biggest changes we navigated when starting a
new residency program was the integration of residents
as primary care physicians into an existing academic faculty practice. I quickly realized I could not use a uniform
message to communicate buy-in from diverse stakeholders who had different priorities and knowledge about
residency training and the specialty of Family Medicine.
As I embarked on a tour to proclaim our vision to expand
primary care training and access at a highly specialized
tertiary-quaternary medical center, I considered the
WIFM “what’s in it for me” factor for each audience and
tailored my presentation accordingly. I have no less than
20 versions of the same slide deck that is personalized for
different groups. Some examples:
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Meeting with Patient Family Advisory Council
WIFM: Patients and family members cared about
recruiting and retaining primary care physicians from the
community to stay in the community and at the health
system. They also cared about having a competent physician as their PCP and “not a student”
My message: I spent a signicant amount of time
explaining GME basics, what I called “Residency 101”
focusing on the difference between a medical student and
a resident physician (emphasis on “physician”), highlighting the extensive training and number of medical education hours resident physicians have already completed,
using fun trivia from Grey’s Anatomy and Scrubs. I shared
our vision and priority to recruit residents with deep ties to
Los Angeles and USC.I enumerated the benets of having a resident as their PCP: more time with each visit,
team-based care with constant attending faculty supervision (“more brains and more hearts caring for you”)
Proof it worked: Resident physicians developed continuity panels. Patients identied the resident physicians
as “their doctor” and saw value in that relationship.
Meeting with Family Medicine Clinic Staff
WIFM: Clinic staff cared about how residents being
integrated into an existing faculty practice would affect
their daily workow and potentially increase inefciencies. They were also facing signicant burn-out due to the
pandemic and staff turnover.
My message: “We already work as a team, and residents will be part of that team.” I emphasized the value of
each clinic staff member as a critical teacher for residents.
“You are helping train the next generation of physicians. It
takes a village.” We also talked about Grey’s Anatomy and
Scrubs because residency is fun, and residents always
bring vibrant fresh energy to the clinic space.
Proof it worked: There is always laughter and highves in the resident clinic. Staff actively volunteer to work
with residents when in the clinic, and morale has improved.
Meeting with Medical Staff Town Hall
WIFM: Medical Staff include faculty physicians and
Advanced Practice Providers in an academic tertiaryquaternary health system. They care about providing high
quality care for their patients. They care about the health
of the health system, and implications of losing patients to
competitors. The academic faculty care about their respective training programs and changing GME landscape.
My message: This new residency program is expanding access and building a primary care workforce for our
mutual medically complex patients. Having robust primary care within our specialty-focused health system is
vital to the health and growth of the health system to keep
our patients in-house and expand our referral base. Also,
as the rst Keck Medicine-sponsored program, the success of this program is important for the opportunity to
expand health system GME into other specialties.
Proof it worked: After the Town Hall, several faculty
from different medical and surgical specialties proactively reached out to offer rotations and didactics for our
new residents. (Joanne Suh, Program Director)
A good leader will create a compelling and inspiring
vision for change. A great leader will effectively communicate the vision and get buy-in from stakeholders so that it
becomes a collective, co-created vision. The fourth step in
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J. Suh et al.
the Kotter Model is often happening simultaneously with the
third step—communicating buy-in to the vision. The quest to
build support and enthusiasm around a change has to go
beyond simply building awareness. Showing everyone what
is in it for them by tailoring the message and vision generates
buy-in, support, and lasting change.
WIFM (What’s InIt ForMe?)
“WIFM” or “What’s In It For me?” is a common acronym
used in change management frameworks to understand and
address the individual motivations and concerns of people
affected by the change. It is the question one asks when confronted with an organizational change: What’s in it for me?
Why should I care? Why should I do it?
Employing WIFM in change management can position
change in a way that feels personal to each stakeholder. In
the same way that feedback for learners is most effective if
directly linked to their personal goals and motivations, so is
change management. Understanding the positive and negative drivers for that individual and making the change directly
relevant to what they care about will maximize change adoption. When communicating buy-in, it is critical to know your
audience. These key motivators will vary widely depending
on the person’s role and function. The WIFMs for health system executives (nancial health and growth, sustainability,
quality and safety) might differ from local managers and
employees on the front line (patient care, workload and
workow, positive working relationships, and mission alignment), so it is critical to have a panoramic view.
Change leaders should anticipate some resistance because
it is a natural reaction to fear change and gravitate toward the
familiar. Therefore, it is critical to customize communication
in order to build support and momentum, and ultimately
motivate action. If they feel heard, valued and respected
WIFM is an important factor to consider to better understand
and mitigate anxiety, uncertainty, and therefore resistance.
Strategies to effectively address WIFM and communicate
vision include:
• Provide information about how the change aligns with
personal and professional values and goals, emphasizing
the positive outcomes for each stakeholder.
• Keep communications simple, direct, and jargon-free.
Practice your elevator pitch.
• Use metaphors, analogies, and examples to bring the
messages to life. Concrete stories about positive teambased care and patient outcomes are always compelling.
• Deliver the message across different forums and vehicles,
including in-person and virtual, written and verbal, 1:1
and groups, formal, and informal meetings
• Offer support mechanisms, such as training and protected
time, to help individuals adapt to the new way of
working
By putting people and their WIFMs rst, change leaders
prioritize the diverse needs and motivations of different people on the team, thereby creating supportive and inclusive
environments primed for the change process.
The following worksheet can assist in systematically
organizing how a leader might approach different stakeholders important to the change process, considering different
WIFMs and personalized messages.
WIFM Worksheet
Vision Statement:
Stakeholder Positive DriversNegative DriversWIFM’ed Vision Statement: