Leading Change in Academic Medicine
Nobody Wakes Up Excited About a New Initiative
You have seen it before. A department chair announces a new clinical workflow, a restructured call schedule, or a curriculum overhaul. There is a town hall. There are slides. There is enthusiasm from the leadership team. And within six months, everything has quietly reverted to the way it was.
Change efforts in academic medicine fail constantly. Not because the ideas are bad. Not because the people are resistant. They fail because the leaders driving them underestimate what it actually takes to make change stick.
The Problem Is Not Resistance. It Is Trust.
Most change management frameworks treat resistance as an obstacle to overcome. Push harder. Communicate more. Get buy-in from key stakeholders. But in my experience coaching physician leaders, resistance is rarely the root issue. The root issue is trust.
Faculty want to know three things before they will invest in a new direction. Does leadership actually understand the problem? Will this change make my daily work better or worse? And will leadership still care about this in six months, or is this the initiative du jour?
If the answer to any of those questions is uncertain, people will wait it out. They have seen too many changes come and go. Waiting is a rational strategy when you do not trust the process.
Kotter Got It Right
John Kotter's Leading Change remains one of the best books on this topic, and his eight-step model holds up remarkably well in academic medicine. The most important step, in my view, is the first one: establishing a sense of urgency.
Not manufactured urgency. Not a crisis that leadership invented to justify a decision they already made. Real urgency. The kind that comes from honestly naming a problem that everyone already feels but nobody has said out loud.
I worked with a division chief who wanted to restructure how her group handled administrative tasks. Her first instinct was to present data on inefficiency. Charts. Benchmarks. Comparison to peer institutions. All of that was fine, but it was not what moved people. What moved people was when she stood up in a faculty meeting and said, "I know you are all drowning in inbox messages that have nothing to do with patient care. I am too. And I think we can fix it."
That is urgency. Naming the pain. Showing that you feel it too.
Small Wins Matter More Than Grand Plans
One of the most common mistakes I see is the big reveal. Leadership spends months designing a comprehensive change plan and then rolls out the whole thing at once. It is overwhelming. Faculty cannot see themselves in it. They do not know where to start, so they do not start at all.
Kotter calls this "generating short-term wins," and it is critical. Pick one visible, achievable piece of the change and do it first. Let people experience the benefit before you ask them to sign on for the rest.
A program director I coach wanted to overhaul his residency's feedback system. Instead of redesigning everything at once, he started with a single rotation. He introduced a brief, structured feedback form and asked residents to try it for one month. The residents loved it. The faculty on that rotation started requesting it. Within a semester, the new system had spread organically to most rotations because people saw it work.
That is how change actually happens. Not through mandates. Through proof.
You Have to Stay With It
Here is where most academic leaders lose the thread. The announcement is easy. The first few months of energy are manageable. But change requires sustained attention over a long period, and academic medicine is not set up for that. Leaders are stretched across clinical, educational, and administrative responsibilities. The new initiative competes with everything else for a finite amount of leadership bandwidth.
If you are going to lead a change effort, you need to protect time for it. Put it on your calendar. Check in with the people affected regularly. Ask what is working and what is not. Adjust. Keep showing up. The moment faculty sense that leadership has moved on to the next thing, the change is dead.
Change Is a Leadership Test
Leading change in academic medicine is one of the hardest things you can do. The environment is complex. The stakeholders are brilliant and skeptical. The institutional inertia is real. But I have watched physician leaders pull it off repeatedly, and the pattern is always the same. They name the problem honestly. They earn trust before they ask for movement. They start small. And they stay with it.
If you are in the middle of a change effort that is stalling, or if you are planning one and want to get it right from the start, I am happy to be a sounding board. This is one of the most rewarding challenges in physician leadership, and you do not have to figure it out alone.
