10 Best Change Models in Organizational Change Management in Nursing

In today’s rapidly evolving healthcare landscape, effective organizational change management has become a critical competency for nursing leaders. The ability to implement, sustain, and evaluate change initiatives directly impacts patient outcomes, staff satisfaction, and operational efficiency. This comprehensive guide explores ten proven change management models that can transform nursing practice and organizational performance.

Change Management in Nursing Organizations

Change management is a structured approach to transitioning individuals, teams, and organizations from their current state to a desired future state. It encompasses the processes, tools, and techniques used to manage the people side of change to achieve the required organizational outcomes.

Why Change Management Matters in Nursing

The healthcare environment is characterized by constant evolution—new technologies, shifting regulations, evidence-based practice updates, and changing patient demographics all necessitate organizational adaptability. Effective change management provides several critical benefits:

• Reduced resistance to change: Structured approaches help address the natural human tendency to resist disruption
• Higher implementation success rates: Organizations with excellent change management are six times more likely to meet project objectives
• Minimized negative impacts: Proper change management reduces productivity dips, staff turnover, and emotional distress
• Accelerated adoption: Methodical approaches speed up the integration of new processes or technologies
• Enhanced organizational resilience: Organizations develop adaptability as a core competency

Implementing change is rarely straightforward. Without the right change management model, approximately 70% of change projects fail to achieve their objectives. Selecting the appropriate change management approach based on the specific organizational context, change type, and desired outcomes is essential for success.

Types of Organizational Change in Nursing

Before exploring specific models, it’s important to understand the different categories of organizational change that nursing organizations typically encounter:

1. Developmental change: Improvements to existing processes, skills, or methods
2. Transitional change: Moving from one defined state to another (e.g., implementing new technology)
3. Transformational change: Fundamental shifts in strategy, identity, or organizational culture

The complexity and scope of the change will influence which change management model is most appropriate.

10 Change Management Models for Nursing Organizations

1. Lewin’s 3-Stage Model of Change

Category: Borrowed (from psychology)
Primary Source: Lewin, K. (1951). Field theory in social science: Selected theoretical papers. Harper & Brothers.

Kurt Lewin’s model remains one of the most influential frameworks for understanding organizational change. Its simplicity makes it accessible, while its depth provides powerful insights into the change process.

The Three Stages:

1. Unfreezing: Creating motivation for change by destabilizing the status quo
   • Communicating the need for change using data and evidence
   • Identifying and addressing concerns and resistance
   • Creating psychological safety for staff to engage in change
2. Moving/Changing: Implementing the change through new behaviors, values, or attitudes
   • Providing training and resources
   • Creating clear action plans with defined roles
   • Encouraging experimentation and learning
3. Refreezing: Stabilizing and institutionalizing the change
   • Reinforcing new behaviors through policy and procedure updates
   • Celebrating successes and recognizing change champions
   • Continuous evaluation and refinement

Best Applications in Nursing:

• Implementing new patient care protocols
• Introducing new equipment or technology
• Changing departmental structures or reporting relationships
• Integrating evidence-based practice changes

Lewin’s model effectively balances simplicity with comprehensive behavioral understanding, making it particularly valuable for addressing resistance to change. The model recognizes that successful change requires both dismantling existing structures and reinforcing new ones.

2. Kotter’s 8-Step Process for Leading Change

Category: Borrowed (from business management)
Primary Source: Kotter, J. P. (1996). Leading change. Harvard Business School Press.

John Kotter’s model provides a more detailed roadmap for organizational transformation, emphasizing the importance of leadership in the change process.

The Eight Steps:

1. Create a sense of urgency: Help others see the need for change and the importance of acting immediately
2. Build a guiding coalition: Assemble a group with enough power and influence to lead the change
3. Form a strategic vision: Develop a clear, compelling vision and corresponding strategy
4. Enlist a volunteer army: Communicate the vision and strategy to gain buy-in
5. Enable action by removing barriers: Eliminate obstacles to change, modify systems or structures
6. Generate short-term wins: Plan for and create visible improvements
7. Sustain acceleration: Build on change and keep momentum going
8. Institute change: Anchor new approaches in the organizational culture

Best Applications in Nursing:

• Major organizational restructuring initiatives
• Implementing comprehensive quality improvement programs
• Transforming nursing leadership structures
• Large-scale cultural transformation efforts

Kotter’s model excels in its emphasis on building momentum and securing early wins, which is particularly valuable in nursing environments where immediate patient care demands can otherwise overshadow change initiatives.

3. ADKAR Model

Category: Borrowed (from business management)
Primary Source: Hiatt, J. M. (2006). ADKAR: A model for change in business, government and our community. Prosci Learning Center Publications.

The ADKAR model focuses on the people side of change, making it especially relevant in nursing, where frontline staff engagement is critical to success.

The Five Elements:

1. Awareness: Understanding why change is necessary
2. Desire: Willingness to support and participate in the change
3. Knowledge: Information about how to change
4. Ability: Skills and capabilities needed to implement the change
5. Reinforcement: Factors that sustain the change

Best Applications in Nursing:

• Training staff in new clinical skills or procedures
• Implementing new documentation systems
• Changing practice guidelines based on new evidence
• Adapting to regulatory requirement changes

The ADKAR model is particularly effective for individual-level change management, addressing both the emotional and practical aspects of change adoption. By focusing on sequential building blocks, it provides a structured approach to supporting staff through transitions.

4. Bridges’ Transition Model

Category: Borrowed (from psychology)
Primary Source: Bridges, W. (1991). Managing transitions: Making the most of change. Addison-Wesley.

Unlike many models that focus on organizational change, Bridges’ model emphasizes the psychological transitions individuals experience during change processes.

The Three Phases:

1. Ending, Losing, and Letting Go: Acknowledging what’s being left behind
2. The Neutral Zone: The in-between state where old systems are gone but new ones aren’t fully operational
3. The New Beginning: Embracing and integrating the change

Best Applications in Nursing:

• Managing emotional reactions to change during major organizational shifts
• Helping nurses adapt to new roles or responsibilities
• Facilitating team mergers or restructuring
• Supporting staff through healthcare system consolidations

Bridges’ model provides valuable insights into the emotional journey of change, addressing the psychological aspects often overlooked in more process-focused models. It acknowledges that emotional acceptance may lag behind procedural implementation.

5. Kübler-Ross Change Curve

Category: Borrowed (from psychology)
Primary Source: Kübler-Ross, E. (1969). On death and dying. Macmillan.

While originally developed to describe grief responses, the Kübler-Ross Change Curve has been adapted to understand emotional reactions to organizational change.

The Stages:

1. Shock/Denial: Initial disbelief about the change
2. Anger: Frustration and resistance
3. Bargaining: Attempting to negotiate or minimize the change
4. Depression: Disengagement as reality sets in
5. Acceptance: Embracing the new reality
6. Integration: Fully incorporating the change

Best Applications in Nursing:

• Preparing change management strategies that address emotional responses
• Supporting staff through difficult transitions like unit closures or mergers
• Developing communications plans that acknowledge emotional reactions
• Creating support systems during transformational change projects

This model helps nursing leaders anticipate and address the emotional journey staff may experience, allowing for targeted interventions at each stage of the emotional process.

6. Satir Change Model

Category: Borrowed (from family therapy)
Primary Source: Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir model: Family therapy and beyond. Science and Behavior Books.

The Satir Change Model describes how people experience and cope with change at a personal level, focusing on performance and productivity fluctuations.

The Five Stages:

1. Late Status Quo: The familiar, comfortable current state
2. Resistance: Denial and resistance to impending change
3. Chaos: Disorientation and decreased performance
4. Integration: Exploration and understanding of new possibilities
5. New Status Quo: Stabilization at a higher performance level

Best Applications in Nursing:

• Understanding productivity fluctuations during change implementation
• Setting realistic expectations for performance during transitions
• Creating appropriate support mechanisms during the chaos stage
• Identifying readiness for additional changes

The Satir model is particularly valuable for managing expectations about performance during change initiatives, helping leaders anticipate and plan for inevitable disruptions to workflow and productivity.

7. Prosci’s ADKAR with 3-Phase Process

Category: Borrowed (from business management)
Primary Source: Hiatt, J. M., & Creasey, T. J. (2003). Change management: The people side of change. Prosci Research.

This comprehensive approach combines the individual-focused ADKAR model with an organizational change management framework.

The Three Phases:

1. Preparing for change: Defining change management strategy and preparing the change management team
2. Managing change: Developing change management plans and taking action
3. Reinforcing change: Collecting feedback, diagnosing gaps, and implementing corrective actions

Best Applications in Nursing:

• Enterprise-wide clinical system implementations
• Organizational restructuring initiatives
• Quality improvement programs
• Accreditation preparation efforts

This integrated approach addresses both individual transitions and organizational process needs, making it particularly valuable for complex, multi-faceted change initiatives in healthcare settings.

8. McKinsey 7-S Framework

Category: Borrowed (from business management)
Primary Source: Waterman, R. H., Peters, T. J., & Phillips, J. R. (1980). Structure is not organization. Business Horizons, 23(3), 14-26.

The 7-S Framework provides a holistic approach to organizational change, emphasizing the interconnectedness of seven critical organizational elements.

The Seven Elements:

1. Strategy: The plan to achieve sustainable competitive advantage
2. Structure: How the organization is arranged hierarchically
3. Systems: Daily activities and procedures
4. Shared Values: Core values and organizational culture
5. Style: Leadership approach and operational style
6. Staff: Human resources and capabilities
7. Skills: Competencies and capabilities of the organization

Best Applications in Nursing:

• Comprehensive organizational assessments
• Ensuring alignment of all aspects during major transformational change
• Diagnosing barriers to change implementation
• Strategic planning initiatives

This framework excels at identifying misalignments between organizational elements that may impede change efforts, helping leaders ensure comprehensive, coordinated approaches to transformation.

9. Stetler Model of Evidence-Based Practice

Category: Original to nursing
Primary Source: Stetler, C. B. (2001). Updating the Stetler Model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49(6), 272-279.

This model specifically addresses implementing evidence-based changes in nursing practice, bridging research and clinical application.

The Five Phases:

1. Preparation: Defining the purpose and identifying potential issues
2. Validation: Critiquing and synthesizing evidence
3. Comparative Evaluation/Decision Making: Making decisions about using the evidence
4. Translation/Application: Converting knowledge into practice change
5. Evaluation: Assessing implementation outcomes

Best Applications in Nursing:

• Implementing new evidence-based nursing interventions
• Updating clinical guidelines based on research
• Evaluating and improving existing nursing practices
• Translating research findings into practical applications

The Stetler Model provides a structured approach specifically designed for nursing practice changes, making it particularly relevant for clinical practice improvements based on evolving evidence.

10. Plan-Do-Study-Act (PDSA) Cycle

Category: Borrowed (from quality management)
Primary Source: Deming, W. E. (1993). The New Economics for Industry, Government, Education. MIT Press.

The PDSA cycle offers an iterative approach to change, emphasizing continuous improvement through small-scale testing.

The Four Stages:

1. Plan: Identify opportunities and plan change
2. Do: Implement small-scale change
3. Study: Analyze results and what was learned
4. Act: Adopt, adapt, or abandon based on results

Best Applications in Nursing:

• Quality improvement initiatives
• Testing and refining new procedures
• Implementing changes in complex environments where outcomes are uncertain
• Continuous improvement of existing processes

The PDSA model excels in environments where rapid testing and adaptation are necessary, making it ideal for nursing settings where patient safety concerns make small-scale testing preferable to large-scale immediate implementation.

Choosing the Right Change Management Model

Selecting the appropriate change management approach depends on several factors:

Assessment Criteria

1. Change scope and complexity: Is this developmental, transitional, or transformational change?
2. Organizational culture: What approaches align with existing values and leadership styles?
3. Timeline and urgency: How quickly must the change be implemented?
4. Available resources: What level of support is available for the change effort?
5. Previous change experiences: What has worked or failed in the past?

Best Practices for Effective Organizational Change Management

Regardless of the specific model selected, several principles apply across successful change initiatives:

1. Secure leadership commitment: Visible, active sponsorship from organizational leaders
2. Involve employees in the change process: Early and meaningful engagement of those affected by the change
3. Communicate effectively: Clear, consistent, and transparent communication throughout the process
4. Address resistance proactively: Identify and manage barriers to adoption
5. Provide adequate resources: Ensure sufficient training, time, and support
6. Measure progress: Establish clear metrics to evaluate change effectiveness
7. Celebrate successes: Recognize achievements to maintain momentum
8. Build change capability: Develop organizational resilience through systematic approaches

Change Management Tools and Techniques

Successful implementation of change management models often requires supporting tools and techniques:

1. Stakeholder analysis: Identifying and understanding key stakeholders’ perspectives
2. Impact assessment: Evaluating how the change will affect different groups
3. Communication planning: Developing targeted messaging for various audiences
4. Training needs assessment: Identifying skill gaps and learning requirements
5. Resistance management planning: Proactively addressing barriers to adoption
6. Feedback mechanisms: Gathering input throughout the change process
7. Change readiness assessments: Evaluating organizational preparedness
8. Change management metrics: Measuring progress and effectiveness

Conclusion

Organizational change is necessary for nursing organizations to adapt and thrive in today’s dynamic healthcare environment. By understanding and applying appropriate change management models, nursing leaders can significantly improve the success rate of change initiatives while minimizing disruption to operations and staff well-being.

The most effective approach often combines elements from multiple models, tailored to the specific organizational context and change requirements. By developing change management as a core competency, nursing organizations can build the adaptability and resilience needed to navigate continuous evolution in healthcare delivery.

Common Questions About Change Management Models

What is Lippitt’s Change Theory?

Lippitt’s Change Theory expands Lewin’s 3-stage model into seven phases:

1. Diagnosing the problem
2. Assessing motivation and capacity for change
3. Assessing change agent’s motivation and resources
4. Selecting progressive change objectives
5. Choosing appropriate change agent role
6. Maintaining change
7. Terminating the helping relationship

This theory is particularly useful for complex, long-term change initiatives where external change agents or consultants are involved.

Who is considered the father of Change Theory?

Kurt Lewin is widely regarded as the father of Change Theory. His Unfreeze-Change-Refreeze model, developed in the 1940s, laid the foundation for many subsequent change theories and continues to influence the field of change management today.

His contributions include:

• The Three-Stage Model of Change
• Force Field Analysis (analyzing driving and restraining forces)
• Group Dynamics research
• Action Research methodology

What is the Lippitt-Knoster Change Theory?

The Lippitt-Knoster Change Theory combines elements of Lippitt’s change theory with Timothy Knoster’s work on managing complex change. This model emphasizes six key elements for successful change:

1. Vision: A clear picture of the desired future state
2. Skills: The capabilities needed to implement the change
3. Incentives: Motivations for people to engage in the change
4. Resources: The tools, time, and support required
5. Action plan: A detailed roadmap for implementation
6. Consensus: Agreement and buy-in from stakeholders

The model suggests that if any of these elements are missing, specific challenges will emerge (e.g., without vision there is confusion; without skills there is anxiety).

How do organizational change models differ from individual behavior change models?

While there is overlap, organizational change models typically focus on systemic approaches and leadership actions needed to transform collective behaviors and structures. Individual behavior change models (like the Transtheoretical Model) concentrate on personal psychological processes and decision-making.

Organizational change management models address factors like:

• Structural and process changes
• Communication across hierarchical levels
• Policy and procedure modifications
• Cultural transformation
• Leadership alignment and sponsorship

The most comprehensive approaches integrate both perspectives, recognizing that organizational change ultimately depends on individual behavioral change at scale

What are some commonly used change models in change management?

Some of the most commonly used change management models include:

• Lewin’s 3-Stage Model of Change – foundational in behavioral change, it involves unfreezing, changing, and refreezing.
• Kotter’s 8-Step Change Model – a widely accepted model of organizational change management that focuses on urgency, leadership, vision, and sustaining the change.
• ADKAR Model – emphasizes individual and organizational transformation through five steps: Awareness, Desire, Knowledge, Ability, and Reinforcement.
• Bridges’ Transition Model – focuses on the psychological and emotional responses throughout the stages of change.
• Plan-Do-Study-Act (PDSA) – a cycle used in healthcare and nursing for iterative, small-scale change projects.
• Transtheoretical Model (Stages of Change) – explores the personal phasen of behavioral change and is useful for both patients and staff.

These popular change management models are essential tools to help change managers and leaders make change effectively within complex healthcare systems.

What is the 7 model of change management?

The term “7 model of change management” typically refers to Lippitt’s Phases of Change, a seven-phase model that expands on Lewin’s change theory. The phases include:

1. Diagnosing the problem
2. Assessing motivation
3. Evaluating the change agent’s role
4. Setting goals
5. Choosing the change agent role
6. Implementing the change
7. Terminating the helping relationship

This model is ideal for long-term and complex organizational change processes. It integrates both leadership and management perspectives and focuses on sustaining change through strategic support and planning. Among common change management models, it’s particularly useful when involving external consultants or change agents.

What is an organizational change model?

An organizational change model is a structured framework used to guide transitions in an organization’s structure, culture, processes, or strategy. These models help change managers and leaders address the importance of change, overcome barriers to change, and implement strategies that stick.

Effective organizational change management models include:

• Kotter’s 8-Step Change Model for large-scale leadership-driven change
• ADKAR for managing the people side of change
• Stetler and Spradley’s models for nursing-specific evidence-based change
• PDSA and Diffusion of Innovation for practical, scalable improvements

Ultimately, these models promote alignment between individual and organizational needs and enable healthcare organizations to change effectively using change management principles.

What is Kotter’s change model in nursing?

Kotter’s 8-Step Change Model in nursing applies the general 8-step process for leading change to clinical and healthcare settings. It includes:

1. Creating a sense of urgency
2. Building a guiding coalition
3. Developing a vision
4. Communicating the vision
5. Removing obstacles
6. Generating short-term wins
7. Consolidating gains
8. Anchoring changes in the organizational structure

In nursing, this change model is used to promote change such as adopting new patient care protocols, launching quality improvement programs, or redesigning nursing workflows. It supports successful organizational change by integrating leadership and management practices that are essential for implementation.

Among the best change management models, Kotter’s model is especially valuable in complex healthcare systems because it ensures structured, scalable, and sustainable change.

What is the 5 change agent model?

The “5 change agent model” isn’t a widely recognized term, but in the context of change management models and methodologies, it can refer to the five roles or skills essential for a change manager or change agent. These typically include:

1. Diagnosing organizational needs
2. Planning the change
3. Communicating with stakeholders
4. Leading the transition
5. Sustaining and evaluating the change

This framework aligns with models like Lippitt’s, Spradley’s, and Lewin’s model, all of which emphasize the importance of the change agent’s role in facilitating successful outcomes. In nursing, change agents are often nurse leaders or educators who implement organizational change while managing emotional and procedural transitions.

What is Kotter’s model of change?

Kotter’s model of change, also known as Kotter’s 8-step change model, is one of the most popular change management models and is especially effective in healthcare and nursing environments. It provides a clear, step-by-step roadmap to leading change:

• Urgency
• Coalition
• Vision
• Communication
• Empowerment
• Short-term wins
• Consolidation
• Institutionalization

Kotter’s change management approach focuses not only on planning but also on emotional buy-in and building momentum across teams. It is ideal for transformational change initiatives, where the goal is deep, sustainable organizational shifts.

When applied in nursing, the model supports initiatives like EHR adoption, care model redesign, and patient safety improvements—making it one of the best change management models available.