Research spotlight: Understanding Change Management in Healthcare

Implementing patient-centered medical homes: the importance of subordinates’ structural power to change implementation

Researcher: Kate Kellogg 

This two-year effort compared two similar healthcare institutions’ efforts to implement the “Patient-Centered Medical Home”, a widely praised (but still not broadly implemented) reform designed to move health care entities to team-based, patient-focused care that emphasizes prevention over intervention. Both received similar grants, but data on one institution’s success—and another’s difficulty—gathered on the ground is where things get really fascinating.For instance, Kellogg found that medical assistants occupy a uniquely powerful structural position vis-à-vis doctors. Central to workflows and engaging with multiple physicians and peers, medical assistants are involved in many of the most important operational aspects of a practice (e.g., keeping doctors on time, providing relevant patient information, and much more). In short, she determined that the institution that enjoyed success in implementing reforms was the one that gave medical assistants tools to use all aspects of their powerful structural position to influence change.
More generally, across multiple studies she has found that frontline reformers, whether doctors or support staff, must be engaged by the institution for successful reform to take place. But change agents and those resistant to change should not be brought together prematurely. Once change agents have agreed upon concrete strategies with their like-minded fellows, it will ease the process of introducing small changes to those who would instinctively fight them. In short, the interactions between individuals shouldn’t be underestimated, as they present a point of leverage from which the biggest institutional changes can emerge.

1. “How to Orchestrate Change from the Bottom Up.” Kellogg, Katherine C. Harvard Business Review (2019).
2. “Subordinate Activation Tactics: Semi-professionals and Micro-level Institutional Change in Professional Organizations.” Kellogg, Katherine C. Administrative Science Quarterly (2018).