Change-Management Approach Improves Clinical Workflow and Patient Health

August 20, 2019


With the premise that effective organizational change requires intentional planning, investigators from the University of Kentucky College of Public Health applied Kotter’s 8-Step Process for Leading Change model to better understand and evaluate how White House Clinics, a federally qualified health center with eight locations in rural Kentucky, implemented a significant organizational change — a proactive office encounter (POE) model — to improve preventive care service delivery, close care gaps, and reduce health disparities among its patients. Dr. Angela Carman, assistant professor of Health, Behavior & Society, is the first author of the resulting article  "A Change-Management Approach to Closing Care Gaps in a Federally Qualified Health Center: A Rural Kentucky Case Study", published in Preventing Chronic Disease. Co-authors are Dr. Robin Vanderpool, Lindsay R. Stradtman, MPH, and Emily A. Edmiston, MPH.


Investigators completed qualitative interviews with 21 clinic personnel who were directly involved with POE implementation. They found evidence of steps 1 through 7 of Kotter’s 8 steps of change in the POE implementation process. Step 8, “anchoring new approaches in the organizational culture”, was seen to be an area for improvement.


Overwhelmingly, participants described POE implementation as one of the organization’s highest priorities. Some expressed that their workload initially increased under the POE model, only to later decrease. New processes such as standing orders for preventive care empowered nursing staff, while daily staff huddles and standardized use of forms streamlined processes. As a result, White House Clinics saw increased numbers of patients receiving recommended screenings such as mammograms, colonoscopies, and testing for hepatitis C and HIV. Going beyond the scope of the initial POE project, staff moved to change processes for administration of preventive care for pediatric patients as well.


The investigators conclude that, although their retrospective study was limited by its use of Kotter’s model (most often used to guide large-scale change), application of organizational change frameworks could be particularly useful for small clinical settings that historically have not had the same resources as larger health care organizations. These smaller clinical settings, which often serve a substantial portion of underserved patients, may benefit from implementing change-management approaches with the potential to improve clinical workflow leading to better patient outcomes and population health.


The authors thank Dr. Aasha Hoogland, Ms. Stephanie Moore, and the White House Clinics staff members for their contributions to this project. The resulting article is a product of a Health Promotion and Disease Prevention Research Center supported by cooperative agreement no. 5 U48DP005014–05 from the Centers for Disease Control and Prevention.



The University of Kentucky College of Public Health is a catalyst of positive change for population health, with a mission to develop health champions, conduct multidisciplinary and applied research, and collaborate with partners to improve health in Kentucky and beyond.