Stages of Organizational Change
Organizational change can be conceptualized in 4 broad stages:
Each stage is important in the development, implementation and maintenance of a palliative
Once the program has been institutionalized (stage 4), change continues within the program and the
organization through an ongoing cyclic process of assessment and innovation.
- identify unmet needs
- search for possible solutions
- create tension for change
- conduct needs assessment
- brainstorm / research ways to meet needs
- communicate needs to key leaders
- decide upon a course of action
- formulate policy/procedure for implementing change
- allocate initial resources
- resources allocated for implementation
- carry out innovation
- observe reaction of organization members
- define roles
- obtain resources to launch program (money, staffing, physical space, etc.)
- begin palliative care practice and observe response.
- market palliative care program.
- form clear roles among program staff
- integrate innovation into routine organization operations
- internalize goals and values surrounding innovation
- referrals to palliative care program become regular
- policies and procedures guide care
- palliative care throughout institution improves
- evaluation leads to improved care
*Based on the Four-stage Model described in:
Glanz K, Lewis FM, Rimer BK. Health Behavior and Health Education:
Theory, Research, and Practice, 2nd Edition. Jossey-Bass, October 1996.
von Gunten CF,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
copyright is granted.
Last updated: February 20, 2002
Change, Groups, Phase 1,
2, 3, 4
Stages of Change
Small Group Structure / Function
Phase 1: Prepare to Plan
Potential of Planning Process
How Much is Enough?
Form Initial Workgroup
Elaborate Initial Idea
Need, Purpose of Program
Planning Steps, Timeline
Resources Needed to Plan
Use of Consultants
Use of Retreats
Write Planning Proposal
Selling, Getting Approval
Phase 2: Plan the Program
Form Planning Workgroup
Review, Revise Process
What is Strategic Planning?
How Much is Enough?
Review Stakeholders, Customers
Conduct Needs Assessment
Conduct SWOT Analysis
Case Study - United Hospital Fund
Define the Program
Service Delivery Model
Strategic Decision Points
University of Virginia
Organizational Structure, Leadership
Suggested Proposal Outline
Phase 3: Implement the Program
High Functioning Team
Standards of Practice, Policies, Procedures
Phase 4: Review Program, Revise Plan
Form Review Workgroup
Continuous Quality Improvement
Appropriateness of Hospitalization
Respond to Denials
Revise Plan, Further Development