Why Change Management Matters
Healthcare organizations undergo near constant change, from new coding guidelines to EHR upgrades to remote work transitions for coding staff. RHIA candidates must recognize several established change management models and understand how each frames the process of moving people from a current state to a desired future state.
Lewin's Three Stage Model
Kurt Lewin's model describes change in three stages: unfreezing, where the need for change is established and resistance to the status quo is reduced; changing, where new processes, behaviors, or systems are actually implemented; and refreezing, where the new state is stabilized and reinforced so the organization does not revert to old habits.
Kotter's Eight Step Process
John Kotter's model provides a more detailed roadmap: establishing a sense of urgency, forming a powerful coalition, creating a vision, communicating the vision, empowering broad based action, generating short term wins, consolidating gains and producing more change, and anchoring new approaches in the culture. HIM leaders often reference Kotter's early steps when justifying investment in a new technology to executive leadership, since establishing urgency and building coalition support are prerequisites for securing resources.
The ADKAR Model
ADKAR focuses on the individual's journey through change, comprising Awareness of the need for change, Desire to participate, Knowledge of how to change, Ability to implement new skills, and Reinforcement to sustain the change. This model is particularly useful for coding staff transitions, such as a shift to a new encoder platform, because it highlights that even highly skilled staff may resist change if they lack awareness of why it is necessary or reinforcement once implemented.
Common Sources of Resistance
Resistance often stems from fear of job loss, lack of trust in leadership, insufficient training, or previous negative experiences with change initiatives. Effective leaders address resistance proactively through transparent communication and involvement of frontline staff in planning rather than only in execution.
Applying Models in Practice
No single model is universally correct; leaders often blend elements, using Kotter's organizational level steps alongside ADKAR's individual focus to address both structural and personal dimensions of change.
Exam Tip
When a scenario describes staff who understand and want to change but lack the specific skills, this points to a gap in Knowledge or Ability under the ADKAR model, not a lack of Awareness or Desire, a distinction the exam tests through detailed scenario wording.